Staffing

It is the process of determining and providing the acceptable number and mix of nursing personnel to meet the patients demand.

Purpose of Staffing
.
1. To provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required.

Factors Affecting Staffing

1.
2. 3.

The type, philosophy and objectives of the hospital and the nursing service; The population served whether pay or charity; The number of patients and severity of their illnessknowledge and ability of nursing personnel are matched with the actual care needs of patients;

Factors Affecting Staffing

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 which should be available nd clearly spelled out. 7. layout of the various nursing units and resources available within the department such as adequate equipment, supplies and materials

Factors Affecting Staffing

8. Budget including the amount alotted to salaries, fringe

benefits, supplies, materials and equipment 9. professional activities and prioritiesin non patient activities like involvement in professional organizations, formal educational development, participation in research and development 10. teaching program on the extent of staff involvement in teaching activities. 11. expexted work of hours per anum of each employee. This is the 40 hour week law 12. patterns of work schedule traditional 5 days a week, 8 hours per day or 31/2 daya of 12 hors / day and 31/2 days off / week.

Factors in Determining Staffing Needs

1.

Activity of Patients Illness

Level of care Degree of dependence Communicability Rehabilitation Needs

2. Special Treatment and Procedures

3. Type of Hospital 4. Ratio of Professional to Non-Professional Nursing Personnel 5. Turn-over of Patients and Nursing Personnel 6. Hospital Policy 7. Budget 8. Available equipment/material/supply 9. Population served

PATIENT CLASSIFICATION CATEGORIES; LEVELS OF CARE

Level I: Self Care or Minimal Care
Patient can take a bath on his own, fed himself and

perform his daily activities of daily living Patients about to be discharged, those on nonemergency, newly admitted, do not exhibit unusual symptoms and requires little treatment/observation and/or instruction.

Nursing Care Hours:

Needed per PT per Day: 3

Ratio of Prof to Non-Prof: 60:40

Level II: Moderate Care or Intermediate Care

Patient who need some assistance in bathing, feeding or

ambulating for short periods of time. Patient may have slight emotional needs, with vital signs 3x per shift Extremes symptoms of illness must have subsided or have not appear

Nursing Care Hours:

Needed per PT per Day: 3

Ratio of Prof to Non-Prof: 60:40

Level III: Total Complete or Intensive Care

Patient are completely dependent upon the nursing

personnel. They are provided complete bath, are fed, may or may not be unconscious. Vital signs more than 3x/shift. Require close observation at least 30 minutes for impending hemorrhage, with hypo or hypertension.

Nursing Care Hours:

Needed per PT per Day: 4.5

Ratio of Prof to Non-Prof: 65:35

Level 4: Highly Specialized Critical Care

Patients need continuous treatment & observation. Vital

signs every 15 to 30 minutes. Hourly input. There are significant changes in doctors orders and care hours per patient per day may range 6-9 or more

Nursing Care Hours:

Needed per PT per Day: 6-7 or higher

Ratio of Prof to Non-Prof: 70:30; 80:20

Nurse must determine the following in assigning patient classification system

1. the number of categories into which the patient

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 4. the time needed to perform these procedures that will be required by a typical patient in each category.

Patient Care Classification System

It is a method of grouping patients according to the

amount and complexicity of their nursing requiremnets and the nursing time and skill they require.

Nursing Care Hours / patient per day according to classification of patients by units
Cases/ patients NCH/ patient/ Day Prof. to Non- Prof. ratio

General medicine Medical Surgical Obstetrics Pediatrics

Nursery ER/IICU/RR

3.5 3.4 3.4 3.0 4.6

2.8 6.0

60:40 60:40 60.40 60:40 70:30

55:45 70:30

Percentage of Patients in Various Levels of Care

Type of Hospital Primary Hospital Minimal of care 70 Moderate Care 25 Intensive Care 5 Highly Spl Care -

Secondary Hospital
Tertiary Hospital Special Tertiary Hospital

65
30 10

30
45 25

5
15 45

10 20

Computing for the Number of Nursing 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. The 40 hour week Law( Republic act 5901), employees working in hospitals with 100 bed capacity and up will wok only for 40 hours a week. For government employees as per memorandum circular no. 6 series of 1996, there is a 3 day special privilege during birthdays, weddings, anniversaries, funerals, relocation, enrollment, graduation leave hospiatlization, and accident leaves

Total Number of working and non- working days and hours of nursing personnel per year
Rights and Privileges Given each personnel per year Vacation leave Sick Leave Legal Holidays 40 hours 48 hours 15 15 10 15 15 10

Special Holidays Special Privileges

Off Duties as per R>A> 5901 Continuing Education Program Total Non- Working Days per year

2 3
104 3 152

2 3
52 3 100

Total Working Days per

213

265

Staffing Formula
.Categorize the patients according to levels of care needed.

