Safe Staffing in Nursing


The paper investigates the issue of safe staffing approaches in the nursing field of expertise. The essential claim behind the paper is that the staffing approach is a versatile term, which unites not only organizational but also economic, psychological, moral, and social issues. This is because the safe staffing in nursing is comprised of the numerous compounds that are responsible for the proper functioning of the health care unit given and should provide enough education, training, and motivation to the medical employees. Hence, when the HR and managers of the health care institution are engaged in the preparation of staffing, they are supposed to pay attention to the economic compound of the schedule. Secondly, the social aspect of staffing is to be concerned. This is of importance as the social needs are directly connected with the working performance of the medical staff of a medical institution.

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The main goal of the personnel policy and safe staffing for nurses for the nearest future is to develop the human resource management system in the healthcare sector. It is to be based on the rational planning of the training and the employment of personnel, the use of modern educational technologies, and effective motivational mechanisms. Within the safe staffing approach, they are to enable the bodies and the institutions of health care to be staffed with the ability to solve tasks at a high professional level improving the quality of medical and medicinal care for the population. Conducting an effective personnel policy in a medical institution requires flexibility in determining the priorities of activities, taking into account the emerging situation. Therefore, the safe staffing approach is implemented when management has not only a forecast but also the means of influencing the situation, and the HR department can develop targeted anti-crisis personnel programs to monitor the situation regularly and adjust the execution of programs considering the effect of external and internal factors.

Literature Review

Currently, staffing is dependent on the financial status of the medical institutions. They, in turn, in various ways are trying to receive money from extra-budgetary sources. The heads of medical institutions understand that it is necessary to become more competitive and actively strive for this goal as well as forget about their personnel and the proper disposal of their qualitative and quantitative resources. In this case, according to the study by Cho et al. (2017), safe staffing is directly connected with and based on the economic development of a particular healthcare unit. The authors fairly highlight several features of the budgetary institution. Firstly, when assessing safe staffing, it is vital to pay attention to the sources of the healthcare income (Cho et al., 2017). Herein, health insurance is a model of the health care system, which appeared not so long ago and changes the guidelines in medical activities. The work of medical workers has transformed a little from this. It happened namely from treatment to prevention, from inpatient to outpatient care, and from the number of services provided to their quality (Cho et al., 2017). Secondly, safe staffing is also dependent on the competition between commercial medical institutions (Cho et al., 2017).

It has recently increased, and extra-budgetary sources of funding have appeared. Hence, the conclusion is that the work of medical personnel is more aimed at affordable quality care for patients. Thirdly, Cho et al. (2017) believe that a high level of knowledge is required among health professionals since their work is associated with risks so that they can be reduced and prevented promptly. This, as the author's point, is to be concerned when creating the required conditions for safe staffing (Cho et al., 2017). Since the mistakes are unacceptable, the complexity of the motivation system due to the lack of possibility to regulate labor remuneration is needed (Cho et al., 2017). Within the framework of safe staffing, Cho et al. (2017) state that there is an acute need to improve professional skills and technical means as medicine does not stand still in addition to the methods of diagnostics, treatment, and prevention are improved. Thus, the system of the medical institution has several distinctive features. These features should be regarded when approaching the construction of a safe staffing system in nursing.

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It is difficult to imagine a sphere of medical activity that would be safe for human health. For example, medical personnel of infectious and tuberculosis treatment facilities is constantly exposed to the threat of infection. According to the study by Baker and Pryjmachuk (2016), in psychiatric clinics, employees sometimes risk their lives when working with mental patients with inadequate behavior. Such a risk impacts the development and the creation of safety staffing. The possibility of negative effects on the body of chemotherapeutic agents used in oncology has not been studied to the fullest extent as well (Baker & Pryjmachuk, 2016). In addition, health workers are exposed to daily stress and experience emotional overloads due to intensive work with a large number of people suffering from a variety of personal, physical, and social problems, which entails a syndrome of emotional exhaustion, depersonalization, and a decline in personal achievements (Baker & Pryjmachuk, 2016). All this is a prerequisite for the establishment of exceptions to the general rules for medical workers regarding the regulation of labor relations and staffing. It is due, first, to the exceptional social importance of public health activities and, secondly, to the need to raise the level of income of medical workers to ensure a decent standard of living for employees and members of their families. Hence, safe staffing is a particular basis for the proper functioning of the medical institution. Safe staffing in nursing is particularly important as nurses are an inseparable part of the work of the health care sector.

