In this assignment, you will research labor relations and common labor union issues for the nursing staff in an acute care organization.
Different work schedules can be part of designing healthcare jobs. The traditional U.S. work schedule of eight hours a day, five days a week, is in transition. Many healthcare jobs by the nature of the work performed require 24-hour-a-day, seven-day-a-week coverage (often called 24/7) on-site at the health facility. However, many healthcare jobs do lend themselves to different schedules or the ability to perform the work someplace other than the health facility. In healthcare and many other industries, workers may work less or more than eight hours at a workplace, and may have additional work at home.13
The work schedules associated with healthcare jobs vary as some jobs must be performed during “normal” daily work hours and on weekdays, while others require employees to work nights, weekends, and extended hours. These include shift work, the compressed workweek, part-time schedules, job sharing, and flextime.

Shift Work
A common work schedule design is shift work. Many healthcare organizations, such as hospitals, residential care facilities, and urgent care centers, need 24-hour coverage and therefore typically schedule three 8-hour shifts per day. As an example the shifts might run as follows:

Day or First Shift: 7:00 A.M. to 3:00 P.M.Evening or Second Shift: 3:00 P.M. to 11:00 P.M.Night or Third Shift: 11:00 P.M. to 7:00 A.M.

Most healthcare employers provide some form of additional pay, called a shift differential, for working the evening or night shifts, since those are typically the most difficult shifts to staff. The shift differential provides an inducement to workers to work those shifts. Some types of shift work have been known to cause difficulties for some employees, such as weariness, irritability, lack of motivation, and illness. However, healthcare facilities with 24/7 staffing requirements do not have much choice in continuing to have evening and night-shift work schedules to cover patient care needs.

Compressed Workweek
Another type of work schedule design is the compressed workweek, in which a full week’s work is accomplished in fewer than five 8-hour days. Compression usually results in more work hours each day and fewer workdays each week, such as four 10-hour days, or a three-day week with 12-hour shifts. Often the workers who shift to 12-hour schedules do not wish to return to 8-hour schedules because they have four days off each week.
A very popular form of a compressed workweek was pioneered more than 20 years ago by Baylor Health Care System primarily for recruiting and retaining nurses. Its staffing plan is described as follows:
The Baylor Plan provides full-time benefits for working 24 hours during the weekend—at a pay rate comparable to working 36 hours during the week. Full-time nurses can also work three 12-hour, four 10-hour or five 8-hour shifts.14
Many healthcare organizations, especially hospitals and medical centers, have adopted programs similar to the Baylor Plan for their nurses and other healthcare professionals.

Part-Time Schedules
Part-time jobs are used when fewer than 40 hours per week are required to do a job. Part-time jobs are attractive to those who may not want to work 40 hours per week—older employees, parents of small children, or students. In some cases, professionals may choose part-time work. Most healthcare employers utilize part-time schedules to cover peak demand times, augment full-time staff at shift change, and provide weekend coverage.

Job Sharing
Another alternative used is job sharing, in which two employees perform the work of one full-time job. For instance, a hospital allows two radiological technicians to fill one job, and each individual works every other week. Such arrangements are beneficial for employees who may not want or be able to work full-time because of family, school, or other reasons. The keys to successful job sharing are that both “job sharers” must coordinate effectively together, and each must be competent in meeting the job requirements.15

In flextime, employees work a set number of hours a day but vary starting and ending times. In another variation, employees may work 30 minutes longer Monday through Thursday, take short lunch breaks, and leave work at 1 P.M. or 2 P.M. on Friday.

Managing Flexible Work
Flexible scheduling allows management to relax some of the traditional “time clock” control of employees, while still covering workloads.16 In some cases, electronic monitoring may be used. For example, transcriptionists that work for a clinic in rural Iowa are home-based employees and are monitored electronically on the number of pages of dictated notes they complete in a workday.

Flexibility and Work–Life Balance
For many healthcare employees, balancing their work and personal lives is a significant concern. The quality of an employee’s personal and family life is improved by flexibility at work, according to 68 percent of HR professionals polled.17 Most employees, regardless of the industry they work in, do not feel they spend enough time with their families.
Work–life balance may take the form of employer-sponsored programs designed to help employees balance work and personal life. For example, the University of Kentucky allows flexible work arrangements for its employees, so Randy Hines, who works as a mechanic, can meet his kids at the bus stop around 2:40 every day and walk them home. Hines’s work begins at 7:30 A.M. and ends at 4 P.M., but he and his supervisor agreed to a schedule that allows him to come in at 6 A.M. and clock out at 2:30 P.M. It saves Hines $400 per month in child care for which the family does not have to pay.18
Work–life balance initiatives can improve recruiting and retention by attracting and keeping people who need the flexibility.19 However, employees may dismiss such programs as window dressing if they are not applied consistently. It is not uncommon to have such policies identified and available but not actually practiced in some organizations.

Permeating the discussion of equal employment laws, regulations, and court cases in preceding chapters is the concept that legal compliance must focus on the jobs that individuals perform. The 1978 Uniform Selection Guidelines20 make it clear that HR requirements must be tied to specific job-related factors if employers are to defend their actions as a business necessity.

Job Analysis and the Americans with Disabilities Act
One result of the Americans with Disabilities Act (ADA) is increased emphasis by employers on conducting job analyses, as well as developing and maintaining current and accurate job descriptions and job specifications.
The ADA requires that organizations identify the essential job functions, which are the fundamental duties of a job. These do not include the marginal functions of the positions. Marginal job functions are duties that are part of a job but are incidental or ancillary to the purpose and nature of the job. As covered in Chapter 4, the three major considerations used in determining essential functions and marginal functions are the following:

• Percentage of time spent on tasks
• Frequency of tasks done
• Importance of tasks performed

Job analysis should also identify the physical demands of jobs. For example, the important physical skills and capabilities used on the job of a nursing assistant could include being able to hear well enough to aid patients and doctors. However, hearing might be less essential for a cook in a hospital cafeteria.

