staffing nursing management
TRANSCRIPT
STAFFING3RD MANAGEMENT FUNCTION
STAFFING
Process of determining and providing acceptable number of personnel to
produce desired level of care
PROFESSIONAL NON-PROFESSIONAL
STAFFING
INVOLVES:
A. SELECTION OF PERSONNEL
B. ASSIGNMENT SYSTEMS
C. DETERMINATION OF STAFFING SCHEDULES
SELECTION OF
PERSONNEL
SELECTION OF PERSONNEL
HRD : HUMAN RESOURCE DEPARTMENT INTERVIEW, HIRE, PERPERMANCE EVALUATION
RECRUITMENT▪ PROCESS OF ENLISTING PERSONNEL FOR EMPLOYMENT▪ PROCESS OF HIRING
ACTIVE RECRUITMENT ATTRACTION OF QUALIFIED APPLICANTS▪ RECOMMENDATIONS▪ ADVERTISEMENT▪ POSTERS▪ JOB FAIR▪ INTERNET
SELECTION OF PERSONNEL
SCREENING3 UNDERLYING PHILOSIPIES OF
SCREENING PROCESS○ 1. SCREEN OUT APPLICANTS WHO DO
NOT FIT THE COMPANY○ 2.MANAGER SHOULD TRY TO FIT THE JOB
TO PROMISING APPLICANT○ 3. FIT APPLICANT TO THE JOB
SELECTION OF PERSONNEL
RESUMESDEMOGRAPHIC INFORMATIONS
EDUCATIONAL BACKGROUND
WORK EXPERIENCES
○ DETERMINES APPLICANT’S MINIMAL HIRING REQUIRMENT
SELECTION OF PERSONNEL
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-DIRECTIVE INTERVIEW▪ APPLICANTS
NARRATES HIMSELF
GROUP INTERVIEW▪ SEVERAL APPLICANTS
ARE INTERVIEWED TOGETHER
BOARD INTERVIEW▪ SELECTED MEMBER
OF PERSONNEL INTERVIEW APPLICANT
STRUCTURE INTERVIEW▪ USES PRE-PREPARED
GUIDELINES FOR INTERVIEW
SELECTION OF PERSONNEL
TEST/EXAMINATIONSMEASURES:
○ CLERICAL & MECHANICAL APTITUDES KNOWLEDGESKILLS
○ GENERAL INTELLIGENCE○ MENTAL, PERCEPTUAL & PSYCHOMOTOR
ABILITIES
TYPES OF TEST APTITUDE TEST
MEASURES CAPACITY ON POTENTIAL ABILITY TO LEARN
PSYCHOMOTOR MEASURES STRENGTH AND COORDINATION
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’S CONDITION
DISADVANTAGESNURSE MAY NOT
HAVE SAME PATIENT THE NEXT DAY OF DUTY
FUNCTIONAL NURSING
HEAD NURSE/SENIOR NURSE
NURSING ASSISTANT
HOUSE KEEPING
TREATMENTMEDICATION
PATIENT
FUNCTIONAL NURSING
HIERARCHIAL STRUCTURE PREDOMINATES
IMPLEMENTS SCIENTIFIC MANAGEMENT
DIVIDES WORK TO BE DONEMEDICATION NURSETREATMENT NURSEBEDSIDE NURSE
FUNCTIONAL NURSING
ADVANTAGES DISADVANTAGES
WORK DONE FASTER
WORKERS WORKS FASTER
DEVELOPED SKILL IN CERTAIN PARTICULAR TASK
HOLISTIC CARE NOT ACHIEVED FRAGMENTATION OF NURSING CARE
NURSE-PATIENT RELATIONSHIP IS NOT FULLY DEVELOPED
EVALUATION OF NURSING CARE IS POOR
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 & REVISION OF NCP
NURSING CARE PLAN
TEAM NURSINGCHARGE NURSE
TEAM LEADER
NURSING STAFF
PATINTS/CLIENTS
TEAM NURSING
ADVANTAGES DISADVANTAGES
WORK SHARED WITH OTHERS
UNPERSONALIZED, FRAGMENTED PATIENT CARE
COMPLEX COMMUNICATION
ACCOUNTABILITY AND RESPONSIBILTY SHARED WITH OTHERS CAUSE CONFUSION
PRIMARY NURSING RN GIVES TOTAL CARE TO 4- 6 PATIENTS
WHILE ON DUTY
PRIMARY NURSE RESPONSIBLE FOR THE CARE OF THE PATIENT
x 24 HOURS THROUGH OUT HOSPITALIZATION
ASSOCIATE NURSE CARE FOR THE PATIENTS USING THE CARE
PLAN DEVELOPED BY THE PN WHEN PN IS OFF DUTY
PRIMARY NURSING
PHYSICIAN HEAD NURSEHOSP. & COMM.
