staffing
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STAFFING & DUTY
SCHEDULING
Pamela M. Veroy RN, MAN
“Be fair In the distributionof duty hours to your nursingstaff.”
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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.
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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
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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.
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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
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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.
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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
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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.
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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
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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
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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
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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
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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
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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.
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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
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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
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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
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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
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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
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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
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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
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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.
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Make a schedule in a weekly or monthly basis and do cycle system with the staff under the area assigned for fairness and
flexibility.
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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