STAFFING

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

Purpose

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 turnover resulting in low morale and dissatisfaction.

Factors Affecting Staffing

the type, philosophy, objectives of the hospital and the nursing service. the population served or kind of patients served whether pay or charity. the number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the actual care needs of patients

availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position. administrative policies such as rotation, weekends, and holiday off-duties. standards of care desired which should be available and clearly spelled out. layout of various nursing units and resources available within the department such as adequate equipment, supplies, and materials budget including the amount allotted to salaries, fringe benefits, supplies, materials and equipment

professional activities and priorities in nonpatient activities like involvement I professional organizations, formal educational development, participation in research and staff development. teaching program or the extent of staff involvement in teaching activities. expected hours of work per annum of each employee. This is influenced by 40 hour week law. 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 days of 12 hours per day and 3 days off per week.

STAFFING

INVOLVES:
A. SELECTION OF PERSONNEL B. ASSIGNMENT SYSTEMS C. DETERMINATION OF STAFFING

SCHEDULES

SELECTION OF PERSONNEL

HRD : HUMAN RESOURCE DEPARTMENT

INTERVIEW, HIRE

RECRUITMENT
PROCESS OF ENLISTING PERSONNEL FOR

EMPLOYMENT PROCESS OF HIRING

ACTIVE RECRUITMENT ATTRACTION OF

QUALIFIED APPLICANTS

RECOMMENDATIONS ADVERTISEMENT POSTERS JOB FAIR INTERNET

SELECTION OF PERSONNEL
1. SCREENING
3 UNDERLYING PHILOSIPIES OF

SCREENING PROCESS
1. SCREEN OUT APPLICANTS WHO DO

NOT FIT THE COMPANY 2.MANAGER SHOULD TRY TO FIT THE JOB TO PROMISING APPLICANT 3. FIT APPLICANT TO THE JOB

SELECTION OF PERSONNEL
2. RESUMES
DEMOGRAPHIC INFORMATIONS
EDUCATIONAL BACKGROUND WORK EXPERIENCES
DETERMINES APPLICANTS MINIMAL

HIRING REQUIRMENT

SELECTION OF PERSONNEL
3. INTERVIEW
FACE TO FACE CONTACT BETWEEN

APPLICANTS AND PERSON IN AUTHORITY TO FILL IN THE POSITION

PRE-EMPLOYMENT INTERVIEW PURPOSES: TO 1. OBTAIN INFORMATION 2. GIVE INFORMATION 3. DETERMINE IF APPLICANT MEETTHE REQUIRMENT FOR THE POSITION

SELECTION OF PERSONNEL

TYPES OF INTERVIEW
DIRECTIVE INTERVIEW USE CLOSE ENDED QUESTIONS NON-DIRECTIVE

GROUP INTERVIEW SEVERAL APPLICANTS ARE INTERVIEWED TOGETHER BOARD INTERVIEW SELECTED MEMBER OF PERSONNEL INTERVIEW APPLICANT STRUCTURE