250(pts.) x .30= 75 pts. Needing min. care 250 (pts.) x .45= 112.5 pts. 75 pts. Needing mod. Care 250 ( pts. )x.15= 37.5 pts need intensive care 250 ( pts. ) x.01=25 pts. Need highly specialized 250 nursing care

Find the number of nursing care hours needed by patients at each level of care per day
-75 pts x 1.5 (NCH needed at Level 1 ) = 112.5 NCH/ day

112.5pts. X 3 (NCH needed at Level 2 ) = 337.5 NCH/day 37.5pts. X 4.5 (NCH needed at Level 3)= 168.75NCH/day 25pts x 6 (NCH needed at Level 4 ) = 150NCH/day TOTAL 768.75 NCH/day

Find the total NCH needed by 250 patients per year

768.75 x 365 ( days/ year ) = 280,593.75NCH/ year Find the actual working hours rendered by each nursing personnel per year. 8 ( hours/ day) x 213 ( working days/year)= 1,704 ( working hours/ year)

Find the total number of nursing personnel needed

a. Total NCH/ year = 280,593.75 =165 working hours / year 1,704 b. Relief x Total Nursing personnel = 165 x 0.15= 25 c. Total Nursing Personnel Needed 165+25 = 190

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 xx5 = 66 nursing attendants

Distribute by shifts 124 nurses x .45 = 56 nurses on AM Shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x .18 = 22 nurses on Nite shift Total 124 66 nsg. Attendants x .45= 30 NA on Am shift 66 nsg. Attendants x.37= 24 NA on Pm shift 66 nsg. Attendants x . 18= 12 NA on Nite shift total 66 Na

Nursing Care Modalities

Scheduling
A schedule is a timetable showing planned workdays and shifts of nursing personnel.
It is to assign working days and days-off to the nursing

personnel so that adequate patient care is assured It is an advanced assignment of specific on and off duty days over a prescribed time period.

Factors to Consider in Scheduling

1. 2. 3.

4.
5.

Ability to cover the needs of the unit Quality to enhance the nursing personnels knowledge, training and experience Fairness to the staff Stability Flexibility

Staff Schedule Principles

Appropriate ratio or balance between professional and non-professional or support staff. 2. Continuity of services. 3. Avoid over staffing and/or understaffing. 4. Consideration of vacations and schedule time off, needs to be planned well in advance to provide for year round distribution.
1.

5. Allowance for adjustment in case of illness and emergencies. 6. Schedule shall be posted at least two (2) weeks in advance of implementation.

Scheduling
TIME SCHEDULING
Guidelines: 1. Ensure equal distribution of manpower base on patient care needs. 2. Fair distribution of off-days. 3. Personnel should maintain a record of their schedule. 4. When conflict arise, patient care is the priority.
5.

Adherence to established rotation.

6 Establish written policies on request for offs, vacation leave and others. 7. Schedule should be posted at least one week before. 8. Schedule should be conform with all the Labor Laws and hospital policies. 9. Provide good staffing mix 10. Ensure teamwork among the staff.

Types of scheduling:
1.

Centralized is based on a master staffing pattern prepared and carried out by one person or coordinator as maybe designated by the Director of Nursing. Decentralized - the Unit Manager prepares the time schedule of her Unit, subject for approval by the supervisor.

2.

3.

Cyclical schedule covers a designated period of time (usually 2 weeks or monthly) with a certain length and sequence of duties. Advantage of Cyclical Schedule
a) b) c)

It is fair to all Saves time Enables employees to planned ahead for their personal needs

Scheduling Objectives; Factors to be considered, Principles, Types

Patient Care Delivery System