The rules of internal labor regulations administer the duration, the beginning, the end, and the procedure of recording working hours, break time for rest and meals, schedules of shifts, and the approaches to attracting employees to perform their duties over the established daily work. The study by Wolf, Perhats, Delao, Clark, and Moon (2017) reveals the fact that the rules are aimed at educating employees of medical institutions on taking a responsible and conscientious attitude to work, improving labor discipline, organizing labor on a scientific basis, using working time rationally, and ensuring public health and the high level of medical care. The staffing herein defines the functional duties, rights, and responsibilities of the health worker (Wolf et al., 2017). Safe staffing is to be developed based on a single qualification directory of positions of managers, specialists, and employees in the field of health care (Wolf et al., 2017). In this case, the authors fairly point to the fact that for medical workers who have half of the monthly standard working time for their main job of fewer than 16 hours per week, the part-time work cannot exceed 16 hours per week. For junior medical personnel, a monthly standard of working time is to be calculated from the established working time of the week (Wolf et al., 2017). Thus, the essence of safe staffing is of particular attention because it serves as a basis for the successful work process of the healthcare sector in general.

Safe staffing also includes the situations when an employee can perform additional work for another or the same job within a specified duration of a working day (a shift) along with the work specified in the employment contract. In such cases, it is more advisable to formalize the combination. Thus, there is no need to conclude an employment contract. Within the framework of safe staffing, according to the study by Mitchell et al. (2017), an agreement is signed between the employee and the employer in writing. Therein, the type and the amount of work entrusted to the employee, the period during which the work is performed, and the amount of payment for its performance are agreed upon. The employed additional work for another profession (a position) can be processed by combining professions (positions) while the work in the same profession (a position) by expanding service areas or increasing the scope of work. Before agreeing with an employee, consent must be sought in writing for additional work (Mitchell et al., 2017). The study by Mitchell et al. (2017) also states that safe staffing is responsible for the special features in the system of remuneration of health workers. As part of measures to improve the efficiency and the quality of health care services, new approaches are being implemented in the area of employee remuneration (Mitchell et al., 2017). A crucial task in the field of preparation for the transition to new sectoral wage systems is the formation of an incentive part of the wage fund for employees of state institutions to ensure the effectiveness of the functions assigned to them as well as the intensity and the quality of providing services to the population. This study proves the fact that safe staffing comprises also remuneration measures as it is important to prevent the rapid turnover of the employees.

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When creating safe staffing, it is important to include numerous criteria and aspects to make it as successful as possible. Thus, according to the research by Jones and Gregory (2017), there should be a procedure and conditions for calculating the length of continuous work entitling them to receive incentive payments for the duration of continuous work. There should be a list of types of compensatory and incentive payments to employees of medical organizations and explanations of the procedure for their establishment (Jones & Gregory, 2017). Finally, the target indicators of the effectiveness and the quality of public services provided by medical organizations of the state healthcare system have to be present. It is to be switched to a wage system that is different from the tariff system of remuneration of state institutions’ employees (Jones & Gregory, 2017). For modern conditions of the organization of both state and non-state health sectors, the place of manifestation of economic relations only in the zone of medical professional activity should imply restrictions, which seems to be their considerable simplification. More precisely, it is just a special case, which is very common but inherent only in a part of the modern healthcare organization.

It is the sections of the industry where funding is provided from the budget and the cost estimates. In other words, only in conditions of exceptionally budgetary single-channel financing in the public health sector, the safe staffing can properly exist.

The Plans Developed to Approach the Problem

The management body has a dual function when creating safe staffing. On the one hand, it is the organizer and the manager of the production of medical services in the institution's subordinate. On the other hand, it is the payer for medical care; hence, safe staffing is dependent on it. However, the medical care sector, in turn, relies on staffing. The relationship between institutions and safe staffing is implemented on the following principle. The state is responsible for the obligations of institutions established and, accordingly, subordinate to it. Institutions, in turn, are accountable for the obligations of the state, i.e. health authorities (Cho et al., 2017). Market relations within the network of medical institutions that have only one budget source of content cannot ensure the proper safe staffing. Hence, there is a constant need to plan sources of budgeting to provide the necessary number of employees.

