nurse staffing

Key Considerations for Staffing Skilled Nursing

Staffing Challenges in Skilled Nursing

Ensuring adequate staffing in skilled nursing facilities is crucial for providing high-quality care to residents. The staffing levels and models implemented can significantly impact the overall functioning and outcomes of these facilities. Let’s explore the importance of staffing in skilled nursing facilities and common staffing challenges faced.

Importance of Staffing in Skilled Nursing Facilities

Staffing plays a vital role in skilled nursing facilities. Adequate staffing levels are essential to maintain a safe and healthy environment for residents. Skilled nursing facilities require a diverse team of healthcare professionals, including registered nurses, licensed practical nurses, certified nursing assistants, and other support staff.

Proper staffing ensures that residents receive timely and appropriate care, medications, and assistance with daily activities. It also allows for effective monitoring of residents’ health conditions and prompt response to emergencies. A well-staffed facility can provide comprehensive care, improve resident outcomes, and enhance overall resident satisfaction.

Common Staffing Challenges Faced

Skilled nursing facilities often face various challenges when it comes to staffing. Some of the common challenges include:

  1. Staff Shortages: The shortage of qualified healthcare professionals, especially registered nurses, can make it challenging to maintain optimal staffing levels. This shortage can lead to increased workloads, burnout, and compromised quality of care.
  2. High Turnover Rates: Skilled nursing facilities may experience high turnover rates, resulting in constant recruitment and training of new staff. High turnover can disrupt continuity of care and impact resident-staff relationships.
  3. Staffing Ratios: Balancing staffing ratios can be complex. Striking the right balance between the number of residents and the number of staff members is crucial for providing personalized care and ensuring resident safety. Skilled nursing staffing ratios vary based on state regulations and facility-specific needs.
  4. Skill Mix: Ensuring an appropriate skill mix among the staff is essential. It involves having the right combination of experienced and novice staff members to meet the diverse needs of residents. Achieving an optimal skill mix can be challenging due to factors such as staff availability, turnover, and budget constraints.
  5. Workload and Staffing Stability: Maintaining a manageable workload for staff while ensuring staffing stability can be a delicate balance. Excessive workloads can lead to staff fatigue, decreased job satisfaction, and compromised resident care. Conversely, inadequate staffing stability can result in inconsistency and disruptions in care provision.

By understanding the importance of staffing in skilled nursing facilities and recognizing the common challenges faced, facility administrators and healthcare professionals can work towards implementing effective staffing strategies and models. These models aim to address the staffing challenges and promote quality care delivery.

Understanding Skilled Nursing Staffing Models

When it comes to staffing in skilled nursing facilities, it’s essential to consider various staffing models that can help optimize the delivery of care. These models provide frameworks for organizing and assigning nursing staff to ensure efficient and effective operations. In this section, we will explore what staffing models are and discuss different types of staffing models commonly used in skilled nursing facilities.

What Are Staffing Models?

Staffing models are systematic approaches used to determine the appropriate number of nursing staff needed and how they are allocated within a healthcare facility. These models take into account factors such as patient acuity, facility size, and regulatory requirements to ensure adequate staffing levels to meet patient needs.

By utilizing staffing models, skilled nursing facilities can better plan and manage their workforce, ensuring that the right number of staff with the appropriate skills are available at all times. This helps to enhance patient care, improve staff satisfaction, and optimize operational efficiency.

Different Types of Staffing Models

There are several different types of staffing models used in skilled nursing facilities, each with its own unique characteristics and benefits. Some common staffing models include:

  • Traditional Staffing Model: The traditional staffing model is a commonly used approach that assigns nursing staff based on predetermined nurse-to-patient ratios. This model typically follows regulatory guidelines and provides a consistent level of care across different shifts.
  • Team Nursing Model: The team nursing model involves dividing the nursing staff into teams, with each team responsible for providing care to a group of patients. This model promotes collaboration and allows for a more holistic approach to patient care.
  • Primary Nursing Model: In the primary nursing model, each patient is assigned a primary nurse who is responsible for their overall care throughout their stay. This model emphasizes continuity and individualized care.
  • Self-Scheduling Model: The self-scheduling model allows nursing staff to have more control over their work schedules. Nurses have the flexibility to choose their shifts based on their availability and the facility’s staffing needs.

