CONTENT I.

Definition of 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. II. Purpose of Staffing Its purpose is to provide a nursing unit with an appropriate and acceptable number of workers in each category to perform the various nursing tasks required. If proper staffing is not done, it will adversely affect the quality and quantity of work done. III. Factors Affecting Staffing Various factors affect staffing and these are: 1.) The type, philosophy and objectives of the hospital and nursing service; 2.) The population served or the kind of patients served whether pay or charity; 3.) The number of patients and severity of their illness knowledge and ability of nursing personnel are matched with the actual care needs of patients; 4.) Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position; 5.) Administrative policies such as rotation, weekends and holiday off-duties; 6.) Standards of care desired which should be available and clearly spelled out. Institutions may utilize the Association of Nursing Service Administrators of the Philippiness (ANSAP) Standard of Nursing Practice; PRC-ANSAPs Standards of Safe Nursing Practice and/or the hospitals themselves may formulate/develop their own standards; 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 (insurance), supplies and materials; 9.) Professional activities and priorities in non-patient activities like involvement in professional organizations, formal educational development, participation in research and staff development; 10.)Teaching program or the extent of staff involvement in teaching activities; 11.)Expected hours of work per year of each employee. This is influenced by the 40-hour week law; and IV.

12.)Patterns of work schedule traditional 5 days per week, 8 hours per day; 4 days a week, 10 hours per day and three days off; or 3 days of 12 hours per day and 3 days off per week. Staffing Needs Nurse staffing varies on every factor that affects it. The environment changes as new patients are admitted each day in the hospital. The effectiveness of a staffing pattern is only as good as the planning that goes into its preparation. Several key concepts were identified according to Anne Bernat. These key concepts are the Full-Time Equivalent (FTE) and Nursing Hours per Patient Day (NHPPD). Full-Time Equivalent (FTE) Full-time equivalent (FTE) is a measure of the work commitment of a full-time employee. FTE hours are the total paid time and includes the productive and nonproductive time. An FTE of 1.0 means that the person is a full-time employee while an FTE of 0.5 means that the person is only a part-time employee. A full time employee works for 8 hours a day for 5 days a week which is equal to 40 hours of work per week for 52 weeks a year. This amounts to 2,080 hours of work time per year. 5 days per week X 40 hours per week X 8 hours per day = 40 hours per week 52 weeks per year = 2,080 hours per year

To get the FTE from the hours per week, the table below can be used to get the FTE. 1.0 FTE 0.8 FTE 0.6 FTE 0.4 FTE 0.2 FTE = = = = = 40 hours or five 8-hour shifts per week 32 hours or four 8-hour shifts per week 24 hours or three 8-hour shifts per week 16 hours or two 8-hour shifts per week 8 hours or one 8-hour shift per week

On June 21, 1969, there has been an implementation of Republic Act 5901 which is known as an act prescribing forty hours a week of labor for government and private hospitals or clinic personnel who are working in hospitals with over 100 bed capacity. Employees working in agencies with less than 100 bed capacity or those in communities with less than one million population will work 48 hours a week. > 100 Bed Capacity < 100 Bed Capacity = = 40 hours a week with 2 days off 48 hours a week with 1 day off

Calculating for Productive Time and Nonproductive Time At work, a person has two different types of working time, the productive and nonproductive time. The productive time is the amount of time the employee works such as patient care and charting. Nonproductive hours are benefit hours which are given to employees. These benefit hours are vacation leave, sick leave, holidays, special privileges, off duties and training programs. The 3 day special privilege is given to all government employees by the Civil Service Commission as per Memorandum Circular No. 6, series of 1996 which can be spent for birthdays, weddings, anniversaries, funerals, relocation, enrollment or graduation leave, hospitalization and accident leaves. The productive time can be taken by subtracting total working hours to the nonproductive time. Productive Time = Total Hours Working Nonproductive Time

organization. In order to attain the NHPPD, first solve for the number of staff available over 24 hours and multiply the sum by 8 hours, then divide the result by the number of patients in a unit. # of Staff X 3 Shifts = # of Staff available for 24 hours # of Staff/24hours X 8 hours = # of Nursing Hours available in 24 hours # of Nursing Hours # of Patients = NHPPD A standard was developed by the Department of Health about the amount of nursing care hours should be given to patients in various units of a hospital. This standard can be found in the Hospital Nursing Service Administration Manual. Cases/Patients 1. General Medicine 2. Medical 3. Surgical 4. Obstetrics 5. Pediatrics 6. Pathologic Nursery 7. ER/ICU/RR 8. CCU NCH/Pt/Day (NHPPD) 3.5 3.4 3.4 3.0 4.6 2.8 6.0 6.0 Prof. to Non Prof. Ratio 60:40 60:40 60:40 60:40 70:30 55:45 70:30 80:20

To get the nonproductive hours of an employee, there would be a need to get the sum of all benefits given to him. Rights and Privileges Given Personnel per Year 1. Vacation Leave 2. Sick Leave 3. Legal Holidays 4. Special Holidays 5. Special Privileges 6. Off- Duties (R.A. 5901) 7. Training Total Non-Working Days Per Year Total Working Days Per Year Total Working Hours Per Year Each Working Hours Per Week 40 hours 48 hours Unit 15 15 15 15 10 10 D 2 2 A 3 3 Y 104 52 S 3 3 -------------------152 100 Days 213 265 Days 1704 2496 Hours

V.

