staffing nursing management report

7/30/2019 Staffing Nursing Management Report

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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



Purpose

The purpose of all staffing activities is toprovide each nursing unit with anappropriate and acceptable number of workers in each category to perform thenursing tasks required. Too few or animproper mixture of nursing personnel willadversely affect the quality and quantity of work performed. Such situation can lead to

high rates of absenteeism and staffs turn-over resulting in low morale anddissatisfaction.



Factors Affecting Staffing

the type, philosophy, objectives of thehospital and the nursing service.

the population served or kind of patients

served whether pay or charity. the number of patients and severity of

their illness-knowledge and ability of

nursing personnel are matched with the

actual care needs of patients



availability and characteristics of thenursing staff, including education, level of preparation, mix of personnel, number and

position. administrative policies such as rotation,

weekends, and holiday off-duties.

standards of care desired which should be

available and clearly spelled out. layout of various nursing units and

resources available within the departmentsuch as adequate equipment, supplies,and materials

budget including the amount allotted tosalaries, fringe benefits, supplies, materialsand equipment



professional activities and priorities in non-patient activities like involvement Iprofessional organizations, formal

educational development, participation inresearch and staff development.

teaching program or the extent of staff involvement in teaching activities.

expected hours of work per annum of eachemployee. This is influenced by 40 hour week law.

patterns of work schedule-traditional 5

days per week, 8 hours per day; 4 days aweek, ten hours per day and three days off;or 3 ½ days of 12 hours per day and 3 ½days off per week.



STAFFING

INVOLVES:

A. SELECTION OF PERSONNEL

B. ASSIGNMENT SYSTEMS

C. DETERMINATION OF STAFFINGSCHEDULES



SELECTION

OF

PER NNEL



HRD : HUMAN RESOURCE DEPARTMENT INTERVIEW, HIRE

RECRUITMENT▪ PROCESS OF ENLISTING PERSONNEL FOR

EMPLOYMENT▪ PROCESS OF HIRING

ACTIVE RECRUITMENT ATTRACTION OFQUALIFIED APPLICANTS▪ RECOMMENDATIONS

▪ ADVERTISEMENT▪ POSTERS

▪ JOB FAIR

▪ INTERNET



SELECTION OF PERSONNEL

1. SCREENING

3 UNDERLYING PHILOSIPIES OF

SCREENING PROCESS

○ 1. SCREEN OUT APPLICANTS WHO DONOT FIT THE COMPANY

○ 2.MANAGER SHOULD TRY TO FIT THE JOB

TO PROMISING APPLICANT

○ 3. FIT APPLICANT TO THE JOB



SELECTION OF

PERSONNEL2. RESUMES

DEMOGRAPHIC INFORMATIONS

EDUCATIONAL BACKGROUND

WORK EXPERIENCES

○ DETERMINES APPLICANT’S MINIMAL

HIRING REQUIRMENT



SELECTION OF

PERSONNEL3. INTERVIEW

○ FACE TO FACE CONTACT BETWEEN

APPLICANTS AND PERSON IN AUTHORITY

TO FILL IN THE POSITION PRE-EMPLOYMENT INTERVIEW

○ PURPOSES: TO

○ 1. OBTAIN INFORMATION

○ 2. GIVE INFORMATION

○ 3. DETERMINE IF APPLICANT MEETTHE

REQUIRMENT FOR THE POSITION



SELECTION OF

PERSONNEL TYPES OF INTERVIEW

DIRECTIVE INTERVIEW▪ USE CLOSE ENDED

QUESTIONS

NON-DIRECTIVEINTERVIEW▪ APPLICANTS

NARRATES HIMSELF

GROUP INTERVIEW▪ SEVERAL APPLICANTS

ARE INTERVIEWEDTOGETHER

BOARD INTERVIEW▪ SELECTED MEMBEROF PERSONNELINTERVIEW APPLICANT

STRUCTURE

INTERVIEW▪ USES PRE-PREPARED

GUIDELINES FORINTERVIEW



SELECTION OF

PERSONNEL4. TEST/EXAMINATIONS

MEASURES:

○ CLERICAL & MECHANICAL APTITUDES

KNOWLEDGE SKILLS

○ GENERAL INTELLIGENCE

○ MENTAL, PERCEPTUAL & PSYCHOMOTOR

ABILITIES



TYPES OF TEST

APTITUDE TEST MEASURES CAPACITY ON POTENTIAL

ABILITY TO LEARN PSYCHOMOTOR

MEASURES STRENGTH ANDCOORDINATION PROFICIENCY MEASURES HOW WELL AN APPILCANT CAN

DO SIMPLE WORK

PSYCHOLOGICAL MEASURES PERSONALITY

CHARACTERISTICS



ASSIGNMENT

SYSTEM

FOR STAFFING



CASE METHOD

PATIENT ASSIGNED TO A NURSE

FOR TOTAL PATIENT CARE

1:1 NURSE/PATIENT RATIO



TOTAL CARE/ CASE NURSING

HEAD NURSE

STAFF NURSE

PATIENT



CASE METHOD

ADVANTAGES

CONSISTENCY OF

CARE FOR 1

WHOLE SHIFT

MORE

OPPORTUNITY TO

OBSERVE AND

MONITOR

PATIENT’SCONDITION

DISADVANTAGES

NURSE MAY NOT

HAVE SAME

PATIENT THE NEXT

DAY OF DUTY



FUNCTIONAL NURSING

HEAD NURSE/SENIOR NURSE

NURSING

ASSISTANTHOUSE

KEEPINGTREATMENTMEDICATION

PATIENT



FUNCTIONAL NURSING

HIERARCHIAL STRUCTUREPREDOMINATES

IMPLEMENTS SCIENTIFICMANAGEMENT

DIVIDES WORK TO BE DONE

MEDICATION NURSE TREATMENT NURSE

BEDSIDE NURSE



TEAM NURSING

INTRODUCED IN 1950s DUE TO

SCARCITY OF RN’S AFTER WW II

BASED ON PHILOSOPHY OF GROUP

ACTION TO ACHIEVE GOAL

FEATURES:

NURSING CARE CONFERENCE

○ PURPOSE: DEVELOPMENT & REVISIONOF NCP

NURSING CARE PLAN



TEAM NURSING

CHARGE NURSE

TEAM LEADER

NURSING STAFF

PATIENTS/CLIENTS



TEAM NURSING

ADVANTAGES DISADVANTAGES

WORK SHARED WITHOTHERS

UNPERSONALIZED,FRAGMENTED

PATIENT CARE

COMPLEX

COMMUNICATION ACCOUNTABILITY AND

RESPONSIBILTY

SHARED WITH

OTHERS

CAUSECONFUSION



PRIMARY NURSING

RN GIVES TOTAL CARE TO 4- 6PATIENTS WHILE ON DUTY

PRIMARY NURSE RESPONSIBLE FOR THE CARE OF THE

PATIENT x 24 HOURS THROUGH OUTHOSPITALIZATION

ASSOCIATE NURSE CARE FOR THE PATIENTS USING THE CARE

PLAN DEVELOPED BY THE PN WHEN PNIS OFF DUTY



PRIMARY NURSING

PHYSICIAN HEAD NURSEHOSP. & COMM.

RESOURCES

PRIMARY NURSE

PATIENT

SRCONDARY

NURSE

PM

SECONDARY ASST.