RESOURCES
PRIMARY NURSEPATIENT
SRCONDARY NURSE
PM
SECONDARY ASST. NURSENIGHT
SECONDARY ASST. NURSE
RELIEVER
PRIMARY NURSING
ADVANTAGES DISADVANTAGES
DEVELOPED TRUSTING RELATIONSHIP BETWEEN RN & PATIENT AND FAMILY
DEFINED ACCOUNTABILITY & RESPONSIBILITY
HOLISTIC/CONTINUITY OF CARE
HIGH COST HIGHER RN SKILL
PROXIMITY OF PATIENT ASSIGMENT
OVERLAPPING OF STAFF FUNCTION
MODULAR OR DISTRICT NURSING 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 ON
TECHNICAL ASPECTS OF CARE
MODULAR NURSING
ADVANTAGES
INCREASED CONTINUITY AND QUALITY OF CARE
MORE TIME SPENT IN DELIVERY OF CARE
MANAGED CARE UNIT-BASED CARE SYSTEM
USES STANDARD CRITICAL PATH WITH NCP
CRITICAL PATH METHOD – CPM CALCULATE A SINGLE TIME ESTIMATE FOR
EACH ACTIVITY, THE LONGEST POSSIBLE TIME COST ESTIMATE FIGURED FOR BOTH NORMAL
& CRASH OPERATING PROCEDURE▪ NORMAL THE LEST COST METHOD▪ CRASH CONDITION IN LESS THAN NORMAL
TIME
CASE MANAGEMENT
2ND GENERATION PRIMARY NURSING
FOCUSES ON ENTIRE EPISODE OF ILLNESS
CARE IS COORDINATED BY A CASE MANAGER
CASE MANAGEMENT
INVOLVES: CRITICAL PATH S
▪ VISUALIZE OUTCOMES WITHIN A TIME FRAME
VARIATION ANALYSIS▪ NOTES POSITIVE OR NEGATIVE CHANGES
FROM CRITICAL PATH▪ CAUSE & CORRECTIVE ACTION TAKEN
INTERSHIFT REPORTS
CASE MANAGEMENTCASE CONSULTATION
○ INDICATED WHEN CLIENT’S CONDITION DIFFERS FROM CRITICAL PATH AS NOTED IN THE INTERSHIFT REPORT
HEALTH CARE TEAM MEETING ○ PROVIDE INTERDISCIPLINARY APPROACH
TO PROBLEM SOLVING
COLLABORATIVE PRACTICE INCLUDE
INTERDISCIPLINARY TEAMS
NURSE-PHYSICIAN INTERACTION IN JOINT PRACTICE
NURSE-PHYSICIAN COLLABORATION IN CARE GIVING
STAFFING SCHEDULE
S
SCHEDULE
TIMETABLE SHOWING PLANNED WORK DAYS AND SHIFT
SCHEDULINGASSIGNING WORK AND OFF DAYS TO
NURSING PERSONNEL TO ASSURE ADEQUATE PATIENT CARE
STAFFING SCHEDULES CENTRALIZED
SCHEDULING
DECENTEALIZED STAFFING
SELF SCHEDULINGCOORDINATED BY
NURSES AND OTHER STAFFCLLECTIVELY DEVELOP AND IMPLEMENT WORK SCHEDULE, TAKING POLICIES AND VARIABLES AFFECTING STAFFING INTO CONSIDERATION
STAFFING SCHEDULES ROTATING
WORKSHIFT DAY OR AM SHIFT EVENING SHIFT NIGHT SHIFT
PERMANENT SHIFT
BLOCK OR CYCLICAL USES SAME SCHEDULE
REPEATEDLY REPEATED EVERY 6
WEEKS
VARIABLE STAFFING USES PATIENT NEEDS
TO DETERMINE THE NUMBER AND MIX OF STAFF
TIME MEASURES DONE FOR DIRECT AND INDIRECT PATIENT CARE
EIGHT HOUR SHIFT, 5 DAY WORK WEEK
STAFFING SCHEDULES TEN HOUR DAY, FOUR
DAY WORK WEEK
TEN HOUR SHIFT, SEVEN-DAY WORKWEEK 7-70 PLAN 10 HOUR SHIFT 7 DAYS
A WEEK, FOLLOWED BY 7 CONSECUTIVE DAYS OFF
TWO TEAKS ALTERNATE WEEKS
NO ROTATION OF SHIFT
TWELVE HOUR SHIFT, SEVEN DAY WORKWEEK
BAYLOR PLAN INTRODUCED IN BAYLOR
UNIVERSITY MEDICAL CENTER IN DALLAS, TEXAS▪ USES 2 DAYS
ALTERNATIVE PLAN▪ NURSES OPTION FOR
WORK▪ TWO 12 HOUR DAYS ON
THE WEEKENDS TO BE PAID FOR 36 HOURS FOR DAY
SHIFT 40 HOURS FOR NIGHT
SHIFT▪ FIVE 8 HOUR SHIFT
PATIENT CLASSIFICATION SYSTEM
************************ PURPOSES
QUANTIFY THE QUALITY OF NURSING CARE BY MATCHING PATIENTS’ NEEDS TO NUMBER AND KIND OF NURSING PERSONNEL USING TIME AS THE UNIT OF MEASURE
