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.

STAFFING

The Hospital Nursing Service Administration Manual of the Department of Health has recommended the following Nursing Care Hours (NCH) for patients in the various nursing units of the hospital.

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

CASES NCH/Patient/Day Ratio of Professional to Non-professional

1. General

Medicine

3.5 60:40

2. Medical 3.4 60:40

3. Surgical 3.4 60:40

Continued…

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

…quantify the quality of nursing care by matching patients’ needs to numbers and kinds of nursing personnel using time as the unit of measure.

Patient classification systems (PCS)

A nurse manager must determine the ff:

Number of categories in which the pt should be divided

Characteristics of pts 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

Table 2. Levels of Care of patients, NCH/pt/day & ratio or prof & non-prof

Level of Care NCH/Patient/Day Ratio professional to non-professional

L1 self care or minimal care

1.5 55:45

L2 moderate or intermediate

3.0 60:40

L3 total or intensive care

4.5 65:35

L4 highly specialized or critical care

6.07 or higher

70:3080:20

Percentage of Nursing Care Hours ..period of NCH at each levels of care depends on the setting in which the care is being given.

- patient can take a bath on his own, feed himself and perform his ADL.- patient about to discharge, those non-emergency, newly admitted do not exhibit unusual symptoms, and requires little tx/observation or instruction.- 1.5 NCH/ 55:45 ration prof and non prof

CLASSIFICATION CATEGORIES

Level I- SELF or MINIMAL CARE

- patients under this level need some assistance.- extreme symptoms of their illness must have subside or have not yet appeared.- slight emotional needs, w/ V/S ordered up to 3x/shift, intravenous fluid or blood transfusion, are semiconscious and exhibiting some psychological or social problems; periodic tx, observation & instructions. - 3 NCH / 60:40 ration prof & non-prof

Level II- MODERATE CARE or INTERMEDIATE CARE

- patients in this category are completely dependent upon the nursing personnel.- they are with marked emotional needs, w/ V/S more than 3x/shift, may be on continuous O2 therapy, w/ chest or abdominal tubes.- require close observation at least 30 mins for impending hemorrhage, w/ or w/o hypo or hypertension & cardiac arrhythmia.- 6 NCH / 65:35 Ration prof & non-prof

Level III- COMPLETE or INTENSIVE CARE

- Need maximum nursing care.- patients need continuous tx & observation; w/ many medication, IV piggy banks; V/S q 15-30 mins; hourly output.- 6-9 NCH / 70:30 to 80:20

Level IV- HIGHLY or SPECIALIZED CARE

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

Type of Hospital

Minimal care

Moderate care

Intensive care

Highly Specialized

care Primary 70 25 5 ---------

Secondary 65 30 5 ---------

Tertiary 30 45 15 10

Specialized Tertiary

10 25 45 20

Computing for the Number of Nursing PersonnelWhen computing for the nursing personnel, one should ensure that there is sufficient staff to cover:

1. All shifts

2. Off-duties

3. Holidays

4. Leaves

5. Absences

6. Time for Staff Development

1. Hospitals with <100+bed capacity

2. Communities with <1M+ population

According to R.A. 5901 otherwise known as “The Forty-Hour Week Law”,

employees will work for 40hrs/wk:

However, a nurse will render 48hrs/wk with only 1 ofF-duty a week if:

1. Hospitals with >100bed capacity

2. Communities with >1M population

There are benefits enjoyed by the personnel regardless of the working hours. As per Civil Service Commission Memorandum Circular No. 6, series of 1996, government

employees are granted 3 days which may be spent for:

1. Birthdays2. Weddings3. Anniversaries4. Funerals (mourning)5. Relocation6. Enrolment/graduation

leave7. Hospitalization8. Accident leaves

Table 4. Total number of working hours and non-working days and hours of nursing personnel per year.

Rights & privileges given each

personnel/year

Working hr/wk48 hrs

Working hr/wk40 hrs

1. Vacation leave2. Sick leave3. Legal holidays4. Special holidays5. Special privileges

15151023

15151023

Continued..

6. Off duties/ R.A. 59017. Continuing Education Prog.Total Non-working days/yearTotal Working days/ year Total Working hours/ year

1043

152213

1,704

523

100265

2,120

1. Ave. number of leaves taken each year---- ---15◦ Vacation Leave ----------------------------- -10◦ Sick Leave------------------------------------ 5

2. Holidays -------------------------------- 123. Special Privileges -------------------------- 34. Continuing Educ Program for Professionals----- 3

Total Average Leaves 33

To compute for relievers needed, the following should be considered:

33 (ave # of days an employee is absent)213 or 265

(# of working days/year that each employee serves)

= 0.15 (15%) for persons who work 40hrs/wk= 0.12 (12%) for persons who work 48hrs/wk

To determine the relievers needed:

Morning shift = 45 – 51% (0.45 – 0.51)

Afternoon shift= 34 – 47% (0.34 – 0.47)

Night shift = 15 – 18% (0.15 – 0.18)

***Note: In the Philippines, the distribution usually followed:

45% (0.45) for the Morning shift37% (0.37) for the Afternoon shift

18% (0.18) for the Night shift

To distribute the staff by shifts:

STAFFING FORMULA

1. Categorize the patients according to levels of care. Multiply the total # of patients by the % of patients at each level of care.