Patient Care Classification System (PCCS) Patient care classification system (PCCS) 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. (Venzon, 2003). Bernat defines the PCCS as a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. As defined by the two authors, PCCS is a tool used to classify patients according to the amount of care they need. The amount of care is generated for each patient through patient acuity. Patient acuity is the determination of level of care needed by a certain patient and is mainly used for staffing purposes. Purposes of the PCCS: In order to fully understand the PCCS, there would be a need to know its purpose to make the PCCS effective. Its purposes are the following: 1.) Staffing 2.) Program costing and formulation of the nursing budget 3.) Tracking changes in patient care needs.

Note: One working day is equal to 8 hours as stated in the R.A. 5901. Nursing Hours per Patient Day (NHPPD) Nursing hours per patient day (NHPPD) is a standard measure that quantifies the nursing time available to each patient by available nursing staff. This measure is useful in quantifying nursing care to both nurses and financial staff in an

4.) Determining values for the productivity equation. 5.) Determining quality. Characteristics of an effective PCCS: The following characteristics are desirable of PCCS, which should: 1.) Differentiate intensity of care among definitive classes. 2.) Measure and quantify care to develop a management engineering standard. 3.) Match nursing resources to patient care requirements. 4.) Relate to time and effort spent on the associated activity. 5.) Be economical and convenient to report and use. 6.) Be mutually exclusive, counting no item under more than one work unit. 7.) Be open to audit. 8.) Be understood by those who plan, schedule, and control the work. 9.) Be individually standardized as to the procedures needed for accomplishment. 10.)Separate requirements for registered nurses from those of other staff. Factors Affecting the PCCS:

2.) Checklist The checklist-style acuity table divides descriptions of care routines into activity categories such as eating and bathing. Activity levels are described in each category. Levels in the eating category might be self-care, help setting up, feed, frequent feedings. Each activity is assigned to an activity level point score. After the nurse totals the points for each patient, the level of care can then be determined according to a range of points per category. 3.) Time or Relative Value Unit Standard In time or relative value unit standard system, it assigns a value unit to various activities of patient care. Those activities are usually clustered according to categories, such as diet, bathing and mobility. 4.) Medicus The medicus is one of the first PCCS developed. It clusters patients into five categories with 5 being the greatest intensity of care. Indicators and the average hours of nursing care required determine the level. Classification Categories:

There are certain factors that mainly affect the PCCS, and these are: 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. Types of PCCS: There are various types of PCCS, the main difference of these types is on how each patient is categorized. The different types are: 1.) Descriptive In the descriptive style, the nurse classifies the patient in the category that most closely describes the care received. The tool used is a narrative on a concise acuity table. The nurse chooses the category that best describes the patient. The main problem with this style is interrater reliability, caused by the subjectivity of the interpretation of the patients degree of care. The descriptive style is a quick-check guide, but the poor interrater reliability leads to a wide range of requested nurse-patient ratios.

Certain units in the hospital may develop their own classification system. Venzon gives a good example of a classification system that has only four classifications. Level I Self Care or Minimal Care. Patient can take a bath on his own, feed himself, feed and perform his activities of daily living. Falling under this category are patients about to be discharged, those in non-emergency, the newly admitted, does not exhibit unusual symptoms, and requires little treatment, observation and/or instruction. Average amount of nursing hours is 1.5. Ratio of professional to nonprofessional nursing personnel is 55:45. Level 2 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. patients may have slight emotional needs, with vital signs ordered up to three times per shift, intravenous fluids or blood transfusion; are semiconscious and exhibiting some psychosocial or social problems; periodic treatments, and/or observations and/or instructions. Average nursing hours is 3 and the ration of professional to nonprofessional personnel is 60:40.