Job Analysis and Wage/Hour Regulations
As will be explained in Chapter 12, the federal Fair Labor Standards Act (FLSA) and most state wage/hour laws indicate that the percentage of time employees spend on manual, routine, or clerical duties affects whether they must be paid overtime for hours worked in excess of 40 hours a week. To be exempt from overtime, the employees must perform their primary duties as executive, administrative, professional, computer professional, or outside sales employees. Primary has been interpreted to mean occurring at least 50 percent of the time.
Other legal-compliance efforts, such as those involving workplace safety and health, can also be aided through the data provided by job analysis and job descriptions. It is difficult for a healthcare employer to have a legal staffing system without performing job analysis. Truly, job analysis is the most basic HR activity and the foundation for most other HR efforts.

Job analysis involves determining what the core job is. A detailed examination of jobs, although necessary, sometimes can be a demanding and disruptive experience for both managers and employees, in part because job analysis can identify the difference between what currently is being performed in a job and what should be done. This is a major issue about job analysis for some employees, but it is not the only concern. Other behavioral factors can affect job analysis.

Current Incumbent Emphasis
A job analysis and the resulting job description and job specifications should not just describe what the person currently in the job does and that person’s qualifications. The incumbent may have unique capabilities and the ability to expand the scope of the job to assume more responsibilities, but the employer might have difficulty finding someone exactly like that employee if the person were to leave. Consequently, it is useful to focus on core duties and necessary knowledge, skills, and abilities by determining what the job would be if the incumbent were to quit or be moved to a different job. Focus should be on the job and not the incumbent working in the job.21

“Inflation” of Jobs and Job Titles
People have a tendency to inflate the importance and significance of their jobs. Since job analysis information is used for compensation purposes, both managers and employees hope that “puffing up” jobs will result in higher pay levels, greater “status” for résumés, and more promotional opportunities.
Inflated job titles also can be used to enhance employees’ images without making major job changes or pay adjustments. For instance, the use of the job title of administrative assistant is very popular in healthcare organizations for individuals that function basically as secretaries or clerical support; the title is inflated to provide more prestige to the job, but the individuals employed in this job are typically compensated as secretaries.
An additional concern is the use of offbeat titles. For example, what is a “growth manager,” a “chief transformation officer,” or “process improvement guru”? What does a “human character manager” really do? These examples illustrate how job titles may be misleading, both inside and outside the place of employment. Best practice would dictate that titles should convey a clear picture of what a job involves.

Employee and Managerial Anxieties
Both employees and managers have concerns about job analysis. The resulting job description is supposed to identify what is done in a job. However, it is difficult to capture all facets of a job in which employees perform a variety of duties and operate with a high degree of independence.

Employee Fears
One concern that employees may have involves the purpose of a detailed investigation of their jobs. Some employees fear that an analysis of their jobs will limit their creativity and flexibility by formalizing their duties. They are also concerned about pay deduction or even layoff as a result of job analysis. However, having accurate, well-communicated job descriptions can assist employees by clarifying their roles, as well as the expectations within those roles. One effective way to handle anxieties is to involve the employees in the revision process.
The content of a job may often reflect the desires and skills of the incumbent employee. For example, in one mental health care facility, an employee promoted to shift supervisor continued to spend considerable time doing direct patient care, rather than supervising employees who provided care. As part of job analysis discussions, the site manager discussed the need for the supervisor to delegate patient care duties to others.

Managerial Straitjacket
Another concern of managers and supervisors is that the job analysis and job descriptions will unrealistically limit managerial flexibility.22 Since workloads and demands change rapidly, managers and supervisors may elect to move duties to other employees, cross-train employees, and have flexible means available to accomplish work. If job descriptions are written or used restrictively, employees may argue that a change or omission to a job description should limit management’s flexibility to require that work. In organizations with unionized workforces, some very restrictive job descriptions may exist.
Because of such difficulties, the final statement in many job descriptions is a miscellaneous clause that consists of a phrase similar to “Performs other duties as needed upon request by immediate supervisor.” This statement covers unusual situations in an employee’s job. However, duties covered by this phrase cannot be considered essential functions under legal provisions including the Americans with Disabilities Act.

Job analysis information about what people are doing in their jobs can be gathered in a variety of ways. Traditionally, the most common methods have been (1) observation, (2) interviewing, and (3) questionnaires. However, the expansion of technology has led to computerization and web-based job analysis information resources. Sometimes a combination of these approaches is used depending on the situation and the organization.

With the observation method, a manager, job analyst, or HR specialist watches an employee performing the job and takes notes to describe the tasks and duties performed. Use of the observation method is limited because many healthcare jobs do not have complete and easily observed job duties or job cycles. Thus, observation may be more effective when analyzing healthcare jobs when used in conjunction with other methods or as a way to verify information.

Work Sampling
One type of observation, work sampling, does not require attention to each detailed action throughout an entire work cycle. This method allows a job analyst to determine the content and pace of a typical workday through statistical sampling of certain actions rather than through continuous observation and timing of all actions. Work sampling is particularly useful for routine and repetitive jobs.

Employee Diary/Log
Another observation method that is relatively popular in healthcare organizations requires employees to “observe” their own

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