It is possible to state that staffing is dependable on the market relations a healthcare institution is engaged in. The first plan developed was aimed at distinguishing between private and state medical sectors. The private ones were targeted at dealing with the issue of safe staffing for nurses more successfully due to the better-developed financial sources. This is the manifestation of the market relations in this field. By definition, market relations arise when goods and services are exchanged for money. However, market relations can appear in professional medical activity in the case of providing paid services (for example, when the patient makes a payment directly to the doctor) (Cho et al., 2017). Such activities are known as a private medical practices. The volume of services of private practitioners is not comparable with the number of other health services (Cho et al., 2017). Private practice has no decisive influence on the development of domestic health care. Given the foregoing, the subject of the health care economy needs to be clarified (Cho et al., 2017). This plan resulted in the transformation of the views of the application of management methods of the safe nurses’ staffing, taking into account the characteristics of health care and other subjects involved in the schemes of delivering medical services (Cho et al., 2017). Among such entities, insurance organizations that execute voluntary and compulsory health insurance, as well as public funds for compulsory medical insurance, appeared (Cho et al., 2017). It worked perfectly as the staffing problem was reduced to a great extent: approximately 70% of nurses’ positions, previously lacked, were occupied (Cho et al., 2017). Hence, to plan a solution for the issue of safe staffing, it was important to perceive the healthcare system as a participant in the market relations.

At the same time, the existing mechanisms of safe staffing restrained positive changes in health care, led to the emergence of unfavorable factors and unmanageable and long-term trends, exacerbated the state of the material and technical base of health care, and caused the underfunding and the socio-economic crisis of the industry. According to the change theory, the motivation of the nurses’ work was decreasing, the staff turnover was increasing, the prestige of medical labor was falling, and the potential for providing high-quality medical care to the population was limited (Baker & Pryjmachuk, 2016). Hence, the second plan was to predetermine the penetration of the principles and the models of management existing in business into the practice of managing medical organizations that acquire greater autonomy in modern conditions, which in turn reveals the problems of healthcare (Mitchell et al., 2017). It means that the nursing personnel, being the main and the most valuable part of health resources, had to ensure the effectiveness and the efficiency of the whole health system and its separate objects and structures, in particular (Baker & Pryjmachuk, 2016). Herein, the change theory states that the personnel is the only type of resource that, over time, not only keeps its original value but acquires a higher value through the accumulation of professional skills and knowledge (Baker & Pryjmachuk, 2016). A special direction of personnel policy in health care was to be represented by the management of human resources (Mitchell et al., 2017). Hence, safe staffing is a term that characterizes, from the qualitative and content point of view, the staffing or the entire staff of the institution, the labor resources of the health of the territory, the region, or the country as a whole. This plan was successfully implemented in both private and state medical institutions and made favorable conditions for the work of the nurses as it raised the motivation and changed the nurses’ attitude towards the work they perform (Mitchell et al., 2017). Thus, the problem of staffing was reduced.

The safe staffing of Western healthcare institutions is characterized by the following features that determine the plans developed to solve the safe staffing issue. Herein, the local and global perspectives were important as they were included in the transcultural theory of nursing. It means that inner hospitals’ issue was to be perceived along with the state-level concerns in nursing and healthcare and be attached to the cultural compound. Hence, the third plan on the safe staffing issue was to include the percentage of the nurses working who belong to various cultures. Such an approach helped deal with the patients who are the other cultures’ representatives. Thus, such aspects as strong economic and political stratification of various categories of health care personnel, in which the most qualified employees occupy strong leadership positions, are to be concerned (Cho et al., 2017). Besides, this plan worked well as it engaged the active participation of the most qualified part of personnel in the development of management decisions. In addition, there was the professional principle of structural division, which significantly hinders communication beyond the boundaries of its narrowly professional group. Moreover, there was a significant dependence of the health care institution’s effectiveness on the personal characteristics of key specialists (Cho et al., 2017). Finally, this staffing approach was to comprise a pronounced liberal leadership style in the lower and middle levels of management, which provides highly qualified specialists with sufficiently large freedom in decision-making.

The functions of the safe staffing level of personnel management were to be comprised of the traditional personnel functions: selection, organization of reception, movement of workers, their professional training, etc. At this level, it was to have identified several inquisitive differences that are typical for healthcare institutions (Cho et al., 2017). The first major dissimilarity between the practices of safe staffing in health care institutions and other industries is the policy of recruitment. For the majority of industrial, construction, and trade enterprises, there is a serious separation from institutions of higher education (Cho et al., 2017). Hence, to approach the problem of safe staffing, it is paramount to pay attention to the place of the medical care institution in the global state policies as they impact the level of recruitment.

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Finally, the management of personnel in health care facilities was significantly different in the issues of training, retraining, and skills development. Each of these factors was included in the safe staffing procedure. In general, only 10.9% of employees of the enterprises passed through the array of vocational training studied each year (Cho et al., 2017). Provided that this trend persists in the coming years, each worker will have the opportunity to upgrade their professional training level once every 10 years (Cho et al., 2017). However, in today’s health care system, retraining, professional development of personnel, and vocational training are conducted primarily at the expense of employees.