NURSE

NIGHT

SECONDARY

ASST. NURSE

RELIEVER



PRIMARY NURSING

ADVANTAGES DISADVANTAGES

DEVELOPED TRUSTINGRELATIONSHIP

BETWEEN RN & PATIENT

AND FAMILY

DEFINED

ACCOUNTABILITY &

RESPONSIBILITY

HOLISTIC/CONTINUITYOF CARE

HIGH COST HIGHERRN SKILL

PROXIMITY OF

PATIENT ASSIGMENT

OVERLAPPING OF

STAFF FUNCTION



MODULAR OR DISTRICTNURSING MODIFICATION OF TEAM & PRIMARY

NURSING DIVIDES AREA INTO MODULE/GROUP OF

PATIENT

EACH MODULE CARED BY A TEAM NURSE

A KIND OF TEAM NURSING RN PLAN THE CARE

DELIVER CARE

DIRECTS PARAPROFESSIONALS ONTECHNICAL ASPECTS OF CARE



MODULAR NURSING

ADVANTAGES

INCREASED CONTINUITY AND QUALITY

OF CARE

MORE TIME SPENT IN DELIVERY OF

CARE



STAFFINGSCHEDULES



SCHEDULE

TIMETABLE SHOWING PLANNED

WORK DAYS AND SHIFT

SCHEDULING

ASSIGNING WORK AND OFF DAYS TO

NURSING PERSONNEL TO ASSURE

ADEQUATE PATIENT CARE



STAFFING SCHEDULES

CENTRALIZEDSCHEDULING

DECENTEALIZEDSTAFFING

SELFSCHEDULING COORDINATED BY

NURSES AND

OTHERSTAFFCLLECTIVELYDEVELOP ANDIMPLEMENT WORKSCHEDULE, TAKINGPOLICIES ANDVARIABLES AFFECTINGSTAFFING INTOCONSIDERATION



STAFFING SCHEDULES

ROTATINGWORKSHIFT DAY OR AM SHIFT

EVENING SHIFT

NIGHT SHIFT

PERMANENT SHIFT

BLOCK ORCYCLICAL

USES SAMESCHEDULEREPEATEDLY

REPEATED EVERY 6WEEKS

VARIABLE STAFFING USES PATIENT

NEEDS TODETERMINE THENUMBER AND MIX OFSTAFF

TIME MEASURESDONE FOR DIRECT

AND INDIRECTPATIENT CARE

EIGHT HOUR SHIFT,5 DAY WORK WEEK



STAFFING SCHEDULES

TEN HOUR DAY, FOURDAY WORK WEEK

TEN HOUR SHIFT,SEVEN-DAYWORKWEEK

7-70 PLAN 10 HOUR SHIFT 7 DAYS A

WEEK, FOLLOWED BY 7CONSECUTIVE DAYS OFF

TWO TEAKS ALTERNATEWEEKS

NO ROTATION OF SHIFT

TWELVE HOUR SHIFT,SEVEN DAYWORKWEEK

BAYLOR PLAN INTRODUCED IN BAYLOR

UNIVERSITY MEDICAL

CENTER IN DALLAS,TEXAS▪ USES 2 DAYS

ALTERNATIVE PLAN

▪ NURSES OPTION FORWORK▪ TWO 12 HOUR DAYS ON

THE WEEKENDS TO BE

PAID FOR 36 HOURS FOR

DAY SHIFT

40 HOURS FOR NIGHTSHIFT

▪ FIVE 8 HOUR SHIFT



PATIENT CLASSIFICATIONSYSTEM

************************ PURPOSES

QUANTIFY THEQUALITY OF NURSING

CARE BY MATCHING

PATIENTS’ NEEDS TO

NUMBER AND KIND OFNURSING PERSONNEL

USING TIME AS THE

UNIT OF MEASURE

FOR STAFFING PROGRAM COSTING

AND FORMULATINGBUDGET

TRACK CHANGES IN

PATIENT CAREMETHODS

DETERMINE VALUESFOR PRODUCTIVITYEQUATION

DETERMINE QUALITY



PATIENT CLASSIFICATION

SYSTEM NURSE MANAGER MUST DETERMINE

THE FOLLOWING NUMBER OF CATEGORIES IN WHICH

PATIENT SHOULD BE DIVIDED

CHARACTERISTIC OF PATIENTS/CATEGORY

TYPE AND NUMBER OF CAREPROCEDURES NEEDED BY PATIEN

/CATEGORY

TIME NEEDED TO PERFORM THEPROCEDURES



PATIENT CARE

CLASSIFICATION SYSTEM

LEVELS OF CARE NCH NEEDED /DAY RATIO OF PROF. TONON-PROFESSIONALS

LEVEL I - SELF CARE

OR MINIMAL CARE

1.5 55:45

LEVEL II – MODERATE

OR INTERMEDIATE

3.0 60:40

LEVEL III – TOTAL OR

INTENSIVE CARE

4.5 65:35

KLEVEL IV – HIGHLY

SPECIALIZED OR

CRITICAL CARE

6.0

7 or higher

70:30

80:20



PATIENT CARE


LEVEL I: Minimal Care or Self care

Can take a bath on his own

Perform ADL on his own

Patient about to be discharge

Non-emergency cases

Do not exhibit unusual symptoms

Requires little treatment



PATIENT CARE


LEVEL II: Intermediate or Moderate Care

Needs assistance in bathing, feeding or

ambulating for short periods of time

Extreme symptoms have subsided or yet toappear

Have slight emotional needs

With IVF or BT

Semi-conscious Have some psychosocial or social problem

Periodic treatment, observation



PATIENT CARE


LEVEL III: Intensive, Total, Complete Care

Completely dependent on nursing personnel

On continuous O2 therapy

With chest or abdominal tubes Requires close observations

LEVEL IV: Highly Specialized Critical Care

Needs continuous treatment & observations

VS q 15 minutes

Hourly I & O

Significant changes in Doctor’s order



PERCENTAGE OF PATIENT AT VARIOUSLEVEL OF CARE/TYPE OF HOSPITAL

TYPE OFHOSPITAL

MINIMALCARE

MODERATECARE

INTENSIVECARE

HIGHLYSPECIALIZED CARE

PRIMARY 70 25 5 -

SECONDAR

Y

65 30 5 -

TERTIARY 30 45 15 10

SPECIAL

TERTIARY

10 25 45 20



COMPUTING FOR NUMBER OFNURSING PERSONNEL NEEDED

Ensure that there is sufficient staff to:

