STAFFING

STAFFING
Unit Managers Responsibility in meeting Staffing needs Mandates in Staffing Factors affecting Staffing
Patient Care Classification System Classification Categories

Percentage of Nursing Hours Computing for the number of personnel needed Shift Distribution Staffing Formula Placement Scheduling Factors and Types Recruitment/Selection/Placement/Indoctrination and more Staffing and Scheduling option

STAFFING
the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demands to provide each nursing unit with an appropriate number of each category of worker to perform the required task to give care and comfort to patients in the unit

Unit Managers Responsibility in meeting Staffing needs

Requirement for night, evening, holiday work that is frequently necessary in health care organization.
It is definitely stressful and frustrating for some nurses.

Inflexible and extended work schedule are major contribution to job dissatisfaction. Solution is that staff should be involved & have SOME control and option in scheduling.

CENTRALIZED OR DECENTRALIZED???????
Decentralized = Unit Managers are responsible in making schedule decision Centralized = Human Resources Department decide on scheduling matters.

STAFFING MANDATES
Bill that had been made to STANDARDIZED Staffing Ratio between NURSES/PATIENT. US setting only Assembly Bill 394 passed in 1999 by California Nurses Association. (Massachuset, New York,Florida, Michigan are also planning to enact legislation)

ASSEMBLY BILL 394 TABLE

UNIT Critical Care/ICU/NICU/DR OR Antepartum/Postpartum couplets/ Pediatrics/Oncology/ ER/Telemetry Postpartum Women Only Medical Surgical (Initial) Medical Surgical/ Oncology Initial Nurse-Patient Ratio 1:2 1:1 1:4

1:6 1:5

Reaction towards Assembly Bill 394

Skill levels are not all the same Staffing abuses and the resultant declines in quality of patient care not occurred in the past Mandatory staffing ratios create significant opportunity costs that may restrict employers and payers from responding to market forces; they may be unable to take advantage of improved technological support or respond to changes in patient acuity

Staffing is a complex function

Identifying the type and amount of nursing care to be given. Predicting the number of each category of personnel that will be needed to deliver care. Recruiting personnel to fill available positions. Selecting and appointing personnel from available applicants. Arranging available nursing personnel into desired configurations, by unit and shift. Assigning responsibilities for patient care.

Factors affecting Staffing:

The type, philosophy and objectives of the hospital and the nursing service; The population served or the kind of patients served whether pay or charity; The number of patients and severity of their illnesses Availability and characteristics of the nursing staff, including education level of preparation, mix of personnel, number and position; Administrative policies such as rotation, weekends and holiday of duties;

Factors affecting Staffing:

Standards of care desired which should be available and clearly spelled out. Institutions may utilize the ANSAPs Standard of Nursing Practice; PRCANSAPs Standards of Safe Nursing Practice and/or the hospitals themselves may formulate or develop their own standards; Layout of the various nursing units and resources available within the department such as adequate equipment, supplies, and materials;

Factors affecting Staffing:

Budget including the amount allotted to salaries, fringe benefits, supplies, materials and equipment; Professional activities and priorities in non-patient activities like involvement in professional organizations, formal educational development, participation in research and staff development;

Factors affecting Staffing:

Teaching program or the extent of staff involvement in teaching activities; Expected hours of work per annum of each employee. This is influenced by the 40-hour week law; and

Hospital nursing service administration manual of DOH

Cases General Medicine Medical Surgical Obstetrics Pediatrics Pathologic Nursery ER/ER/ICU CCU
NCH/Pt. /day

3.5 3.4 3.4 3.0 4.6 2.8 6.0 6.0

Prof to Non Prof Ratio 60:40 60:40 60:40 60:40 70:30 55:45 70:30 80:20

WORKLOAD MEASUREMENT TOOL

Simplest formula in use where all nursing and ancillary staff are treated equally for determining hours of nursing care. No differentiation is made for differing acuity levels of patients
NCH/PPD=Nursing Hours worked in 24 Hours Patient Census