The number and the structure of the health workforce were planned to be identified by the state/region plan and program. This fourth plan was based on the long-term forecast of the population’s need for medical, medicinal, and sanitary-hygienic support, considering the demographic situation, the health dynamics of the population, migration processes, and structural restructuring of the industry (Baker & Pryjmachuk, 2016). This plan was not as successful as it was expected because the structure of the personnel arrangement of the industry indicated a decrease in the number of medical and paramedical personnel. It was noted especially in the primary health care and rural areas: the growing disproportion between the number of doctors and average health workers and the ways of the provision of medical specialists between individual subjects clearly showed this. Herein, it is necessary to mention that the first condition for the successful planning of personnel was organizing the development of cadres both quantitative and qualitative. It does not make sense if the training system and medical workers are not able to provide both of these aspects (Baker & Pryjmachuk, 2016). At the same time, trained medical personnel should have found practical applications corresponding to their professional qualifications (Baker & Pryjmachuk, 2016). The second prerequisite for effective safe staffing is implementing the concept of integrated development of medical personnel and the health system itself. Such plans appeared to be fruitful as they permitted the time for the nurses’ professional development.

The fifth plan of approaching the safe staffing problem was to comprise the provision of medical organizations with medical and pharmaceutical personnel and to properly manage the system of professional training of medical and pharmaceutical employees to the requirements of the industry. Moreover, it included the organization of the employment system, consolidation of medical and pharmaceutical personnel in medical organizations, and the social support of young professionals. In addition, the following important aspects of planning were involved as well. They included the improvement of measures aimed at motivating and stimulating materially medical and pharmaceutical workers, increasing the prestige of medical specialties, career development of medical personnel, and promoting social partnership with professional public organizations. These plans, due to their complexity, were successful and helpful as they reduced the employees’ fatigue and decreased the turnover.

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Prospects for radical improvement of safe staffing and personnel work, the timely and qualitative solution of more complicated tasks assigned to the personnel service, were to be directly related to the use in their activity of modern computer facilities and automated control systems. In conditions of using computer facilities effective selection, placement, assessment, and planning of staff requirements, training, retraining, and certificating, including those by automated processing of user information in the computer database, became possible (Wolf et al., 2017). The automated processing of information using the new technologies allowed for specialists, departments, and institutions to quickly receive real-time data, that is immediately after the request, summary reports, personal and professional characteristics, information on official movements, and others. As a consequence, the plans implemented were more successful than failed as they created better working conditions and the space for personal development.

The Philosophy and the Use to Determine Interventions

Despite the growing importance of external factors, internal ones are crucial in the functioning and the development of the organization. Hence, the philosophy of the safe staffing herein presupposes that the main components of the internal environment are the goals for the team of the medical institution, the flexibility of the structure of the medical institution, highly qualified manpower resources, the latest equipment, sufficient material, and financial reserves, high medical technologies, and high service culture in the organization (Mitchell et al., 2017). The culture of the organization is understood as the manner of behavior in which the basic values of members of a medical institution are embodied (Baker & Pryjmachuk, 2016). The culture of the organization is reflected in implementing the planned scope of work of the organization and the continuous improvement of the medical institution’s personnel policy. The interventions, in this case, are to be built on the nursing aspects mentioned. At the same time, the philosophy also includes the fact that in the safe staffing framework for nurses, the following problems remain relevant today. The following aspects are to be taken into account when discussing and creating this concern. Firstly, this is the disparity in the number and the structure of personnel in the scope of activities, tasks, and directions of health care reforms (Baker & Pryjmachuk, 2016). Secondly, it is the imperfection of the regulatory framework (Baker & Pryjmachuk, 2016). Thirdly, this is a discrepancy between the level of training of specialists in the needs of practical public health and the tasks of structural reorganization of the industry (Baker & Pryjmachuk, 2016). Fourthly, it is a lack of scientifically based methods for planning the number of medical personnel (Baker & Pryjmachuk, 2016). Fifthly, it is the presence of disproportions in the structure of medical personnel between general practitioners and narrow specialists, nurses and average medical workers, different territories, institutions of specialized types of care and the primary link, etc. (Baker & Pryjmachuk, 2016). In addition, there should be inadequate social protection for health workers and a low level of remuneration, which does not allow for attracting and retaining specialists in the industry, an increase in the outflow of young specialists. Finally, it is a low level of participation in the decision on personnel issues of professional public organizations.