Each staffing model has its own advantages and considerations. Skilled nursing facilities should carefully evaluate their unique requirements, patient population, and available resources when selecting and implementing a staffing model.

By understanding different staffing models, skilled nursing facilities can make informed decisions to enhance staffing efficiency, improve patient outcomes, and create a positive work environment for their nursing staff. In the following sections, we will explore each staffing model in more detail, discussing their key features, pros, and cons.

Traditional Staffing Model

Overview of the Traditional Staffing Model

The traditional staffing model is one of the most commonly used models in skilled nursing facilities. In this model, staffing is organized based on a predetermined nurse-to-patient ratio. The staffing ratios may vary depending on the type of care required and the acuity level of the patients.

Under the traditional staffing model, nurses are assigned to specific units or floors within the facility. They are responsible for providing direct care to the patients on their assigned unit, including administering medications, performing assessments, and assisting with activities of daily living. The nurse-to-patient ratio determines the number of nurses required to care for a certain number of patients at any given time.

Pros and Cons of the Traditional Staffing Model

The traditional staffing model has its advantages and disadvantages. Let’s take a closer look at some of them:


  1. Consistency: The traditional staffing model provides consistency in patient care by assigning dedicated nurses to specific units. This allows nurses to develop relationships with patients and gain a deeper understanding of their needs.
  2. Familiarity with Unit: Nurses working in the traditional staffing model become familiar with the layout and routines of their assigned unit. This familiarity can enhance efficiency and improve patient outcomes.
  3. Easier Communication: With nurses consistently assigned to specific units, communication among the nursing team becomes easier. Nurses can collaborate with colleagues and share information more effectively, leading to better coordination of care.


  1. Limited Flexibility: The traditional staffing model may lack flexibility in responding to fluctuating patient needs. If there is a sudden increase in patient acuity or a surge in admissions, the fixed nurse-to-patient ratio may not be sufficient to meet the demands, potentially compromising patient care.
  2. Staff Burnout: Nurses working in the traditional staffing model may experience higher levels of burnout due to the demanding nature of their assigned unit. The fixed nurse-to-patient ratio may not adequately account for the complexity of patient needs, leading to increased stress and workload.
  3. Inefficient Resource Allocation: The traditional staffing model may result in inefficient resource allocation. Nurses may be overworked in some units while being underutilized in others, leading to suboptimal distribution of staffing resources.

To make an informed decision about the staffing model that best suits your facility’s needs, it’s important to consider several factors, such as patient acuity, nurse competency, and regulatory requirements. Additionally, it can be helpful to explore alternative staffing models, such as the team nursing model, primary nursing model, and self-scheduling model, to determine if they may better align with your facility’s goals.

Team Nursing Model

The team nursing model is a staffing approach commonly used in skilled nursing facilities to provide comprehensive and coordinated care to patients. In this model, a team of healthcare professionals collaborates to deliver nursing care to a group of patients. Let’s take a closer look at the overview of the team nursing model and its pros and cons.

Overview of the Team Nursing Model

In the team nursing model, a team typically consists of a registered nurse (RN) who serves as the team leader, licensed practical nurses (LPNs)/licensed vocational nurses (LVNs), and nursing assistants. The team works together to meet the healthcare needs of a specific group of patients assigned to them.

Under the team nursing model, the team leader, usually an RN, is responsible for assessing and coordinating patient care, making critical decisions, and delegating tasks to other team members. LPNs/LVNs and nursing assistants provide direct patient care under the supervision of the team leader.

By distributing patient care responsibilities among team members, the team nursing model allows for a more efficient and collaborative approach to providing care. It promotes effective communication, shared decision-making, and coordinated efforts to address patient needs.

Pros and Cons of the Team Nursing Model

Like any staffing model, the team nursing model has its advantages and disadvantages. Let’s explore some of the pros and cons:


  1. Collaboration and Communication: The team nursing model encourages collaboration and open communication among team members, fostering a cohesive and coordinated approach to patient care.
  2. Efficiency: By dividing patient care responsibilities among team members, the team nursing model can increase efficiency and allow for more patients to be cared for simultaneously.
  3. Skill Utilization: The model allows for optimal utilization of the skills and expertise of different team members. Each member can contribute their unique abilities to provide comprehensive care.
  4. Flexibility: The team nursing model provides flexibility in the assignment of tasks and responsibilities. Team members can adapt to changing patient needs and workload demands.