CALCULATING STAFFING NEEDS (Walsh,2003)

Category I Category II Category III Category Acuity Level Acuity Level Acuity Level IV Acuity Level NCH/PPD AM Shift

2.3

2.9

3.4

4.6

NCH/PPD PM Shift
NCH/PPD Night Shift

2.0
0.5

2.3
1.0

2.8
2.0

3.4
2.8

CALCULATING STAFFING NEEDS (Walsh,2003)

When you came on duty this morning you had the following patients; 1 patient in category l acuity level 2 patients in category ll acuity level 3 patients in category lll acuity level 1 patient in category IV acuity level Note that you must be overstaffed or understaffed by more than half of the hours a person is working to reduce or add staff. For Example, nurses working 8 hours shift, the staffing must be over or under more than 4 hours to delete or add staff.

Seatwork!!!!!
Calculate the staffing needs for a day shift. You have one RN and one LPN working 8 hours shift and a ward clerk for 4 hours. ARE YOU UNDERSTAFFED OR OVERSTAFFED??? 2 patients in category acuity level I 3 patients in category acuity level II 2 patients in category acuity level III 0 patient in category acuity level IV

PATIENT CARE CLASSIFICATION SYSTEM

Level I Self Care or Minimal Care
Requires minimal medical treatment. Requires minimal nursing intervention but close observation. Average amount of nursing care hours per patient per day is 1.5. Ratio of professional to non professional nursing personnel is 55:45. Examples: stable vital signs and psychological status, one intravenous line, good renal and hepatic function, can perform activities of daily living (ADL)

PATIENT CARE CLASSIFICATION SYSTEM

Level II Moderate Care or Intermediate Care
Requires minimal medical treatment. Requires moderate nursing observation and intervention. Average nursing care hours per patient per day is 3 and the ratio of professional to non-professional is 60:40. Examples: Need some assistance in performing ADL in a short period of time, IVF therapy, arterial line in place, stable vital signs and psychological status

PATIENT CARE CLASSIFICATION SYSTEM

Level III Total, Complete or Intensive Care
Requires frequent, close nursing observation and intervention. Requires moderate medical intervention. The nursing care hours per patient per day is 6 with a professional to non professional ratio of 65:35. Examples: Completely dependent on nursing personnel, may or may not be unconscious with marked emotional needs, on continuous oxygen therapy or on respirator but on weaning process, with chest or abdominal tubes, with arterial line or CVP line in place, frequent intravenous medications, fluids, vital signs every hour.

PATIENT CARE CLASSIFICATION SYSTEM

Level IV Highly Specialized Critical Care
Requires continuous treatment and observation. The nursing care hours per patient per day may range from 6-9 or more and the ratio of professionals to non professionals also range from 70:30 to 80:20. Examples: Maintained continuously on respirator, respiratory muscles paralyzed or reflexes obtunded by narcotics, receiving transfusions, multiple IVFs, unstable vital signs, coagulation problems or impaired renal and hepatic function.

LEVELS OF CARE

NCH Needed Per Pt. Per Day 1.5 3.0 4.5 6.0 7.0 or higher

Ratio of Prof to Non-Prof 55:45 60:40 65:35 70:30 80:20

Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care

Table 1. Categories or levels of care of patients, nursing care hours needed per patient per day and ratio of professionals to non professionals.

TYPE OF HOSPITAL Primary Hospital Secondary Hospital

MINIM AL CARE 70 65

MODER ATE CARE 25 30

INTENSIVE CARE 5 5

HIGHLY SPL. CARE -

Tertiary Hospital
Special Tertiary Hospital

30
10

45
25

15
45

10
20

Table 2. Percentage of patients at various levels of care per type of hospital.

