La Concordia College

Graduate School of Nursing

1739 Pedro Gil, Paco, Manila

Staffing

Untivero, Aivie R.

MSN 1

Foundations of Nursing Management

Objectives

1. To be able to know definition of staffing.

2. To be able to know the purpose and rationale of proper staffing.
3. To identify the factors affecting staffing
4. To know the principle of staffing
5. To be able to differentiate the methods of assigning patients and know the patient
classification system
6. To be able know how to compute for the nursing personnel needed for staffing
pattern.

Staffing

-process of determining and providing the acceptable number and mix of

nursing personnel to produce a desired level of care to meet the patients
demand.

Types of Staffing

a. Centralization- staffing decisions are made by the personnel in a central office

or staffing center
b. Decentralization- unit manager is often responsible for the covering all the the
scheduled staff absences.

Purpose of Staffing:

-to provide appropriate and acceptable number of workers in each category to

perform the nursing tasks required.

Factors Affecting Staffing

1. Type, philosophy and objectives of the hospital and nursing service

2. Population served
3. Number of patients and severity of their illness
4. Availability and characteristics of nursing staff
5. Administrative policies
6. Standards of care desired
7. Layout of the various nursing units
8. Budget
9. Professional actions and priorities in non-patients activities
10. Teaching program or extent of staff involvement in teaching activities
11. Expected of work per annum of employee
12. Patterns of work schedules

Principles of Staffing

1. Identify the type and amount of nursing care needed by agency

2. Determine personnel categories that have knowledge and skill to perform needed
care measures
 3. Predict the number of personnel in each job category
4. Obtain budgeted positions in each job category
5. Recruit personnel to fill available positons
6. Select and appoint personnel from available applicants
7. Combining personnel into desired configurations, by unit and shifts
8. Orient personnel to fulfill assigned responsibilities
9. Assigning responsibilities for patient care

System Approach to Staffing

Inputs
- Average daily census
- Complexity of patients care needs
- Staff members capabilities

Process
- Updating the patients census forecasts on daily or by shift
- Daily assessing the proportion unit census in each patient classification
- Orienting each employee to job responsibilities, time schedule, patient care
assignment
- Calculating the number of employees

Outputs
- Personnel roster of nursing personnel permanently assigned to each nursing unit
- Total fund allocation to overtime
- Personnel forecast plan

Feedback
- Computerized reports
- How recent each employees assignment to weekend duty

METHODS OF ASSIGNING PERSONNEL

Functional Method
- Separating tasks involved in each patients care
- Assigning each staff to perform one or two care tasks for all patients

Advantage:
-Staff become skillful in performing tasks
-Increase speed and efficiency
-Improves experience
-improves productivity
Disadvantage:
-Patients care is fragmented
-No nurse understands the patients total needs
 -Responsibilities to patients are divided.
Team Method
- Binds the professional, technical, and ancillary nursing personnel into small teams of
mutually supportive workers toward a common goal to patients care.
- Combines superior knowledge and skills of professional workers
- One RN is appointed as team leader

Team leader
-decides which aspects of care for assigned patients will be performed
-coordinates team members activities
-
Advantages:
-combines different categories of personnel
-technical and ancillaries are supervised in providing protective care
-workload is balanced
-maintain interest in clients well-being
-barriers between nurses and clients are minimize

Disadvantages:
-not coordinated team effort but assembly-line production

Primary Nursing
- Best with all professional nurses
- Total responsibility for the patients care day after day for a small closed 4-6 patients
- More of their time is devoted to patients care
- Sophisticated understanding of biological science, medical therapeutics and nursing
theory to carry out primary responsibilities
- Directs and evaluates all care given to her patients

Advantages:
-Wide range of skills and knowledge
-increase trust and satisfaction
-excellent communication

Modular Nursing
- professional and non-professional cooperate in caring for the patients under
leadership of professional nurse.
- Direct nursing care with assistance of nursing aides

Nursing Care Management

- Set of activities undertaken by a single nurse to mobilize, monitor and evaluate all
resources used by the patient during total course of illness to achieve patient care.