INTERVIEW

APPLICANTS NARRATES HIMSELF

INTERVIEW

USES PRE-PREPARED GUIDELINES FOR INTERVIEW

SELECTION OF PERSONNEL
4. TEST/EXAMINATIONS
MEASURES: CLERICAL & MECHANICAL APTITUDES
KNOWLEDGE SKILLS

GENERAL INTELLIGENCE MENTAL, PERCEPTUAL & PSYCHOMOTOR

ABILITIES

TYPES OF TEST

APTITUDE TEST
MEASURES CAPACITY ON POTENTIAL

ABILITY TO LEARN

PSYCHOMOTOR
MEASURES STRENGTH AND

COORDINATION

PROFICIENCY
MEASURES HOW WELL AN APPILCANT CAN

DO SIMPLE WORK

PSYCHOLOGICAL
MEASURES PERSONALITY

CHARACTERISTICS

ASSIGNMENT SYSTEM FOR STAFFING

CASE METHOD

PATIENT ASSIGNED TO A NURSE FOR TOTAL PATIENT CARE

1:1 NURSE/PATIENT RATIO

TOTAL CARE/ CASE NURSING

HEAD NURSE
STAFF NURSE PATIENT

CASE METHOD

ADVANTAGES
CONSISTENCY OF

DISADVANTAGES
NURSE MAY NOT

CARE FOR 1 WHOLE SHIFT MORE OPPORTUNITY TO OBSERVE AND MONITOR PATIENTS CONDITION

HAVE SAME PATIENT THE NEXT DAY OF DUTY

FUNCTIONAL NURSING
HEAD NURSE/SENIOR NURSE

MEDICATION

TREATMENT

NURSING ASSISTANT

HOUSE KEEPING

PATIENT

FUNCTIONAL NURSING

HIERARCHIAL STRUCTURE PREDOMINATES IMPLEMENTS SCIENTIFIC MANAGEMENT DIVIDES WORK TO BE DONE

MEDICATION NURSE TREATMENT NURSE BEDSIDE NURSE

FUNCTIONAL NURSING

WORK DONE FASTER WORKERS WORKS FASTER

HOLISTIC CARE NOT ACHIEVED FRAGMENTATION OF NURSING CARE NURSE-PATIENT RELATIONSHIP IS NOT FULLY DEVELOPED EVALUATION OF NURSING CARE IS POOR

DEVELOPED SKILL IN CERTAIN PARTICULAR TASK ADVANTAGES

DISADVANTAGES

TEAM NURSING
INTRODUCED IN 1950s DUE TO SCARCITY OF RNS AFTER WW II BASED ON PHILOSOPHY OF GROUP ACTION TO ACHIEVE GOAL FEATURES:

NURSING CARE CONFERENCE PURPOSE: DEVELOPMENT & REVISION OF NCP NURSING CARE PLAN

TEAM NURSING
CHARGE NURSE

TEAM LEADER

NURSING STAFF PATIENTS/CLIENTS

TEAM NURSING

WORK SHARED WITH OTHERS

UNPERSONALIZED, FRAGMENTED PATIENT CARE COMPLEX COMMUNICATION ACCOUNTABILITY AND RESPONSIBILTY SHARED WITH OTHERS CAUSE CONFUSION DISADVANTAGES

ADVANTAGES

PRIMARY NURSING

RN GIVES TOTAL CARE TO 4- 6 PATIENTS WHILE ON DUTY PRIMARY NURSE

RESPONSIBLE FOR THE CARE OF THE

PATIENT x 24 HOURS THROUGH OUT HOSPITALIZATION

ASSOCIATE NURSE
CARE FOR THE PATIENTS USING THE CARE

PLAN DEVELOPED BY THE PN WHEN PN IS OFF DUTY

PRIMARY NURSING
PHYSICIAN HEAD NURSE

HOSP. & COMM. RESOURCES

PRIMARY NURSE PATIENT

SRCONDARY NURSE PM

SECONDARY ASST. NURSE NIGHT

SECONDARY ASST. NURSE RELIEVER

PRIMARY NURSING

DEVELOPED TRUSTING HIGH COST HIGHER RN SKILL RELATIONSHIP BETWEEN RN & PATIENT AND FAMILY

DEFINED ACCOUNTABILITY & RESPONSIBILITY HOLISTIC/CONTINUITY OF CARE

PROXIMITY OF PATIENT ASSIGMENT OVERLAPPING OF STAFF FUNCTION

ADVANTAGES

DISADVANTAGES

MODULAR OR DISTRICT NURSING

MODIFICATION OF TEAM & PRIMARY NURSING

DIVIDES AREA INTO MODULE/GROUP OF

PATIENT EACH MODULE CARED BY A TEAM NURSE

A KIND OF TEAM NURSING RN

PLAN THE CARE DELIVER CARE DIRECTS PARAPROFESSIONALS ON

TECHNICAL ASPECTS OF CARE

MODULAR NURSING

ADVANTAGES
INCREASED CONTINUITY AND QUALITY

OF CARE
MORE TIME SPENT IN DELIVERY OF

CARE

STAFFING SCHEDULES

SCHEDULE

TIMETABLE SHOWING PLANNED WORK DAYS AND SHIFT SCHEDULING

ASSIGNING WORK AND OFF DAYS TO

NURSING PERSONNEL TO ASSURE ADEQUATE PATIENT CARE

STAFFING SCHEDULES

CENTRALIZED SCHEDULING DECENTEALIZED STAFFING

SELF SCHEDULING
COORDINATED BY

NURSES AND OTHER STAFFCLLECTIVELY DEVELOP AND IMPLEMENT WORK SCHEDULE, TAKING POLICIES AND VARIABLES AFFECTING STAFFING INTO CONSIDERATION