Ex. Find the # of nursing personnel needed for 250 bed capacity in a tertiary hospital

250 (pts) x .30 = 75 pts need L1250 (pts) x .45 = 112.5 pts need L2

250 (pts) x .15 = 37.5 pts need L3250 (pts) x .10 = 25 pts need L4

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 NCH/day112.5 pts x 3 (NCH at L2) =337.5 NCH/day37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day 25 pts x 6 (NCH at L4) =150 NCH/day

Total =768.75 NCH/day

3. Find the total NCH needed by given number of patients or bed capacity/year.

768.75NCH/day 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.) immediateb.) reliever

c.) total personnel

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 needed165 + 25 = 190

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

190 x .65 = 124 professional nurses190 x .35 = 66 nursing attendants

190 nursing personnel

7. Distribute by shift

124 x .45 = 56 nurses on AM shift124 x .37 = 46 nurses on PM shift124 x .18 = 22 nurses on Night shift

124 nurses

66 x .45 = 30 nsg attendants on AM shift66 x .37 = 24 nsg attendants on PM shift66 x .18 = 12 nsg attendants on Night shift 66 nursing attendants

SCHEDULING

It is a timetable showing planned work days and shift for nursing personnel.

Scheduling is to assign working days and days off to the nursing personnel so that adequate patient care is assured.

SCHEDULE

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 staff4. Stability5. Flexibility

ASSESSING A SCHEDULING SYSTEM

…sets a basic time pattern that is repeated in cycles.

Cyclic staffing

(Exhibit 7-9 p. 107)

…include systems of scheduling personnel such as 10-hour and 12-hour shifts, weekend alternative, team rotation, and flexible hours.

Modified workweeks

…is a method of scheduling in which the nurse manager determines the needs per day and shift and the nursing staff schedule themselves to meet these needs.

Self-scheduling

(Exhibit 7-8 p. 106)

…is a system of measuring worker output and is commonly defined as outputs divided by inputs.

Productivity

…are contract workers hired from a staffing agency for a period of time that may be for one to several days or weeks. Temporary workers are not employees of the health care agency where they work.

Temporary workers

Oversees staffing activities through human resource management that includes use of a patient classification system and provision of qualified nursing personnel in adequate numbers to meet patient care needs.

Manager behavior

Uses input from employees to develop and implement a staffing philosophy and staffing policies that inspire personnel to work to their maximum level of productivity.

Leader behavior

Basic to planning for staffing of a division ofnursing is the fact that qualified nursingpersonnel must be provided in sufficientnumbers to ensure adequate, safe nursing carefor all patients 24 hours a day, 7 days a week,52 weeks a year.

“Each staffing plan must be tailored to the needs of the agency and cannot be

determined with a simple worker-patient ratio or formula.”

(Exhibit)

(Exhibit 7-7 p. 105)

Classification categories◦ Factor◦ Prototype

Guidelines Average care time for a patient in each

category Method for calculating required staffing,

personnel mix, and required nursing care hours

Components of Patient Classification System

10-hour shift12-hour shiftWeekend alternativeFlex timeOthers

Modified approaches to nurse staffing & scheduling

Is commonly defined as output / input

Percent productivity = required staff hours / provided staff hours

x 100

Productivity

…include recruitment, hiring, assignment, scheduling, calculating turnover, preparing payroll, developing and administering policies, and related activities.

Staffing activities

involves tasks like interviewing, hiring, coaching, retention of state and performance evaluation/appraisal

Human Resource Department

are persons employed in an agency or department

Personnel

the process of enlisting personnel for employment; the process of hiring

Recruitment

the process of choosing or selecting candidates according to their qualifications to the job; the process of elimination

Selection

capacity to retain employees once they are hired

Retention

Word of mouth Advertisement Flyers Newsletter Bulletin Posters Career Days Job Fairs Placement Employee recommendation

Modes of Recruitment

Philosophies in the screening process:

The manager should screen out applicants who do not fit the agency’s image.

The manager should try to fit the job to a promising applicant.

Usually the manager should try to fit the applicant to the job.

Screening Potential Staff

Application Forms and Resumes◦Determine whether the applicant meets minimal hiring requirements.

◦Furnish background data useful in planning the selection interview.

◦Obtain names of references who may be contacted for additional information about the applicant’s work experience and general character.

◦Collect information for personnel administration (SSN, # of dependents etc..)

Letter of Reference Interview

◦face to face contact between the job seeker and a person with full authority to fill the position under discussion.

◦The purpose of the interview is to obtain information, to give information, and to determine if the applicant meets the requirements for the position.

Directive interview : uses closed-ended question

Non-directive interview : the applicant narrates himself.

Structure interview: the interviewer uses pre-prepared guidelines for interview.

Group interview: several applicants or interviewees are interviewed together.

Board interview : conducted by selected member of the personnel to an applicant.

Types of Interview

Aptitude Test: measures capacity on potential ability to learn

Psychomotor: measures strength & coordination

Job knowledge

Proficiency: measures how well the applicants can do a simple work

Psychological test: measures personality characteristics

Test Used in Selection of Applicant

PURPOSES

1. For staffing2. Program costing and formulating budget3. Track changes in patient care methods4. Determine values for productivity

equation5. Determine quality

PATIENT CLASSIFICATION SYSTEM

Issuance of assignments, orders and instructions that permits the worker what is expected of the to achieve organizational goals and objectives

III. DIRECTING

…is getting the work done through employees.

Delegating

Is the process by which a manager assigns specific task/duties to workers with commensurate authority to perform the task.

The worker in return assumes responsibility & is held accountable for its result.

1. Ability of the worker to carry out the task.

2. Fairness not only to the employee but to the team as a whole.

2 Important Criteria in Delegation

Select the right person Delegate both interesting & uninteresting task

Provide staff with enough time to learn

Delegate gradually Delegate in advance Consult before delegating Avoid gaps & overlaps

Principles of Delegation