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An Age Old Staffing Question: Your Part-Time/Full Time Nursing Mix

November 18, 2014 | Irene Fleshner

Skilled Nursing For years, people have asked me … “What is the optimal mix of full- and part-time employees to efficiently and effectively staff my facility?” Given that the employer mandate provision of the ACA is scheduled to begin in 2015, this issue may become more than just one of staffing best practice. Whether the employer mandate is implemented as is, or undergoes some modification as a result of the recent election, is yet to be determined. While we’re waiting for the politicians to decide our future, you can take action today to define the optimal full- vs part-time staffing mix for your organization. 

The determination of how many full- vs. part-time staff you need is specific for each organization.  Unfortunately, there isn’t a formula or ratio that works for all situations.  Few studies have been done to identify the ideal full- vs part-time staff mix that will yield the best outcomes.  So there isn’t much evidence in the literature that we can turn to.  Therefore, we need to approach this question, as we approach all staffing decisions, and begin with identifying the types of patients/residents who are being cared for. 

  1. What kind of care are you providing?
    First, determine whether your primary focus is on short stay rehab patients and medically complex care or providing long-term care for frail elderly. Why is this important? There are two reasons. Short stay centers or units tend to have variability in census and patient care needs. These two issues lead to the need to adjust staffing levels and mix every day and in some instances every shift, especially if the variability in care needs and census is random rather than predictable.  The use of part-time staff whether regularly scheduled or per diem  provides the flexibility necessary to meet variable needs.  On the other hand, facilities that provide long-term care have more predictable census and care needs and therefore can employ more full-time staff.
  2. What is your care delivery model?
    The next issue to consider is your care delivery model.  Have you implemented consistent assignment and/or a universal worker model?  There are challenges with maintaining consistent assignments with a higher proportion of part-time staff.  
  3. Do you have a lot of open shifts on your schedule?
    The stability of your workforce has a big impact on your full- vs part-time staffing mix.  Do you have high turnover, frequent call offs and staff on FMLA?  If so, you will consistently have many open shifts on your schedule.  To avoid overtime, you will likely need more part-time staff. And lastly, the customs and preference of your local workforce are a major consideration. You may have determined that you need 30% part-time staff, but the job seekers in your community are looking for full-time employment.  In this instance, organizations will need to identify creative approaches and incentives to attract part-time employees. 

Determining the optimal full- vs part-time staffing mix for your organization requires consideration of multiple variables and should be reviewed on a regular basis as your business evolves.

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About Irene Fleshner

Irene Fleshner, RN, MHA, FACHE, serves as a Principal for Reno Davis & Associates and the Senior Vice President for Strategic Nursing Initiatives for Genesis HealthCare.

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