Level 3 Total, Complete or Intensive Care. Patients under this category are completely dependent upon the nursing personnel. They provided complete bath, are fed, may or may not be unconscious, with marked emotional needs, with vital signs more than three times per shift, may be on continuous oxygen therapy, and with chest or abdominal tubes. They require close observation at least every 30 minutes for impending hemorrhage, with hypo or hypertension and/or cardiac arrhythmia. The nursing hours is 6 with a ratio of 65:35. Level 4 Highly Specialized Critical Care. Patients under this level need maximum nursing care with a ratio of 80:20 in terms of personnel. Patients need continuous treatment and observation; with many medications, IV piggy backs; vital signs every 15-30 minutes; hourly output. There are significant changes in doctors orders and the nursing hours rangers from 6-9 or more. Levels of Care Level 1 Self Care Minimal Care Level 2 Moderate Immediate Care Level 3 Total Intensive Care Level 4 Highly Specialized Critical Care Percentage of Nursing Care Hours The percentage of nursing care hours at each level of care depends on the setting in which the care is being given. In some hospitals, such as that of the primary hospitals, they can only cater basic illnesses and cannot cater more severe cases that secondary and tertiary hospitals can provide. Type of Hospital Primary Secondary Tertiary Special Tertiary Minimal Care 70 65 30 10 Moderate Care 25 30 45 25 Intensive Care 5 5 15 45 Critical Care 10 20 NHPPD 1.50 3.0 4.5 6.0 or higher Ratio 55:45 60:40 65:35 80:20

VI.

Computing for the Number of Nursing Personnel Needed In computing for the number of personnel needed, one should ensure that there is sufficient staff to cover all shifts, off-duties, holidays, leaves, absences, and time for staff development programs (Nonproductive Hours). Relievers Needed Relievers are the personnel who replace the absentees or people on leave. To get the number of personnel needed, divide the average number of days an employee is absent per year by the number of workings days per year that each employee serves. This will be 0.15 per person who works 40 hours per week and 0.12 per person on a 48 hour week job. 40 Hours Per Week 33 213 = 0.1549295774647887323943661971831 or 0.15 48 Hours Per Week 33 265 = 0.12452830188679245283018867924528 or 0.12 It will be noted that although an employee is entitled to 15 days sick leave and 15 days vacation leave, 12 holidays, 3 days of continuing education, plus 3 days of special privileges which totals to 48 days, an employee gets only an average of 33 days leave per year. Distribution by Shift Studies have shown that morning or day shift needs 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. In the Philippines, the distribution of 45, 37 and 18 percent is usually followed. 45% for the morning shift 37% for the afternoon shift 18% for the night shift

The Staffing Formula To compute for the staff needed in all units of a certain level of hospital, there are certain steps to be followed: 1.) Categorize the number of patients according to level of care needed. 7.) Distribute by shifts. # of Patients x constant for minimal care = # of Patients needing minimal care # of Patients x constant for moderate care = # of Patients needing moderate care # of Patients x constant for intensive care = # of patients needing intensive care # of Patients x constants for special care = # of Patients needing special care 2.) Find the total number of nursing hours(NH) needed by the number of patients per day. # of Patients needing minimal care x NH at level 1 = NHPPD1 # of Patients needing moderate care x NH at level 2 = NHPPD2 # of Patients needing intensive care x NH at level 3 = NHPPD3 # of Patients needing special care x NH at level 4 = NHPPD4 Total Number of NHPPD = NHPPD1 + NHPPD2 + NHPPD3 + NHPPD4 3.) Find the total NHPPD needed by the patients per year. Total Number of NHPPD x 365 (days/year) = # NH/year 4.) Find the actual workings hours rendered by each nursing personnel per year. # of working hours/day x Total Working Days/year = # of working hours/year 5.) Find the total number of nursing personnel needed. a.) Total NH/year # of working hours/year = Total Nursing Personnel b.) Relief x Total Nursing Personnel = Relievers c.) Total Nursing Personnel Needed = Total Nursing Personnel + Relievers 6.) Categorize to professional and non-professional personnel. Ratio of professionals to non-professionals by the level of hospital. Kelly-Heidenthal, Patricia. Nursing Leadership and Mangement. Thomson Delmar. Australia. 2003. Pg. 239-241. Tomey, Ann Marriner. Guide to Nursing Management. 7th Edition. Mosby. St. Louis. 2004. Pg. 395-396. Swansburg, Russell and Richard Swansburg. Introductory Management and Leadership for Nurses. 2nd Edition. Jones and Barlett Publishers. Massachusetts. 1997. Pg. 128134. nd Venzon, Lydia. Nursing Management Towards Quality Care. 2 Edition. C&E Publishing Inc. Philippines. 2003. Pg. 56-66.
By: Don Chen BSN-4O July 22, 2008 http://dchen.wordpress.com/

Total Number of Personnel Needed x ratio of professionals = # of Professionals Total Number of Personnel Needed x ratio of nonprofessional = # of NonProfessional

# of Professional x AM Shift = # of Professionals on AM Shift # of Professional x PM Shift = # of Professionals on PM Shift # of Professional x Night Shift = # of Professionals on Night Shift Total Number of Professionals Needed = AM + PM + Night shift professional personnel # of Non-prof x AM Shift = # of Non-prof on AM Shift # of Non-prof x PM Shift = # of Non-prof on PM Shift # of Non-prof x Night Shift = # of Non-prof on Night Shift Total Number of Non-Professionals Needed = AM + PM + Night shift nonprofessional Bibligraphy