  1. Hierarchical Structure: The team nursing model may have a hierarchical structure, with the team leader having more authority and decision-making power. This can sometimes lead to a lack of autonomy for other team members.
  2. Communication Challenges: In a large team, effective communication can be a challenge. Miscommunication or delays in relaying information may occur, potentially impacting patient care.
  3. Dependency on Team Leader: The team nursing model heavily relies on the expertise and guidance of the team leader. If the team leader is overwhelmed or unavailable, it may affect the overall functioning of the team.
  4. Staffing Ratios: Adequate staffing ratios are crucial for the successful implementation of the team nursing model. Insufficient staffing levels may strain the team and compromise patient care.

When considering the team nursing model for a skilled nursing facility, it is important to assess the facility’s specific needs, patient population, and available resources. It may be beneficial to explore other staffing models such as the primary nursing model or the self-scheduling model to determine the best fit for your facility. Additionally, ensuring appropriate skilled nursing staffing ratios is essential for maintaining quality care and patient safety.

Primary Nursing Model

Overview of the Primary Nursing Model

The primary nursing model is a staffing approach that emphasizes continuity of care and individualized patient relationships. In this model, a registered nurse (RN) is assigned as the primary nurse responsible for coordinating and providing care to a specific group of patients. The primary nurse collaborates with other healthcare team members but maintains the primary responsibility for the patient’s care throughout their stay.

Under the primary nursing model, the primary nurse takes a holistic approach to care, focusing not only on physical needs but also on the emotional, psychological, and social well-being of the patient. This model promotes stronger nurse-patient relationships, as the primary nurse becomes familiar with the patient’s unique needs, preferences, and goals.

The primary nurse assumes responsibility for coordinating and delegating tasks to other members of the healthcare team, such as licensed practical nurses (LPNs) or certified nursing assistants (CNAs). However, the primary nurse maintains overall accountability for the patient’s care plan and ensures that it is implemented effectively.

Pros and Cons of the Primary Nursing Model

Like any staffing model, the primary nursing model has its advantages and disadvantages. Here are some pros and cons to consider:

– Enhanced continuity of care and consistent nurse-patient relationships.– Higher staffing demands due to the need for dedicated primary nurses.
– Individualized care plans tailored to each patient’s unique needs and preferences.– Potential for increased workload and responsibility for primary nurses.
– Improved patient satisfaction and engagement.– Requires effective communication and collaboration among the healthcare team.
– Increased nurse autonomy and job satisfaction.– May be challenging to implement in facilities with limited resources.
– Opportunities for professional growth and skill development for primary nurses.– May not be suitable for all patient populations or care settings.

The primary nursing model offers several benefits, including the promotion of continuity of care, individualized attention, and stronger nurse-patient relationships. However, it also comes with challenges such as increased staffing demands, potential workload burdens for primary nurses, and the need for effective communication and collaboration among the healthcare team.

When considering the primary nursing model for a skilled nursing facility, it is important to assess the facility’s resources, patient population, and staffing ratios. Each model has its own unique advantages and challenges, and the decision should be based on the specific needs and goals of the facility.

Self-Scheduling Model

The self-scheduling model is an innovative approach to staffing in skilled nursing facilities that empowers nurses to have more control over their work schedules. With this model, nurses have the ability to choose their shifts and create a schedule that suits their needs while ensuring adequate coverage for the facility. Let’s take a closer look at the self-scheduling model, including its overview, pros, and cons.

Overview of the Self-Scheduling Model

In the self-scheduling model, nurses are given the autonomy to select their shifts based on their availability and preferences. This model operates on the principle of trust and responsibility, allowing nurses to take ownership of their schedules and make adjustments as needed. The facility sets certain guidelines and parameters to ensure adequate staffing levels are maintained, but within those guidelines, nurses have the flexibility to create a schedule that works best for them.