Rationale of Proper Staffing

o Personnel salaries comprise the largest budget representing around 60%-70%
 o Nursing personnel are demoralized by imbalance between workload and staff size.
Understaffed Unit- frustration, fatigue and disillusionment
Overstaffed Unit- boredom, interpersonal friction
Alternately Understaffed and overstaffed- irritation, uncertainty
and confusion
Improper Mix of Professional and Non-Professional- role
confusion, communication problems, time waste

PATIENT CARE CLASSIFICATION SYSTEM

- Method of grouping patients according to the amount and complexity of their nursing
care requirements and the nursing time and skill they require.
- Serve in determining the amunt of nursing care required generally within 24hours

To develop a workable patient classification system, nurse manager must determine the
ff:

-number of categories into which the patients should be divided

-characteristics of patients
-type and number of care procedures
-time needed to perform these procedures

Classification Categories
Level I (Self Care or Minimal Care)
-patients can perform activities of daily living
-requires a little treatment
-amount of nsg care per hour per pt is 1.5, ratio of professional to non-
professional is 55:45

Level II (Moderate Care or Intermediate Care)

-patients needs some assistance
-observations
- amount of nsg care per hour per pt is 3, ratio of professional to non-
professional is 60:40

Level III (Total, Complete or Intensive Care)

-completely dependent to nursing personnel
-require close observation
- amount of nsg care per hour per pt is 6, ratio of professional to non-
professional is 65:35

Level IV (Highly Specialized Critical Care)

-need maximum nursing care
-continuous treatment and observation
- amount of nsg care per hour per pt is 6-9, ratio of professional to non-
professional is 70:30 or 80:20
COMPUTING FOR THE NURSING PERSONNEL NEEDED
One should ensure that there is a sufficient staff to cover all shifts.
 RA 5901- Forty-Hour Week Law

- provides that employees working with 100 bed capacity and up will work only
40hrs/week.

-also applies to employees working in agencies at least one million population

Relievers Needed

Must consider the ff:

1. Average no. of leaves taken each year.15

a. VL.10
b. SL..5
2. Holidays12
3. Special privileges .3
4. CEP for prof.3

Total ave..33

Average days that the employee is absent (33)

No. of working days per year that each employee X computed no. of nursing
serves (213 or 265)
personnel

Distribution by the Shift

Morning shift 45%

Afternoon shift 37%
Night shift 18%

STAFFING FORMULA

Steps to compute for the Staff needed for In-Patient units are the ff:

1. Categorize the no. of patients according levels of care needed.

Multiply the total number of patients by the percentage of patients at each level
of care ( minimal, intermediate, intensive, or highly specialized)

To illustrate:

Find the number of nursing personnel needed for 250 patients in a

tertiary hospital.

Categorize the no. of patients according 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 needing intensive care
250 pts x 0.01 = 25 pts highly specialized nursing care
250

2. Find the number of nursing care hours (NCH) needed by patients at each level
of care per day.

a. Find the number of patients at each level by the average no. of NCH needed per
day.
b. Get the sum of the NCH needed at various levels

To illustrate
75 pts x 1.5 (NCH needed for level I) = 112.5 NCH/ day
112.5 pts x 1.5 (NCH needed for level II) = 337.5 NCH/day
37.5 pts x 1.5 (NCH needed for level III) = 168.75 NCH/ day
25 pts x 1.5 (NCH needed for level IV) = 150.0 NCH/ day
768. 75 NCH/ day

3. Find the number NCH needed by the given no. of patients.

Multiply the total NCH per day by the total no of days per year.

To illustrate
Find the total NCH needed by 250 patients per year

768. 75 x 365 (days/year) = 280, 593. 75 NCH/ year

4. Find the actual number of working hours rendered by each nursing personnel per
year.
Multiply the number of hours on duty per day by the actual working days per
year.

