Staffing

Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demand. The purpose of all staffing activities is to provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required. Too few or an improper mixture of nursing personnel will adversely affect the quality and quantity of work performed. Such situation can lead to high rates of absenteeism and staffs turn-over resulting in low morale and dissatisfaction. Factors Affecting Staffing

Factors that affect staffing include 1. the type, philosophy, and objectives of the hospital and nursing services;

2.

the population served

3. the number of patients and severity of their illness 4. availability and characteristics of the nursing staff, 5. administrative policies such as rotation, weekends and holiday off-duties;
6.

Standards of care desired which should be available and clearly spelled out.

7. layout of the various nursing units and resources available within the department such as

adequate equipment, supplies, and materials; 8. budget including the amount allotted to salaries, fringe benefits, supplies, materials, and equipment; 9. professional activities and priorities in non patient activities like
10.

Teaching program or the extend of staff involvement in teaching activities; Expected hours of work per annum of each employee. This is influenced by the 40hour week- law;

11.

12. patterns of work schedule-traditional 5 days per week; 8 hours per day;

TABLE 1. Nursing care hours per patient per day according to classification of patients by units. Cases/Patients 1. General Medicine 2. Medical 3. Surgical 4. Obstetrics 5. Pediatrics 6. Pathologic Nursery 7. ER/ICU/RR NCH/PT/Day Prof. to Non Prof. Ratio 60:40 60:40 60:40 60:40 70:30 55:45 70:30

3.5 3.4 3.4 3.0 4.6. 2.8 6.0

Patient Care Classification System

The Patient care classification system is a method of grouping patients according to the amount and complexity of their nursing care requirements and the nursing time and skill they require. To develop a workable patient classification system, the nurse manager must determine the following: 1. the number of categories into which the patients should be divided: 2. the characteristics of patients in each category; 3. the type and number of care procedures that will be needed by a typical patient in each category; and

4. the time needed to perform these procedures that will be required by a typical patient in each category. The number of categories in a patient classification may range form three to four, which is the most popular, to five or six. Patient care classifications have been developed primarily for medical, surgical, pediatrics, and obstetrical patients in acute care facilities.

Classification Categories The various units may develop their own ways of classifying patients care according to the acuity of their patients illnesses. Level 1 - Self Care or Minimal Care- Patient can take a bath on his own, feed himself, feed and perform his activities of daily living.

Level II Moderate Care or Intermediate Care Patients under this level need some assistance in bathing, feeding, or ambulating for short periods of time. Extreme symptoms of their illness must have subsided or have not yet appeared. Level III Total, Complete or Intensive Care Patients under this category are completely dependent upon the nursing personnel. They are provided complete bath, are fed, may or may not be unconscious, with marked emotional needs, with vital sighs more that three times per shift, may be on continuous oxygen therapy, and with chest or abdominal tubes. Level IV- Highly Specialized Critical Care Patients under this level need maximum nursing care with a ration of 80 professionals to 20 nonprofessionals.

Table 2. Categories or levels of care of patients, nursing care hours needed per patient per day and ratio of professional to non-professionals. Levels of Care Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care NCH Needed Ratio of Prof. to Per PT. Per Day Non- Prof. 1.50 5:45

3.0

60:40

4.5 6.0 7 or higher

65:35 70:30 80:20

Percentage of Nursing Care Hours Table 3. Percentage of patients at various levels of care per type of hospitals. Percentage of Patients in Various Levels of Care Type of Hospital Minimal Moderate Intensive Highly Care Care Care Spl. Care

Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital

70% 65% 30% 10%

25 30 45 25

5 5 15 45

10 20

Computing for the Number of Nursing Personnel Needed

When computing for the number of nursing personnel in the various nursing units of the hospitals, one should ensure that there is sufficient staff to cover all shifts, offduties, holidays. The Forty- Hour Week Law (Republic Act 5901), provides that employees working in hospitals with 100-bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million populations. Employees working in agencies with less than one hundred-bed capacity or in agencies located in communities with less than one million populations will work forty-eight hours a week and therefore will get only one offduty a week.

Table 4. Total number of working and non-working days and hours of nursing personnel per year. Rights and Privileges Given Each Personnel per year 1. Vacation Leave 2. Sick Leave 3. Legal Holidays 4. Special Holidays 5. Special Privileges 6. Off-Duties as per R.A. 5901 7. Continuing Educational Program Total Non-Working Days Per Year Total Working Days Per Year Total Working Hours Per Year Working Hours Per Week 40 Hours 15 15 10 2 3 104 3 ------152 213 1704 48 hours 15 15 10 2 3 52 3 ------100 265 2120

Relievers Need To compute for relievers needed, the following should be considered:
1.

2. 3. 4.