COMPUTING FOR THE NUMBER OF PERSONNEL NEEDED

one should ensure that there is sufficient staff to cover all shifts, offduties, holidays, leaves absences and time for staff development programs. The Forty-Hour Week Law (Republic Act 5901) provides that employees working in hospitals with 100 bed capacity and up will work only 40 hours per week.

COMPUTING FOR THE NUMBER OF PERSONNEL NEEDED

Employees working in institutions with less than one hundred bed capacity or those located in communities with less than one million population will work 48 hours a week and therefore will get only one off-duty a week. The latest is the granting of the 3-daY special privilege to government employees by the Civil Service Commission as per Memorandum Circular No. 6, series of 1996, which may be spent for birthdays, weddings, anniversaries, funerals, relocation, enrolment or graduation leave, hospitalization or accident leaves.

STAFFING FORMULA
To compute for the staff need in the in-patient units of the hospital, the following steps are considered. Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care (whether minimal, intermediate, intensive or highly specialized).

STAFFING FORMULA
Example: 250(patients) x .30 = 75 patients needing minimal care 250(patients) x .45 = 112.5 patients needing moderate care 250(patients) x .15 = 37.5 patients needing intensive care 250(patients) x .10 = 25patients needing highly specialized care

STAFFING FORMULA
1. Find the total number of nursing care hours needed by the patients at each category level. 2. Find the number of patients at each level by the average number of nursing care hours (NCH) needed per day. 3. Get the sum of the nursing care hours needed at various levels. 4. Find the actual number of nursing care hours.

STAFFING FORMULA
Example:

75 patients 112.5patients 37.5patients 25patients

x 1.5 x3 x 4.5 x6

(Level I) = (Level II) = (Level III) = (Level IV) =

112.5 NCH/day 337.5 NCH/day 168.75NCH/day 150 NCH/day 768.75NCH/day

STAFFING FORMULA
Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year. Example: 768.75 x 365(days/year) = 280,593.75 NCH/year

STAFFING FORMULA
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. Example: 8(hrs/day) x 213(working days/year) = 1,704 (working hours /year)

STAFFING FORMULA
Find the total number of nursing personnel needed. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year. Total NCH per year = 280,593.75 = 165 Working hours/year 1,704 Note: Constant values: 0.15 for 40 hours per week ; 0.12 for 48 hours per week Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week). Relief x Total Nsg Personnel = 165 x 0.15 =25 Add the number of relievers to the number of nursing personnel needed. Total Nursing Personnel needed: 165+25=190

STAFFING FORMULA
Categorize the nursing personnel into professionals to non professionals. Multiply the number of nursing personnel according to the ratio of professionals to non professionals. (65:35 ratio) Example: 190 x .65 = 124 professional nurses; 190 x .35= 66 nursing attendants

STAFFING FORMULA

Distribute by shifts. *Note: morning shift: 45% nursing personnel; afternoon shift- 37% nursing personnel; night shift-18% of nursing personnel Example: 124 nurses x .45 = 56 nurses in AM shift 124nurses x .37 = 46nurses in PM shift 124 nurses x .18 = 22 nurses on nightshift Total: 124 nurses

66NA 66NA 66NA

x .45 = 30NA in AM shift x .37 = 24 NA in PM shift x .18 = 12 NA in night shift Total: 66 NA

STAFFING FORMULA
It should be noted that computed nursing personnel are only for in-patients. Therefore, additional personnel should be hired for those in supervisory and administrative positions and for those in special units such as Operating Room, Delivery Room, Emergency Room, and OutPatient Department. A Head Nurse is provided for every nursing unit. Likewise, a Nursing Superior is provided 1.) to cover every shift in each clinical department or area specialty unit; 2.) for each geographical area in hospitals beyond 100 beds and; 3.) for each functional area such as Training, Research, Infection Control and Locality Management. Hospitals now are also wellness centers. Therefore, additional personnel are necessary for health education classes both at the in-patient and out-patient units.