FOR STAFFING PROGRAM COSTING
AND FORMULATING BUDGET
TRACK CHANGES IN PATIENT CARE METHODS
DETERMINE VALUES FOR PRODUCTIVITY EQUATION
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 CARE PROCEDURES NEEDED BY PATIEN /CATEGORY
TIME NEEDED TO PERFORM THE PROCEDURES
PATIENT CARE CLASSIFICATION SYSTEM
LEVELS OF CARE NCH NEEDED /DAY RATIO OF PROF. TO NON-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
6.07 or higher
70:3080:20
PATIENT CARE CLASSIFICATION SYSTEM LEVEL I: Minimal Care or Self care
Can take a bath on his ownPerform ADL on his ownPatient about to be dischargeNon-emergency casesDo not exhibit unusual symptomsRequires little treatment
PATIENT CARE CLASSIFICATION SYSTEM LEVEL II: Intermediate or Moderate Care
Needs assistance in bathing, feeding or ambulating for short periods of time
Extreme symptoms have subsided or yet to appear
Have slight emotional needs With IVF or BT Semi-conscious Have some psychosocial or social problem Periodic treatment, observation
PATIENT CARE CLASSIFICATION SYSTEM 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 VARIOUS LEVEL OF CARE/TYPE OF HOSPITAL
TYPE OF HOSPITAL
MINIMAL CARE
MODERATE CARE
INTENSIVE CARE
HIGHLY SPECIALIZED CARE
PRIMARY 70 25 5 -
SECONDARY
65 30 5 -
TERTIARY 30 45 15 10
SPECIAL TERTIARY
10 25 45 20
COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED Ensure that there is sufficient staff to:
Cover all shiftsOff dutiesHolidaysLeavesAbsencesTime 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/WEEK WITH 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 MEMORANDUM
CIRCULAR NO. 6 SERIES OF 1966 GOVERNMENT EMPLOYEES ARE GRANTED
3 DAYS WHICH MAY BE SPENT FOR: BIRTHDAY WEDDINGS ANNIVERSARIES FUNERAL RELOCATION ENROLLMENT/GRADUATION LEAVE HOSPITALIZATION ACCIDENT LEAVE
RIGHTS AND PRIVELEGES OF PERSONNEL/YEAR
48 WORKING HOURS /WEEK
40 WORKING HOUR/ WEEK
1. Vacation Leave2. Sick leave3. Legal holidays4. Special holidays5. Special privileges6. Off duties/ RA 59107. Continuing
Education Program
15151023
1043
15151023
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 patients according 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 minimal care – L1▪ 250 patients x .45 = 112.5 patient needing moderate care
– L2▪ 250 patients x .15 = 37.5 patients need intensive care – L3▪ 250 patients x .01 = 25 patients needed highly specialized
nursing care – L4
Staffing formula
2. Find the # of NCH needed by patients at each level of 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 rendered by each nursing personnel per year 8 hours x 213 working day/year = 1,704
working 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 hours a
week)
Add no. of relievers to no. of nursing personnel needed▪ 165 + 25 = 190 nursing care personnel needed
STAFFING FORMULA6. Categorize as to professional and non-professional
personnel Ratio of professional to non-professional in tertiary hospital
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/ 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