staffing
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STAFFING & DUTY
SCHEDULING
Pamela M. Veroy RN, MAN
“Be fair In the distributionof duty hours to your nursingstaff.”
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 patient’s demand.
• Purpose: 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. The type, philosophy and objectives f 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
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 desired which should be available and clearly spelled out.
Factors affecting staffing• 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 alloted to salaries, fringe benefits, supplies,
materials and equipment;• 9. professional activities and priorities in non-
patient activities like involvement in professional organizations, formal educational development, participation in research and staff development
Factors affecting staffing
• 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-hr week law; and
• 12. patters 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.
Nursing Care hours per patient/day according to classification of patients per 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
• It 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.
• Purpose:• 1. Serve in determining the amount of nursing
care required, generally within 24 hours.• 2. to determine the category of nursing
personnel who should provide that care.
Classification CategoriesLevel I-Self
Care or Minimal Care-NCH 1.5/pt/day- Ratio 55:45
-Can take a bath on his own; feed himself; perform his own ADL. -For discharge pt; non-emergency, newly admitted don’t exhibit unusual s/s; - requires little treatment and observation
Level II – Moderate Care or
Intermediate Care
-NCH 3/pt- Ratio 60:40
-Need some assistance in bathing, feeding, ambulating for short period.-Extreme s/s of illness must have subsided or have not yet appeared-May have slight emotional needs-v/s taking ordered 3x/shift; with IVF/BT; are semi-conscious and exhibiting some psychosocial or social problems;- periodic treatments and/or observations and /instructions
Classification CategoriesLevel III –
Total, Complete or
Intensive Care
-NCM 6hrs/pt/day-Ratio 65:35
-Patient 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 v/s monitoring more than 3x/shift-Maybe on continuous oxygen therapy, 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
Classification CategoriesLevel IV- Highly
Specialized Critical Care
-NCH 6-9 or more /pt/day- Ratio 70:30 or 80:20
-Need maximum level of nursing care with a ratio of 80 professionals to 20 non-professionals.-Needs continuous treatment and observation-With many medications, IV piggy backs; v/s monitoring every 15-30 minutes; hourly output.-There are significant changes in doctor’s orders
Categories of Level of Care of Patients: Nursing Care Hours/Pt/Day & Ratio of Prof-Non Prof
Levels of Care NCH Needed Per Pt./Day
Ratio of Prof to Non-Prof
Level I – Self-Care or Minimal Care
1.50 5:45
Level II Moderate or Intermediate
Care
3.0 60:40
Level II Total or Intensive Care
4.5 65:35
Level IV Highly Specialized or Critical Care
6.07 or higher
70:3080:20
Percentage of patients at various levels of care per type of hospital
Type of Hospital Minimal Care
Moderate Care
Intensive Care
Highly Spl. Care
Primary Hospital 70 25 5 -
Secondary Hospital 65 30 5 -
Tertiary Hospital 30 45 15 10
Special Tertiary Hospital
10 25 45 20
Computing for the number of nursing personnel needed
- 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)- for 100 bed capacity and up
-Granting of the 3-day special privilege to govt. employees by the Civil Service Commission as per Memorandum Circular No. 6 series of 1996 (birthdays, weddings, anniversaries, funerals (mourning), relocation, enrollment or graduation leave, hospitalization, and accident leave.
Total No. working-Non working days & hours of nursing personnel per year
Rights & Privileges Given Each Personnel Per Year
Working Hours Per Week
40 hours 48 hours
1. Vacation Leave2. Sick Leave3. Legal Holidays4. Special Holidays5. Special Privileges6. Off-Duties as per R.A. 59017. Continuing Education Program Total Non-working Days per year Total working days per year Total working hours per year
15151023
1043
152213
1,704
15151023
523
100265
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 15
b. sick leave 5
2. Holidays -----------------------------------------------------12
3. Special Privileges as per CSC MC#6 s. 1996-------3
4. Continuing Educ. Prog. For professionals------------3
Total Average Leave-------33
To determine the relievers needed
- divide 33 by number of working days per year each employee served (whether 213 or 265)
- result will be 0.15 per persons works for 40 hour/week
- result will be 0.12 per persons works for 48 hour/week
- multiply the computed reliever per person by the computed number of nsg personnel
- this will give you the total number of relievers
Staffing FormulaTo illustrate: Find the number of nursing according to levels of care needed.
1. Categorize the patients according to levels of care needed
250 pts x 0.30 = 75 pts needing minimal care
250 pts x 0.45 = 112.5 pts needing moderate care
250 pts x 0.15 = 37.5 pts needed intensive care
250 pts x 0.01 = 25 pts need highly specialized 250 nsg care
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 MCH/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 II) = 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/yr) = 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 prof to non-prof in a tertiary hospital is 65:35
190 x .65 = 134 professional nurses
190 x .35 = 66 nursing attendants
7. 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 night shift
Total 124 nurses
66 nsg attendants x .45 = 30 nsg. attendants on AM shift
66 nsg attendants x .37 = 24 nsg attendants on PM shift
66 nsg attendents x .18 = 12 nursing attendants on noc
Total = 66 nursing attendants
Assessing a Scheduling System
1. Ability to cover the needs of the unit
2. quality to enhance the nursing personnel's knowledge, training and experience
3. fairness to the staff – fair share of weekends, holiday offs, rotation patters for the whole year
including assignment to “difficult” or “light” or “undesirable” units or shifts
4. stability – the schedule must be harmonized with their family or social activities of the nurse staff
5. flexibility – ability to handle changes brought by emergency leaves.
Make a schedule in a weekly or monthly basis and do cycle system with the staff under the area assigned for fairness and
flexibility.
A one-week cyclical schedule
Personnel S M T W T F S
7/3 Headnurse/Senior Nurse x x
Staff Nurse x x
Nsg. Att. x x
3/11 Staff Nurse x x
Nsg. Att. x x
11/7 Staff Nurse x x
Nsg. Att. x x
Gen. Rel. 3/11; 11/7 S. nurse 3/11 3/11 11/7 x x 3/11 11/7
N. Att. 3/11 11/7 x 7/3 3/11 11/7 x
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