STAFFING SCHEDULES

ROTATING WORKSHIFT
DAY OR AM SHIFT EVENING SHIFT NIGHT SHIFT

VARIABLE STAFFING
USES PATIENT

PERMANENT SHIFT
BLOCK OR CYCLICAL
USES SAME

NEEDS TO DETERMINE THE NUMBER AND MIX OF STAFF TIME MEASURES DONE FOR DIRECT AND INDIRECT PATIENT CARE

SCHEDULE REPEATEDLY REPEATED EVERY 6 WEEKS

EIGHT HOUR SHIFT, 5 DAY WORK WEEK

STAFFING SCHEDULES

TEN HOUR DAY, FOUR DAY WORK WEEK TEN HOUR SHIFT, SEVEN-DAY WORKWEEK
7-70 PLAN 10 HOUR SHIFT 7 DAYS A

TWELVE HOUR SHIFT, SEVEN DAY WORKWEEK BAYLOR PLAN

INTRODUCED IN BAYLOR

UNIVERSITY MEDICAL CENTER IN DALLAS, TEXAS

WEEK, FOLLOWED BY 7 CONSECUTIVE DAYS OFF TWO TEAKS ALTERNATE WEEKS NO ROTATION OF SHIFT

USES 2 DAYS ALTERNATIVE PLAN NURSES OPTION FOR WORK

TWO 12 HOUR DAYS ON

THE WEEKENDS TO BE PAID FOR 36 HOURS FOR DAY SHIFT 40 HOURS FOR NIGHT SHIFT FIVE 8 HOUR SHIFT

PATIENT CLASSIFICATION SYSTEM

QUANTIFY THE QUALITY OF NURSING CARE BY MATCHING PATIENTS NEEDS TO NUMBER AND KIND OF NURSING PERSONNEL USING TIME AS THE UNIT OF MEASURE

FOR STAFFING PROGRAM COSTING AND FORMULATING BUDGET TRACK CHANGES IN PATIENT CARE METHODS DETERMINE VALUES FOR PRODUCTIVITY EQUATION DETERMINE QUALITY

************************

PURPOSES

PATIENT CLASSIFICATION SYSTEM

NURSE MANAGER MUST DETERMINE THE FOLLOWING

NUMBER OF CATEGORIES IN WHICH

PATIENT SHOULD BE DIVIDED

CHARACTERISTIC OF PATIENTS/CATEGORY
TYPE AND NUMBER OF CARE

PROCEDURES NEEDED BY PATIEN /CATEGORY

TIME NEEDED TO PERFORM THE

PROCEDURES

PATIENT CARE CLASSIFICATION SYSTEM

LEVELS OF CARE NCH NEEDED /DAY RATIO OF PROF. TO NONPROFESSIONALS 55:45 60:40 65:35 70:30 80:20

LEVEL I - SELF CARE OR MINIMAL CARE LEVEL II MODERATE OR INTERMEDIATE LEVEL III TOTAL OR INTENSIVE CARE KLEVEL IV HIGHLY SPECIALIZED OR CRITICAL CARE

1.5 3.0 4.5 6.0 7 or higher

PATIENT CARE CLASSIFICATION SYSTEM

LEVEL I: Minimal Care or Self care

Can take a bath on his own
Perform ADL on his own Patient about to be discharge

Non-emergency cases
Do not exhibit unusual symptoms Requires little treatment

PATIENT CARE CLASSIFICATION SYSTEM

LEVEL II: Intermediate or Moderate Care

Needs assistance in bathing, feeding or

ambulating for short periods of time Extreme symptoms have subsided or yet to appear Have slight emotional needs With IVF or BT Semi-conscious Have some psychosocial or social problem Periodic treatment, observation

PATIENT CARE CLASSIFICATION SYSTEM

LEVEL III: Intensive, Total, Complete Care

Completely dependent on nursing personnel
On continuous O2 therapy With chest or abdominal tubes

Requires close observations

LEVEL IV: Highly Specialized Critical Care

Needs continuous treatment & observations VS q 15 minutes Hourly I & O Significant changes in Doctors order

PERCENTAGE OF PATIENT AT VARIOUS LEVEL OF CARE/TYPE OF HOSPITAL

TYPE OF HOSPITAL

MINIMAL CARE

MODERATE CARE

INTENSIVE CARE

HIGHLY SPECIALIZE D CARE

PRIMARY
SECONDAR Y TERTIARY SPECIAL TERTIARY

70
65 30 10

25
30 45 25

5
5 15 45

10 20

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED

Ensure that there is sufficient staff to:

