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If the jobs are organized in a proper manner, he reasons, the result will
be most efficient job structure, and the most favourable job attitudes will
follow as a matter of course.
Nurse administrators believe the staffing plan details such as shift- start
time, number of staffs assigned on holidays, and number of employees
assigned to each shift can be modified to accommodate the units
workload and workflow.
Provide sufficient staff to permit a 1:1 nurse- patient ratio for each shift
in every critical care unit
Involve the heads of the nursing staffs and all nursing personnel in
designing the departments overall staffing program.
Post time schedules for all personnel at least eight weeks in advance.
Empower the head nurse to adjust work schedules for unit nursing
personnel to remedy any staff excess or deficiency caused by census
fluctuation or employee absence.
II.
III.
b.
c.
Staff Related
a.
b.
c.
Institution/Organization Related
a.
b.
c.
which the staff nurse will continue to perform even after she is
promoted to the existing scale of nursing sister.
3. Out of the entitlement worked out on the basis of the norms, 30%posts
may be sanctioned as nursing sister. This would further improve the
existing ratio of 1 nursing sister to 3.6. staff nurses fixed by the
government in settlement with the Delhi nurse union in may 1990.
4. The assistant nursing superintendent are recommended in the ratio of 1
ANS to every 4.5 nursing sisters. The ANS will perform the duty
presently performed by nursing sisters and perform duty in shift also.
5. The posts of Deputy Nursing Superintendent may continue at the level
of 1 DNS per every 7.5 ANS
6. There will be a post of Nursing Superintendent for every hospital having
250 or beds.
7. There will be a post of 1 Chief Nursing Officer for every hospital
having 500 or more beds.
8. It is recommended that 45% posts added for the area of 365 days
working including 10% leave reserve (maternity leave, earned leave,
and days off as nurses are entitled for 8 days off per month and 3
National Holidays per year when doing 3 shift duties).
Most of the hospital today is following the S.I.U.norms. In this the post of the
Nursing Sisters and the Staff Nurses has been clubbed together and the work of
the ward sister is remained same as staff nurse even after promotion. The
Assistant Nursing Superintendent and the Deputy Nursing Superintendent have
to do the duty of one category below of their rank.
The Nurse-patient Ratio as per the S.I.U. Norms
1. General Ward
1:6
casuality)
3.
Nursery
4.
I.C.U.
5.
Labour Room
6.
O.T.
7.
1:2
Casualty-
a. Casualty main attendance up to 100 3 staff nurses for 24 hours, 1:1per shift.
patients per day thereafter
1:35
b.for every additional attendance of 35
patients
c.
1:15
9. OPD
NAME OF THE DEPARTMENT
Blood bank
Paediatric
Immunization
Eye
ENT
Pre anaesthetic
Cardio lab
Bronchoscopy lab
Family planning
Medical
Dental
Orthopaedic
Gyne
Xray
Skin
V D centre
Chemotherapy
Neurology
Microbiology
Psychiatry
Burns
2
In addition to the 10% reserve as per the extent rules, 45% posts may be added
where services are provided for 365 days in a year/ 24 hours.
The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian
Nursing Council, 1985)
The norms are based on Hospital Beds.
1. Chief Nursing Officer
4. A.N.S.
5. Ward Sister
6. Staff Nurse
:1 for 3 beds in Teaching Hospital in general ward& 1
for 5 beds in Non-teaching Hospital +30% Leave reserve
7. Extra Nursing staff to be provided for departmental research function.
8. For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) +
30% leave reserve
9. For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leave
reserve.
10. It is suggested that for 250 beded hospital there should be One Infection
Control Nurse (ICN).
For specialised depertments, such as Operation Theatre, Labour Room, etc.
1:25 +30% leave reserve. norms are not based on Nursing Hours or Patient's
Needs here.
Conclusion
The key to success of any hospital primarily depends upon its human resource
than any other single factor.The core determinants of staffing in the hospital
organization are quality, quantity and utilization of its personnel keeping in
view the structure and process. The staffing norms should aim at matching the
individual aspiration to the aims and objectives of the organization.
Research Inputs
1. Fourteen unit attributes to guide staffing (ref-7)
Using the nursing executive centers hospital data base, researchers contacted a
cross section of leading hospitals nationwide, balanced by size, geography,
location and teaching status. For each hospital, the senior most nursing leader,
usually a chief nurse or vice president of patient care services was asked to
participate in a 1 hr interview with center researchers. The fourteen attributes
identified includes: patient at risk for deteriorating rapidly, wide fluctuation in
the patients volume,wide disparity in patient type and treatment, high level of
admission, discharge and transfer, high degree of nursing autonomy(less
physician oversight), high proportion of protocol driven care, complex patient
care needs post discharge, premium on interdisciplinary communication, high
percentage of patient with comorbidities, premium on highly technical skills,
high level of ADL transports, Heightened observational needs, high percentage
of obese patients and premium on multitasking.
2. Nurse staffing and patient outcomes (ref-8)
The authors from the University of Lowa, investigated nurse staffing and
patient outcomes in 42 inpatient nursing care units in a large university hospital.
Acute care unit level data were collected from hospital records to examine the
relationships among total hours of nursing care, RN skill mix, and adverse
patient outcomes, which included medication errors, patient falls, pressure
ulcers, patient complaints, infections and death. They found that the proportion
of hours of RN care was inversely related to the unit rates of medication errors,
pressure ulcers, patient complaints, infections and deaths. An unexpected
finding was that as the RN proportion increased, the rates of adverse outcomes
decreased, up to the level of 87.5%, after which adverse outcomes rates also
began to increase. Our explanation may be that better reporting resulted when
more RNs were working.
References:
1. Basavanthappa BT. Nursing administration. Ist edn. New Delhi: Jaypee
brothers medical publishers (p) ltd; 2000.