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The problem of flexibility of the medical institution’s structure is becoming one of the main health problems and, if the situation remains the same, shortly the scale of the identified staffing difficulties may acquire its rise. A serious negative impact on the healthcare system is exerted by a growing staff deficit, a persistent decline in the staffing of medical personnel, both medical and secondary, which already leads to a decrease in the availability and the quality of medical care to the population (Jones & Gregory, 2017). Thus, the analysis of healthcare modernization and the formation of the medical services market served as the basis for the development and the implementation of conceptual approaches in shaping the personnel policy of medical organizations. The same concerns the assessment of the main trends in the change in the nature and the content of the work nurses (Jones & Gregory, 2017). The main intervention approaches herein are including the expert evaluation of available resources, modeling the personnel situation, taking into account the impact of socioeconomic and medical-demographic factors, developing personnel activities, introducing personnel policy, and evaluating the effectiveness of this policy and personnel processes. These approaches also should be aimed at enhancing the latest equipment, sufficient material and financial reserves, and high medical technologies as they represent a part of the staff planning. This is because the distribution of the finances is the basis for the planning and technologies’ development.

Thus, to deal with the issue of the highly qualified manpower resources, it is paramount to use such an intervention as a proper planning approach for the staff. The design of the structure and the number of personnel in the hospital is calculated using staff standards, which sometimes do not correspond to the specific conditions of the hospital. Regarding this issue, one should focus not only on staff standards but also on specific local conditions and, first of all, the nature of the population, the technologies used for the treatment, and the diagnostic process (Jones & Gregory, 2017). There are many publications, laws, and directories that strictly regulate the duties of all medical workers (Wolf et al., 2017). However, it is only in theory. In practice, very often the distribution of the duties between highly qualified manpower resources of the medical personnel does not correspond in many respects to the official duties described in the job descriptions. Most of the clerical work is associated with the need to process a large flow of information, vagueness in the distribution of rights and duties, etc. The majority of it concerns the relationship between doctors and nurses (Wolf et al., 2017). A nurse often performs the part of the doctor’s duties. This leads to the deterioration in the quality of medical care for the population. In many ways, the presence of such a problem is because there is a shortage of medical personnel (Wolf et al., 2017). Thus, some nurses have to combine the work of other specialties. For example, a surgeon incorporates the work of an oncologist doctor since there is a free rate in the hospital for this specialty, but there is no one ready to fully occupy it (Wolf et al., 2017). In such a difficult situation, it becomes simply necessary for a nurse to perform the part of the doctor’s duties, mainly regarding the filling of medical records.

The problem of the organization’s high service culture should be intervened in the following way. Safe staffing should create conditions for motivation of higher labor productivity and satisfaction with the work of medical workers. People are primarily attracted to those jobs where conditions for the development of their abilities are created and high and permanent earnings are guaranteed. One of the interventions is to recognize the interests of all specialists of the institution. It should be remembered that staff planning is effective when it is integrated into the overall organization planning process, including its high service culture, which serves as a kind of motivation and planning (Wolf et al., 2017). Thus, as a means of intervention, in this case, the main task of the HR department of the institution is to ensure that the state has as many medical workers of the appropriate qualifications as it should be by the staffing table and that the institution creates conditions for receiving high returns from each employee (Wolf et al., 2017). At the same time, it is necessary to conduct a multidimensional analysis of positive and negative trends in the development of personnel and to make timely corrections in case of significant changes in the structure. Certainly, there may appear unexpected issues that are difficult to plan and that could not have been implemented when planning the interventions. One of them is the financial crisis, which may hypothetically behold a country or a region. Due to this reason, the financing can be disturbed and prevent the safe staffing approaches from a successful application. Moreover, another unexpected issue is the political reforms that concern the medical field. The impact the situation of safe staffing and dictate the conditions of work.

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One of the leading directions of health care reforms is a whole range of issues related to improving the management of the public health system. The organization of the medical institutions’ activities acquires special significance at the present stage of the development of Russian public health. Management problems are reflected in all concepts and programs of health care reform in the country, and such a notion as management is increasingly intertwined with health. The system of safe staffing in health care institutions is more effective than in most other branches of economic activity. The organizational culture, which also includes safe staffing of medical institutions, is similar to that of other enterprises of the high importance of the culture of power in it and, at the same time, is different from the majority in the presence of elements of the creative activity culture. Differences in the system of personnel management of health care institutions are determined by their specifics. Safe staffing is the main, inalienable, and the most significant part of health resources that ultimately determines the effectiveness and efficiency of the whole system. It currently requires priority attention from central, regional, and local authorities. This direction is particularly in need of investment since the human resources potential is an indicator of competitiveness not only of medical workers themselves but of the entire medical institution and public health in general.

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