Nursing Department

OPERATION THEATER Staffing Plan

Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 1 of 8

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Title: Scheduling and Staffing Plan for the Operating Room

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Conditions: Applies to all nursing and ancillary staff assigned to work in the Operation Room Department.

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Purpose: 3.1 To provide each nursing unit in the Operating Room with an appropriate number of the right types of workers to perform the nursing tasks required to give care and comfort to patients in that unit. To provide sufficient staff to permit a nurse patient ratio in every critical care unit on each shift. To involve the Unit Nurse Supervisor and the Director of Nursing, Head Nurse, Staff Nurse, Midwives and other relevant groups, in the construction of the overall staffing plan of the unit. To assign the Head Nurse of each unit to translate the master staffing plan including vacation plan / schedule for the personnel assigned in her unit.

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Definitions: 4.1 Staffing is a complex function, consisting of sequence of interdependent steps. Methods of Assigning Personnel:

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 2 of 8

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Functional Method or Task Allocation for Assigning Personnel consist of separating nurse tasks and assigning each nursing staff member to perform one or two care functions for all patients in a unit or for a large number of patients in the unit. Team Method for Assigning Personnel a method of assignment intended to combine professional, technical and ancillary nursing personnel into small groups to provide total care to a selected group of patients. One of the registered nurse is appointed by the head nurse to be the leader of the team. Patient Allocation this is a system in which each nurse is delegated responsible for the care of a specific group of patients or just one patient, as in intensive care or labor ward setting. This kind of allocation may be for the duration of one shift only, or nurses may work with the same patients whenever they are on duty, over a period of days or weeks. Primary Method works best in an organization with an all registered nurse staff. In this method each nurse is given overall responsibility for planning, executing and evaluating the nursing care for a small case load of four to five patients.

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Procedure: 5.1 Nursing man power planning should have a systematic and scientific approach to determine the number of staff required to give care to a specified group of patients for an acceptable standards. The actual number of nurse for a particular unit per hour is determined by the professional judgment. Then this number is converted into the Whole Time Equivalent by using the Teleford Method as a formula: Number of Nurses x Working Hours per Day x 7 Days (1 week) Total Working Hours per Week (51 hours per week)

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 3 of 8

Example: Surgery Department (Main): 25 x 8.5 hours x 7 days ------------------------------- =29 FTE 51 hours per week Surgery Department (OB-OR): 11 x 8.5 x 7 days ------------------------- = 13 FTE 51 hours per week

Anesthesia Department: 11 x 8.5 x 7 days ------------------------- = 13 FTE 51 hours per week Recovery Room/Post Anesthesia Care Unit: 10 x 8.5 x 7days ------------------------ = 12 FTE 51 hours per week In addition to this, a 23% should be added to this number to make provision for vacations, sick leaves, public holidays, emergency leave, etc. Therefore the annual requirement for this particular unit will be: Surgery Department (Main): 29 + 23% = 36 Surgery Department (OB-OR): 13 + 23% = 16

Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 4 of 8

Anesthesia Department: 13 + 23% = 16 Recovery Room/Post Anesthesia Care Unit: 12 + 23% = 15 In conclusion, to keep 25 nurses on duty at any one time, it requires 36 nurses for surgery then 16 for anesthesia and 15 for PACU. 5.3 This ratio takes consideration of vacation, public holidays (e.g. Ramadan and Hajj Holidays), sick and emergency leaves, etc. According to this ratio, the total number of nurses required for a particular hospital will simply be determined by the number of beds, volume and acuity in the unit. Staff working at 8 and a half hour shift (or 8 hours and 30 minutes per day) are expected to work at 51 hours per week. Each shift includes one 30 minutes break and each staff should have one meal break at 30 minutes. 5.3.1 5.3.2 5.5 Split Duty: starts from 0800H 1230H then 1600H 2000H Straight Duty: from 0800H to 1630H

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The Weekly Schedule consists of 8 and half hours shifts from Saturday to Thursday, with one day off duty (Friday) accordingly. e.g. 0800H 12:30H then 1600H 2000H There are four methods of assigning personnel, before they can specify the details of the overall staffing program for the department: 5.5.1 5.5.2 5.5.3 5.5.4 Functional Method or Task Allocation (for Anesthesia Nurses) Team Method (for PACU and Surgery Nurses) Patient Allocation Primary Method