Cover all shifts
Off duties Holidays

Leaves
Absences Time for staff development

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED

RA 5901: Forty-Hour Week Law

EMPLOYEES WILL WORK 40 HOURS/WEEK

FOR:
Hospitals with 100 bed capacity or more

Community population with at least 1 million

population

However;
ANURSE WILL RENDER 48 HOURS/WEEK

WITH ONLY I DAY OOF DUTY A WEEK IF

Hospitals with less than 1oo bed capacity Communities with less than 1 million population

STAFFING

CIVIL SERVICE COMMISSION MEMORANDUM CIRCULAR NO. 6 SERIES OF 1966 GOVERNMENT EMPLOYEES ARE GRANTED 3 DAYS WHICH MAY BE SPENT FOR:

BIRTHDAY WEDDINGS ANNIVERSARIES FUNERAL RELOCATION ENROLLMENT/GRADUATION LEAVE HOSPITALIZATION ACCIDENT LEAVE

RIGHTS AND PRIVELEGES OF PERSONNEL/YEAR 1. 2. 3. 4. 5. 6. 7. Vacation Leave Sick leave Legal holidays Special holidays Special privileges Off duties/ RA 5910 Continuing Education Program

48 WORKING HOURS /WEEK 15 15 10 2 3 104 3 152

40 WORKING HOUR/ WEEK 15 15 10 2 3 52 3 100

Total Non-working days/year

Total Working days/year

Total Working hours/year

213
1,704

265
2,12o

STAFFING FORMULA
1. Categorize the number of patients according to the levels of care needed.

Multiply total # of patient by % of patient at each Level of Care Ex. Find the # of Nursing Personnel needed for 250 bed capacity in a tertiary hospital
250 patients x .30 = 75 patients needing minimal care L1 250 patients x .45 = 112.5 patient needing moderate care L2 250 patients x .15 = 37.5 patients need intensive care L3 250 patients x .01 = 25 patients needed highly specialized nursing care L4

Staffing formula
2. Find the # of NCH needed by patients at each level of care /day

A. find the number of patients at each level by the average number of NCH needed/day B. get the sum of NCH needed at various level

75 patients x 1.5 NCH needed at Level I = 112.5 112.5 patients x 3 NCH needed at Level II = 337.5 37.5 patients x 4.5 NCH needed at level III= 168.75 25 patients x 6 NCH needed at Level IV = 150 _______ total NCH/day 768.75

STAFFING FORMULA
3. Find the total NCH needed by given no. of patient or bed capacity/ year
total NCH needed/day x total number of

days in a 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 hours x 213 working day/year = 1,704

working hours/year

STAFFING FORMULA
5. Find the total # of nursing personnel needed
Total NCH /year = 280,593.75 = 165 TNP

working hrs/year

1,704

Find the number of reliever

Total Nsg. Personnel x 0.15 (For those working 40

hours a week) = 165 x 0.15 = 25 total Nsg. Personnel x 0.12 (For those working 48 hours a week)
Add no. of relievers to no. of nursing personnel

needed
165 + 25 = 190 nursing care personnel needed

STAFFING FORMULA
6.

Categorize as to professional and nonprofessional personnel

Ratio of professional to non-professional in tertiary hospital is 65:35
190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants

7.

Distribute by shift
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 night shift

STAFFING FORMULA
7.

Distribute nursing attendants/ shift

66 nursing attendant x .45 = 30 nsg. Attendant AM shift 66 nursing attendant x .37 = 24 nsg. Attendant PM shift 66 nursing attendant x .18 = 12 nsg. attendant

NCH/ patient / day : according to classification/unit

The Hospital Nursing Service Administration Manual of DOH has recommended the following NCH for patients in various nursing units of hospitals

----------------------------------------CASES 1. GENERAL MEDICINE 2. MEDICAL 3. SURGICAL 4. OBSTETRICS NCH/PT/DAY 3.5 3.4 3.4 3.0 PROF TO NONPROF RATIO 60:40 60:40 60:40 60:40

5. PEDIATRICS
6. PATHOLIGIC NURSERY 7. ER/ICU/RR 8. CCU

4.6
2.8 6.0 6.0

70:30
55:45 70:30 80:20