Self-scheduling models often utilize scheduling software or platforms that facilitate easy shift swapping and management. These platforms provide real-time updates on available shifts, allowing nurses to view the schedule and make adjustments accordingly. By allowing nurses to have a say in their schedules, it can lead to increased job satisfaction, improved work-life balance, and decreased burnout.

Pros and Cons of the Self-Scheduling Model

Like any staffing model, the self-scheduling model comes with its own set of advantages and considerations. Here are some of the pros and cons associated with this staffing approach:

Pros of the Self-Scheduling ModelCons of the Self-Scheduling Model
Provides flexibility and autonomy to nursesRequires effective communication and collaboration among nurses
Allows nurses to have better work-life balanceMay lead to scheduling conflicts and gaps in coverage if not managed properly
Increases job satisfaction and engagementRequires a robust scheduling platform or software
Reduces turnover and burnoutRequires clear guidelines and policies to ensure fairness and equity
Facilitates better nurse-patient ratiosMay require additional administrative oversight and management

It’s important to note that the success of the self-scheduling model depends on effective communication and collaboration among nurses. Clear guidelines and policies should be established to ensure fairness and equity in the scheduling process. Additionally, having a robust scheduling platform or software can streamline the process and minimize scheduling conflicts.

When considering the implementation of the self-scheduling model in a skilled nursing facility, it’s crucial to take into account factors such as nurse preferences, desired nurse-patient ratios, and the facility’s specific needs. By tailoring the model to the facility’s requirements, it becomes possible to create a staffing system that benefits both nurses and patients.

Choosing the Right Staffing Model

When it comes to staffing skilled nursing facilities, choosing the right staffing model is crucial for ensuring optimal patient care and staff satisfaction. Different staffing models have their own advantages and limitations, so it’s important to consider several factors before making a decision.

Factors to Consider

  1. Patient Needs: Assess the specific needs of your patients and determine which staffing model aligns best with those requirements. Consider factors such as the acuity level of patients, the complexity of care needed, and the desired level of individualized attention.
  2. Staff Skill Mix: Evaluate the skills and expertise of your nursing staff. Some staffing models may require a certain skill mix to effectively deliver care. It’s important to choose a model that allows your staff to utilize their skills and experience to the fullest extent.
  3. Staffing Ratios: Staffing ratios play a critical role in determining the quality of care provided. Consider the recommended skilled nursing staffing ratios for different models and ensure that the chosen model allows for appropriate staffing levels to meet patient needs.
  4. Cost and Resources: Assess the financial implications and resource requirements of each staffing model. Some models may require additional staff or technology investments, while others may offer cost-saving opportunities. Consider your facility’s budget and available resources when making a decision.
  5. Staff Satisfaction and Burnout: Take into account the impact of different staffing models on staff satisfaction and burnout. Some models may lead to increased job satisfaction and reduced burnout, while others may place additional burdens on staff. Consider the well-being and morale of your nursing team when selecting a model.

Tailoring the Model to Your Facility’s Needs

Once you have considered the various factors, it’s important to tailor the chosen staffing model to the specific needs of your facility. Here are some steps to help you in the process:

  1. Evaluate Flexibility: Assess the flexibility of the staffing model and determine if it can adapt to fluctuating patient needs and staffing availability. Flexibility is crucial in ensuring that your facility can respond effectively to changes in demand.
  2. Training and Education: Identify any training or education requirements associated with the chosen model. Ensure that your staff receives the necessary training to effectively implement and maintain the model. Ongoing education is important to keep staff updated on best practices and ensure compliance.
  3. Communication and Collaboration: Establish clear lines of communication and collaboration between staff members when implementing the staffing model. Effective communication is key to ensuring seamless coordination and continuity of care.
  4. Continuous Evaluation: Regularly evaluate the effectiveness of the chosen staffing model. Solicit feedback from staff and patients to identify any areas of improvement. Make adjustments as needed to optimize the model’s impact on patient care and staff satisfaction.

By carefully considering the factors mentioned above and tailoring the chosen staffing model to your facility’s unique needs, you can enhance the overall effectiveness and efficiency of your skilled nursing staffing. Remember, the ultimate goal is to provide high-quality care while maintaining a positive work environment for your nursing staff.


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