Cover all shifts

Off duties

Holidays

Leaves

Absences

Time for staff development



COMPUTING FOR NUMBER OF

NURSING PERSONNEL NEEDED

RA 5901: Forty-Hour Week Law EMPLOYEES WILL WORK 40 HOURS/WEEK

FOR:

▪ Hospitals with 100 bed capacity or more▪ Community population with at least 1 million

population

However;

ANURSE WILL RENDER 48 HOURS/WEEKWITH ONLY I DAY OOF DUTY A WEEK IF

▪ Hospitals with less than 1oo bed capacity

▪ Communities with less than 1 million population



STAFFING

CIVIL SERVICE COMMISSION MEMORANDUMCIRCULAR NO. 6 SERIES OF 1966

GOVERNMENT EMPLOYEES ARE GRANTED 3DAYS WHICH MAY BE SPENT FOR: BIRTHDAY

WEDDINGS ANNIVERSARIES

FUNERAL

RELOCATION

ENROLLMENT/GRADUATION LEAVE

HOSPITALIZATION

ACCIDENT LEAVE



RIGHTS ANDPRIVELEGES OF

PERSONNEL/YEAR

48 WORKINGHOURS /WEEK

40 WORKING HOUR/WEEK

1. Vacation Leave

2. Sick leave

3. Legal holidays

4. Special holidays

5. Special privileges

6. Off duties/ RA 59107. Continuing

Education Program

15

15

10

2

3

1043

15

15

10

2

3

523

Total Non-working

days/year

Total Working

days/year

Total Working

hours/year

152

213

1,704

100

265

2,12o



STAFFING FORMULA

1. Categorize the number of patientsaccording to the levels of care needed. Multiply total # of patient by % of patient at

each Level of Care

Ex. Find the # of Nursing Personnel needed for 250 bed capacity in a tertiary hospital

▪ 250 patients x .30 = 75 patients needing minimalcare – L1

▪ 250 patients x .45 = 112.5 patient needingmoderate care – L2

▪ 250 patients x .15 = 37.5 patients need intensivecare – L3

▪ 250 patients x .01 = 25 patients needed highlyspecialized nursing care – L4



Staffing formula

2. Find the # of NCH needed by patients at each levelof care /day▪ A. find the number of patients at each level by the

average number of NCH needed/day

▪ B. get the sum of NCH needed at various level

75 patients x 1.5 NCH needed at Level I = 112.5 112.5 patients x 3 NCH needed at Level II = 337.5

37.5 patients x 4.5 NCH needed at level III= 168.75

25 patients x 6 NCH needed at Level IV = 150

_______

total 768.75

NCH/day



STAFFING FORMULA

3. Find the total NCH needed by given no.of patient or bed capacity/ year total NCH needed/day x total number of

days in a year

768.75 x 365 days/year = 280,593.75 NCH/year

4. Find the actual working hours renderedby each nursing personnel per year

8 hours x 213 working day/year = 1,704working hours/year



STAFFING FORMULA

5. Find the total # of nursing personnel needed Total NCH /year = 280,593.75 = 165 TNP

working hrs/year 1,704

Find the number of reliever ▪ Total Nsg. Personnel x 0.15 (For those working 40

hours a week) = 165 x 0.15 = 25

▪ total Nsg. Personnel x 0.12 (For those working 48 hoursa week)

Add no. of relievers to no. of nursing personnelneeded

▪ 165 + 25 = 190 nursing care personnel needed



STAFFING FORMULA

6. Categorize as to professional and non-professional personnel

Ratio of professional to non-professional in tertiaryhospital is 65:35

▪ 190 x .65 = 124 professional nurses

▪ 190 x .35 = 66 nursing attendants

7. Distribute by shift 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



STAFFING FORMULA

7. Distribute nursing attendants/ shift

66 nursing attendant x .45 = 30 nsg.

Attendant AM shift

66 nursing attendant x .37 = 24 nsg. Attendant PM shift

66 nursing attendant x .18 = 12 nsg.

attendant

NCH/ ti t / d di



NCH/ patient / day : according

to classification/unit

The Hospital Nursing Service

Administration Manual of DOH has

recommended the following NCH for

patients in various nursing units of hospitals



-------------------------------------

-----CASES NCH/PT/DAY PROF TO NONPROF

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. PATHOLIGIC

NURSERY

2.8 55:45

7. ER/ICU/RR 6.0 70:30

8. CCU 6.0 80:20

staffing nursing management report

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