To illustrate

8 (hrs/day) x 213 (working days/ year) = 1704 (working hrs/ year)

5. Find the total number number of nursing personnel needed.

a. Divide the total no. of nursing care needed per year by the actual no. of
working hours rendered by an employee per year
b. Find the number of relievers.
Multiply the no. of nursing personnel needed by 0.15 (working 40/hrs per
week) or by 0.12 (working by 48hrs/week)
c. Add the no. of relievers to the total no. of nursing personnel needed.
To illustrate
a. Total NCH per year = 280, 593. 75 = 165
Working hrs per year 1, 704

b. Reliever x Total Nursing Personnel = 165 x 0.15

c. Total Nursing Personnel needed 165 + 25 = 190
 6. Categorize to professional and non- professional personnel.
Multiply the no. of nursing personnel according to the ratio of professional to non-
professional.

To illustrate
190 x 0.65 = 124 professional nurses
190 x 0.35 = 66 nursing attendants

7. Distribute by shifts
124 nurses x 0.45 = 56 nurses on AM shift
124 nurses x 0.37 = 46 nurses on PM shift
124 nurses x 0.18 = 22 nurse on Night shift

66 nsg attendants x 0.45 = 30 nsg attendants on AM shift

66 nsg attendants x 0. 37 =24 nsg attendant on PM shift
66 nsg attendants x 0.18 = 22 nsg attendant on Night shift

NOTE:
-applicable only for the in-patients
- additional personnel for supervisory and administrative positions and special units
- additional personnel is necessary for health education classes both at the in-patient and
out- patient.

Impact of Shortage of Nursing Staff upon Staffing

Cross Training giving of personnel with varying educational background and
expertise the skills necessary to take on task.

Closed Unit Staffing staff members on a unit make a commitment to cover

all absences and needed extra help

Mandatory overtime employees are forced to work additional shifts often

under threat of patient abandonment should they refuse to do so.

List of Tables

Table 1: Nursing Care Hours Per Patient Per Day according to Classification of
Patients by Units
 CASES/ PATIENTS NCH/Pt/DAY PROF TO NON-
PROF
RATIO
General Medicine 3.5 60:40
Medical 3.4 60:40
Surgical 3.4 60:40
Obstetrics 3.0 60:40
Pediatrics 4.6 70:30
Pathologic Nursery 2.8 55:45
ER/ICU/ RR
6.0 70:30
CCU
6.0 80:20

Table 2: Levels of Care of Patients, Nursing Care Hours Needed Per Patient Per
Day and Ratio of Professionals to Non-Professionals

Levels of Care NCH/Pt/DAY

Level I 1.5
- Self/ Minimal Care

Level II 3.0
- Moderate/ Intermediate Care

Level III
-Total/ Intensive Care 4.5

Level IV
- Highly Specialized 6-7

Table 3: Percentage of Nursing Care Hours

-depending on the level of care given to the patient

Percentage of Patients in Various Levels of Care

 Type of Hospital Minimal Moderate Intensive Highly
Specialized
Primary 70 25 5 -

Secondary 65 30 5 -

Tertiary 30 45 15 10

Special Tertiary 10 25 45 20

Table 4: Total Number of Working and Non-Working Days and Hours of Nursing
Personnel Per Year

Rights and Privileges Given Each Working Hours Per Week

Personnel Per Year
40 Hours 48 Hours
1. Vacation Leave 15 15
2. Sick Leave Hospitals PROF
15 TO NON-PROF 15
3. Legal Holidays 10 RATIO 10
4. Special Holidays Primary Hospital 2 55:45 2
5. Special Privileges 3 3
6. Secondary
Off-Duties as per R.A 5901 Hospital 104 60:40 52
7. Continuing Education Program 3 3
Tertiary Hospital 65:35
152 100
Total Non-Working Days/year 213 265
Total Working Days/year 1704 2120
Total Working Hours/year

Table 5: Ratio of Professional to Non-Professional