Average number of leaves taken each year------15 a. Vacation Leave ----------------------10 b. Sick Leave ------------------------------5 Holidays --------------------------------------12 Special Privileges as per CSC MC#6 s.1996 --------------------------------------- 3 Continuing Education Program for Professionals -------------------------------- 3

Total Average Leaves ---------------------------33 It will be noted that although an employee is entitled to 15 days sick leave and 15 days vacation leave, 12 holidays, 3 days for continuing education, plus 3 days of special privileges or 48 days total, he or she gets only an average of 33 days leave per year. To determine the relievers needed, divide 33. This will be 0.15 per person who works 40 hours per week and 0.12 per person for those working 48 hours per week. Multiply the computed reliever per person by the computed number of nursing

personnel. This will give the total number of relievers needed.

Distribution by shifts Studies have shown that the morning or day shifts need the most number of nursing personnel at 45 to 51 percent; for the afternoon shift 34 to 37 percent; and for the night shift 15 to 18 percent. Staffing Formula 1. Categorize the number of patients according to the level of care needed. 2. Find the total number of nursing care hours needed by the patients at each category level. a. Find the number of patients at each level by the average number of nursing care hours needed per day. b. Get the sum of the nursing care hours needed at the various levels. 3. Find the actual number of nursing care hours needed by the given number of patients. 4. Find the actual number of working hours rendered by each nursing personnel per year. 5. Find the total number of nursing personnel needed. a. Divide the total number of nursing care needed per year by the actual number or

working hours rendered by an employee per year. b. Find the number of relievers. c. Add the number of relievers to the number of nursing personnel needed. 6. Categorize the nursing personnel into professionals and non-professionals. 7. Distribute by shifts. To illustrate: Find the number of nursing personnel needed for 250 patients in a tertiary hospital. 1. Categorize the patients according to levels of care needed. 250 pts x .30 = 75 patients needing minimal care. 250 pts x .40 = 112.5 patients needing moderate care 250 pts x .15 = 37.5 patients need intensive care 250 pts x .10 = 25 patients need highly specialized nursing care -----250

2. Find the number of nursing care hours (NCH) needed by patients at each level of care per day.

75 pts x 1.5 (NCH needed at Level I) = 112.5 NCH/day 112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day 37.5 pts x 4.5 (NCH needed at Level III) = 168.75 NCH/day 25 pts x 6 (NCH needed at Level IV) = 150 NCH/day --------------------Total 768.75 NCH/day 3. Find the total NCH needed by 250 patients per year. 768.75 x 365 (days/year) = 280,593.75 NCH/year 4. Find the actual working hours rendered by each nursing personnel per year. 8 (hrs/day) x 213 (working days/ year) = 1,704 (working hours/year)

5. Find the total number of nursing personnel needed. a. Total NCH per year = 280,593.75 = 165

Working hrs/ year 1,704 b. Relief x Total Nsg Personnel = 165 x 0.15 = 25 c. Total Nursing Personnel needed 165 + 25 = 190 6. Categorize to professional and non professional personnel. Ratio of professionals to non-professionals in a tertiary hospital is 65:35 190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants 7. Distribute by shifts. 124 nurses x .45 = 56 nurses on AM shifts 124 nurses x .37 = 46 nurses on PM shifts 124 nurses x .18 = 22 nurses on night shifts Total 125 nurses 66 Nsg attendants x .45 = 30 Nursing attendants on AM shifts 66 Nsg attendants x .37 = 24Nursing attendants on PM shifts 66 Nsg attendants x .18 = 12 Nursing attendants on night shifts Total 66 Nursing attendants

Placement It is important for a manager to consider some factors when assigning employees to a position or area where these employees have very good chance for success. Proper placement fosters personal growth, provides a motivation climate for the employee, maximizes productivity and organizational goals have better chances of being met. Inappropriate placement often results in frustration, poor quality of work, reduced organizational efficiency, rapid turn-over, and poor image for the agency. Factors that may be considered would be inherent in the employee, past experience and training, culture of the clientele, decision-making skills, and communication skills. Employees who are placed in areas of their interest adapt faster. Their feet are lighter, and, they are a lot happier than those places in areas which are not of interest to them. New staff nurses can be place in units where they can work at their own pace and feel more confident when supervised. Experienced and well- trained nurses adapt faster, feel confident in their skills and abilities to contribute maximally to the organizations vision, mission, philosophy, goals, and objectives. However, they would still need orientation to their new jobs. Traditionally in our culture, male nurses are seldom placed in Maternity Units where women are

not comfortable when cared by male nurses. Inhibition on physical contact with female patients when intimate parts of the body are involved, are still predominant on our culture. Nurses with graduate degrees such as Masters degree in Nursing are easily placed in position requiring such degree as specified by the Philippine Nursing Act of 2002 (RA 9173) such as teaching or managerial/ administrative positions or in clinical nursing specialty areas.