Staffing

purpose: 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.

Factors Affecting Staffing:

1. the type, philosophy, and objectives of the hospital and the 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.
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 nonpatient 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 annum of each employee. This is influenced by the 40-
hour week law
12. patterns of work schedule-traditional 5 days per week, 8 hours per day, 4 days a week,
ten hours per day and three days off; or 3 ½ days of 12 hours per day and 3 ½ days off
per week.

The Hospital Nursing Service Administration Manual of the Department of Health

has recommended the following nursing care hours for patients in the various nursing
units of the hospital.

Table 1. Nursing Care Hours per patient per day according to classification of
patients by units.

Cases/Patients NCH/Pt/day Prof. to Non Prof. Ratio

1. General Medicine 3.5 60:40

2. Medical 3.4 60:40
3. Surgical 3.4 60:40
4. obstetrics 3.0 60:40
5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
7. ER/ICU/RR 6.0 70:30
8.CCU 6.0 80:20

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. This assessment can serve in determining the amount of nursing care
required, generally within 24 hours, as well as the category of nursing personnel who
should provide that care.

To develop a workable patient classification system, the nurse manager must determine
the following:
 Number of categories in which the pt should be divided
 Characteristics of patients per category
 Type & number of care procedures that will be needed by a pt per category
 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 from three to four,
which is the most popular, to five or six. These classes relate to the acuity of illness
and care requirements, whether minimal, moderate, or intensive care. Other factors
affecting the classification system would relate to the patient’s capability to meet his
physical needs to ambulate, bathe, feed himself, and other instructional needs
including emotional suport.

Classification Categories
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, those newly admitted, do
not exhibit unusual symptoms, and requires little treatment/ observation and/ or
instruction. Average amount of nursing care hours per patient per day is 1.5. Ratio of
professional to non-professional nursing personnel is 55:45.
Level II – Moderate Care or Intermittent 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 semi-conscious and exhibiting some
psychosocial or social problems; periodic treatments, and/or observations and/or
instructions. Average nursing care hours per patient per day is 3 and the ratio of
professional to non-professional personnel is 60:40.
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 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 care hours per patient per day is 6 with a professional to non-professional ratio
of 65:35.
Level IV – Highly Specialized Critical Care – Patients under this level need
maximum nursing care with a ratio of 80 professionals to 20 non-professionals. Patients
need continuous treatment and observation; with many medications, IV piggybacks;
vital signs every 15-30 minutes; hourly output. There are significant changes in
 doctor’s orders and care hours per patient per day may range from 6-9 or more, and
the ratio of professionals to non-professional also range from 70:30 to 80:20.

Table 2. Categories or levels of care of patients, nursing care hours needed per
patient per day and ratio of professionals to non-professionals.

Levels of care NCH Needed Per Patient Ratio of Prof. to Non-

Per Day Prof.

Level I 1.50 5:45

Self Care or Minimal Care

Level II 3.0 60:40

Moderate or Intermediate
Care

4.5 65:35
Level III
Total or Intensive Care

6.0 7:30
Level IV
7 or higher 80:20
Highly Specialized or
Critical Care

Percentage of Nursing Care Hours

The percentage of nursing care hours at each level of care also depends on the
setting in which the care is being given. For primary hospitals, about 70 percent of their
patients need minimal care, 25 percent needs moderate care. Patients needing intensive
care are given emergency treatment and when their condition becomes stable or when
immediate treatment is necessary and the hospital has no facilities for this, the patient is
transferred to a secondary or tertiary hospital.
In a secondary hospital, 65 percent of the patients need minimal care, 30 percent
need moderate care, and only five percent need intensive care. In tertiary hospitals, about
30 percent of patients need minimal care; 45 percent need moderate care, 15 percent
need intensive care, while 10 percent will need highly specialized intensive care. In special
tertiary hospitals about 10 percent will need minimal care; 25 percent need moderate
care; 45 percent need intensive care; while about 20 percent will need highly specialized
intensive care.

Table 3. Percentage of patients at various levels of care per type of hospital.

Percentage of Patients in Various Levels of Care

Type of Hospital Minimal Care Moderate Care Intensive Care Highly Spl. Care

Primary Hospital 70 25 5 -
Secondary 65 30 5 -
Hospital
30 45 15 10
Tertiary Hospital
10 25 45 20
Special tertiary
Hospital

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, off-duties,
holidays, leaves, absences, and time for staff development programs.
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 population. Employees working in
agencies with less than one hundred-bed capacity or in agencies located in communities
with less than one million population will work forty-eight hours a week and therefore will
get only one off-duty a week.
There are also benefits that have to be enjoyed by each personnel regardless of
the working hours per week. The latest is the granting of the three-day special privilege to
government employees by the Civil Service Commission as per Memorandum Circular No.
6, series of 1996, which may be spent for birthdays, weddings, anniversaries, funerals
(mourning), relocation, enrollment or graduation leave, hospitalization, and accident
leaves.

Table 4. Total number of working and non-working days and hours of nursing personnel
per year.
Rights and Privileges Given Working Hours Per Week
Each Personnel per Year 40 Hours 48 Hours

1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off-Duties as per R.A. 5901 104 52
7. Continuing Education Program 3 3

Total Non-Working Days Per Year 152 100

Total Working Days Per Year
213 265
Total Working Hours Per Year
1,704 2,120

Relievers Needed
To compute for relievers needed, the following should be considered:
1. Average number of leaves taken each year ------------ 15
a. Vacation Leave ------------------------------------ 10
b. Sick Leave ------------------------------------------ 5
2. Holidays ------------------------------------------------------ 12
3. Special Privileges as per CSC MC#6 s.1996 -------------- 3
4. Continuing Education Program for Professionals ------ 3
Total Average Leaves 33

To determine the relievers needed, divide 33 (the average number of days an

employee is absent per year) by the number of working days per year that each employee
serves (whether 213 or 265). 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 wil give the total number of relievers needed.