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 5 of 8

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It is the Head Nurse / Acting Head Nurse or In-Charge Nurse responsible to calculate and ensure that each employee works the correct number of hours per schedule. Hours and tour of duty are arranged to provide quality nursing care needs of patients take priority when scheduling staff. On-Call duty will be covered from 2000H to 0800H for the regular days and 0800H 2000H and 2000H 0800H for Fridays (Day and Night OnCall Duties) from the different units (Anesthesia, Surgical and PACU) and will be staying at the OB OR in case there will be an emergency or urgent procedure to be done. The Head Nurse will determine whether the OnCall Nurses will go for Reverse Duty (from 1600H 2000H) or Straight Duty (0800H 1300H) on the next day after their On-Call Duty depending on the number of booked cases. In the event that there will be more than one case ongoing for the on-call time, a scheduled second and third on-call duty nurses may be asked to go on duty and will then be considered as a time-back as per policy. Each staff will have five on-call duties in a month to cover 20 hours blanket overtime. During Ramadan, duty hours will be changed according to the approved hospital scheduled hours. Weekend Coverage: Weekend is defined as Friday. Orientation: It is necessary for newly hired employees to attend the hospital and general nurse orientation according to hospital policy. The unit orientation should be adjusted at the Head Nurses discretion of certain employees, i.e. rehires, transfer, etc. Vacant Master Schedule Positions: The Head Nurse may change an employees master schedule to meet unit needs. When a position is vacant, an employee may request in writing to change. This will be approved according to unit needs and seniority. Schedule Posting: The Head Nurse prepares, prints and posts a draft schedule for staff to review and to request changes (i.e. 2 weeks) prior to the schedule being finalized. Final Schedule: All changes will be made by the Head Nurse / Charge Nurse and a final schedule generated for posting and a copy sent to the 5

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 6 of 8

Nursing Office and the Nursing Supervisor. 5.15 Schedule Changes: Staffs are requested to minimize changes after the schedule is finalized. Request for schedule changes will be considered by the Head Nurse on an individual basis. Except in emergency situations, the staff nurse is expected to find another nurse of equal qualifications to cover the shift. Exchange of Duty: Staffs will need to fill up the Exchange of Duty form then will be signed by the Head Nurse and the Supervisor at least one day prior to the said exchange duty dates. Staff Vacation Planner: Name of all staff, ID Number and their contract date will be written in the yearly vacation planner. The proposed schedule vacation leave will be marked x according to the number of weeks and the vacation leave will only be approved according to the contract date of the staff. Any emergency leave filed by a staff within their contract period will be approved depending on the department heads discretion and valid reason. Staffing Study: Should gather data about environmental factors within and outside the organization that affects staffing requirement. Three cardinal rules for forecasting staff requirement: 5.18.1 To base the staffing projections upon past staffing history. 5.18.2 To review current staffing levels. 5.18.3 To review the future plans for the institution. 5.19 When a Head Nurse initiates a schedule change to balance the schedule, rescheduled rest/work shift must be scheduled and indicated at the time a shift is rescheduled. Planning for staffing require judgment, experience and thorough knowledge of the requirements of the unit. Staffing plans are also influenced by institutional missions and objectives related to research, training and other specialties; by the number and composition of the medical staff and the medical services offered and arrangement of the physical structure of the institution. 6

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 7 of 8

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Productivity: is defined as output divided by input: Required staff hours ----------------------------- x 100 = Productivity Provided staff hours Productivity in nursing is related both to how efficiently clinical nurses deliver care and how effective that care is relative to its quality and appropriateness.

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Attachment: 6.1 6.2 6.3 6.4 Operation Theater (Anesthesia, Surgical and PACU) Master Schedule Exchange of Duty Form Daily / Weekly / Monthly Unit Assignment Form Yearly Vacation Plan Form

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References: 7.1 OR Policy and Procedure AHH-NUR-OR 002, November 2004

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Approval Section:

Prepared by : __________________________________ Ms. Bella M. Samonte Clinical Quality Assurance Manager ______________ Date

__________________________________ Ms. Jasmin Aeryll T. Lapnawan Department Quality Coordinator (OR PACU Nurse)

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Original Issue Date: June 2011 Effective Date: July 2011 Due for Revision on: July 2013 Number of Pages: 8 of 8

Reviewed by :

__________________________________ Ms. Pacita C. Frias Nursing Department Head

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__________________________________ Dr. Abdulaziz Dorra Head of the Surgery Department

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__________________________________ Dr. Mohammad Askar Chief of Anesthesia/Head of Operating Room Approved by :

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__________________________________ Dr. Abdulaziz Al Hammadi Vice Director of Medical Affairs

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__________________________________ Dr. Reema Al Hammadi Director of Medical Affairs

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__________________________________ Mr. Mohammad Al Hammadi Executive Director

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