Distribution by Shifts
Studies have shown that the 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 usually followed is 45 percent for
the morning shift, 37 percent for the afternoon shift and 18 percent for the night shifts.

Staffing Formula
1. Categorize the patients according to levels of care. Multiply the total # of patients
by the percentage of patients at each level of care (whether minimal, intermediate,
intensive or highly specialized).
2. Find the # of nursing care hrs (NCH) needed by patients at each category level.
a. Find the number of patients at each level by the average number 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. Multiply the total nursing care hours needed per day by the total number
of days in a year.
4. Find the actual number of working hours rendered by each nursing personnel per
year. Multiply the number of hours on duty per day by the actual working days 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 of
working hours rendered by an employee per year.
b. Find the number of relievers. Multiply the number of nursing personnel needed by
0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours
per week).
c. Add the number of relievers to the number of nursing personnel needed

6. Categorize the nursing personnel into professionals and non-professionals. Multiply

the number of nursing personnel according to the ratio of professionals to non-
professionals.

7. Distribute by shifts.

Example:
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
250 (pts) x .45 = 112.5
250 (pts) x .15 = 37.5
250 (pts) x .01 = 25
250
2. Find the # of nursing care hrs (NCH) needed by patients at each level of care/ day.
75 pts x 1.5 (NCH at L1)
112.5 pts x 3 (NCH at L2) =
37.5 pts x 4.5 (NCH at L3)=
25 pts x 6 (NCH at L3)
Total
patients needing minimal care
patients needing moderate care
patients needing intensive care
patients needing highly specialized care
= 112.5 NCH/day
337.5 NCH/day
168.75 NCH/day
= 150 NCH/day
= 768.75 NCH/day

3. Find the total NCH needed by given number of patients or bed capacity/year.
768.75 x 365 (days) = 280,593.75 NCH/year

4. Find the actual number of working hours rendered by each nursing personnel/year.
8 (hrs/day) x 213 (working days/year) = 1,704 (working hrs/year)

5. Find the total # of nursing personnel needed.

a. Total NCH/year = 280,593.75 = 165
working hrs/yr 1,704
b. Relief x total immediate nsg personnel
165 x 0.15 = 25
c. Total nsg. Personnel needed
165 + 25 = 190

6. Categorize the nursing personnel into professional and non-professional.

190 x .65 = 124 professional nurses
190 x .35 = 66 nursing attendants
190 nursing personnel
7. Distribute by shifts.
124 x .45 = 56 nurses on AM shift
124 x .37 = 46 nurses on PM shift
124 x .18 = 22 nurses on Night shift
124 nurses

66 x .45 = 30 nsg attendants on AM shift

66 x .37 = 24 nsg attendants on PM shift
66 x .18 = 12 nsg attendants on Night shift
66 nursing attendants
It should be noted that the above personnel are only for the in-patients. Therefore,
additonal personnel should be hired for those in supervisory and administrative positions
and for those in special units such as the Operating Room, the Delivery Room, the
Emergency Room, and Out-Patient Department.

Developing Job Descriptions

A job description is a statement that sets the duties and responsibilities of a specific
job. It includes the needed characteristics or qualifications of the individual to perform
such duties successfully. It is an important management tool to make certain that
responsibilities are wisely delegated, that work is efficiently distributed, that talents are
fully used, and morale is maintained.

Contents of a Job Description

A job description usually contains the following:
1. Identifying Data
Position Title: Staff Nurse
Department: Nursing
Supervisor’s Title: Head/ Senior Nurse

2. Job Summary – This includes the essential features of the job that distuingish it from the
others.
3. Qualification Requirements – Educational preparation, training and experience
necessary to fill the position.
4. Job Relationships –Source of Workers
5. Specific and Actual Functions and Activities

Uses of Job Description

A job description is used
1. for recruitment and selection of qualified personnel
2. to orient new employees to their jobs
3. for job job placement, transfer or dismissal
4. as an aid in evaluating the performance of an employee. Objectives evaluation benefits
both the employer and the employee. Discussions on how well or how poorly an employee
does in his job become the basis for improvement and/ or further action.
5. for budgeting purposes. Salaries are equated with the level of responsibilities and skills
defined in the job description and thus become the basis for position justification and
budgetary preparations
6. for determining depatmental functions and relationships to help define the
organizational structure. One of the organizing principles is grouping employees
performing similar functions to avoid duplication or overlapping of functions and to
improve work flow.
7. for classifying levels of nursing functions according to skill levels required. This enables
nursing administrators to determine whether a realignment of responsibilities is indicated
8. to identify training needs
9. as basis for staffing
10. to serve as channel of communication
 Job descriptions are discussed with the nursing personnel to enable them to see the
extent to which their jobs contribute to patient care, their place in the nursing team and
the hospital as a whole, and how each one of them contributes to the achievement of the
goals and objectives of the hospital.
Job descriptions from unit to unit or hospital to hospital may vary. It is
recommended that the Chief Nurse formulate the job descriptions of their staff keeping in
mind the scope of nursing practice provided for by the Philippine Nursing Act of 2002, R.A.
9173 and the management process.