Staffing & Patient Staffing & Patient Classification Classification Systems (PCS)Systems (PCS)

St. Names : St. Names : Hamed Hamed HantouliHantouli Omar MajdobiOmar Majdobi Ahmad IkhleefAhmad Ikhleef Ala’a OmarAla’a Omar Mo’men Al-Mo’men Al-KhateebKhateeb

InstructorInstructor : : Samah Samah IshtayaIshtaya

28 – 10 - 2013 Monday 28 – 10 - 2013 Monday

Out Line :• Introduction.

• Definitions of staffing

• Purpose, Objectives, & Variables affect staffing

• Staffing plan

• System approach of staffing & Components of nursing workload

• Definitions of Patients classification & Patients classification systems.

• Purpose & Desirable characteristics of Patients classification systems.

• Elements & Types of Patients classification systems.

• Uses of Patients classification systems.

IntroductionIntroduction

Nurse staffing methodology Nurse staffing methodology should be an orderly, systematic process, based upon sound rational, applied to determine the number and kind of nursing personnel required to provide nursing care of a predetermined standard to a group of patients in a particular setting. The end result is prediction of the kind and number of staff required to give care to patients.

A patient classification System A patient classification System provides a method of quantitatively estimating and assessing ‘patients needs relation to nursing care. It is a way of determining the amount and type of care a patient requires as well as providing a means standardizing nursing care practice.

 

Definitions Of StaffingDefinitions Of Staffing

Staffing refers to the number and composition of personnel assigned to work in a unit at a given time. Staffing is the end result in prediction of the kind and number of staff required to give care to patient.

Staffing Mix is the ratio of RNs to other personnel ( agencies vary on their staffing mix policies).e.g., a shift on one unit might have 40% RNs, 40% LPNs, and 20% all others.

PurposePurpose, , ObjectivesObjectives, & , & Variables Variables affect staffingaffect staffing

The Purpose of staffing: is to provide the appropriate numbers and mix of nursing staff (nursing care hours) to match actual or projected patient care needs (patient care hours) that will lead to the delivery of effective and efficient nursing care.

Staffing objectives:Staffing objectives:

1. Provide an -all professional -nurse staff in critical care units, operating rooms, labor and delivery unit, and emergency room.

2. Provide sufficient staff to permit 1 :1 nurse-patient ratio for each shift in every critical care unit.

3. Staff general medical-surgical, obstetric ,pediatric, and psychiatric units to achieve a 2 :1 professional nurse practical nurse ratio.

4. Provide sufficient nursing staffing in general medical -surgical, obstetric, pediatric, and psychiatric units to permit a 1: 5 1: 5 nurse—patient ratio on day and afternoon shifts and 1 :10 1 :10 nurse—patient ration night shift .

5. Involve the vice-president of nursing, divisional nursing directors, one representative from the head nurse to staff nurse, and practical nurse groups in designing the department’s overall staffing program.

Workload Budgets: Indicate the amount of work produce by a unit in terms of units of services, which are used to calculate expense budget.

Average daily census is the average number of patients cared for day for a period of time.

Average length of stay is the average number of days that patients stay in the agency.

Care hours calculation determined the average required care hours per patient per 24 hours for each classification level and the sum or the total hours of care needed for all patients.

Variables Affect StaffingVariables Affect Staffing

Staffing Plan:Staffing Plan:

Planning for staffing should be Planning for staffing should be considering the following:considering the following:

1.Changing concepts of nursing roles for clinical nursing practitioners and specialists.

2.Patient populations that are changing as birth rates decline and longevity increases.

3.Institutional missions and objectives related to research, training, and many specialties.

4.Personnel policies and practices.

5.Policies and practices related to admission and discharge times of patients, assignment of patients to units, and intensive and progressive care practices.

6. The degree to which other departments carry out their supporting services (to perform non nursing duties such as dietary functions, clerical work, messenger and escort activities, and housekeeping).

6. The number and composition of the medical staff and the medical services offered.

7. Data to be analyzed will include number of admissions, discharges, and transfers; amount of supervision needed for assistive personnel; patient teaching; emergency responses; mode of care delivery; and staff mix.

Components of nursing workloadComponents of nursing workload

• Number of patients admitted per day, month, year.

• Number of patients with each medical diagnosis.

• Number of patients with each nursing diagnosis.

• Level of disease severity for each patient.

• Intensity of nursing needed by each type of patient.

• Average length of stay for each type of patient.

• Number of nursing measures of each type of patient.

• Average time required for each nursing measure.

Patient classification is defined as “the categorization or grouping of patients according to an assessment of their nursing care requirements over a specified period of time.

Patient classification system is a means of categorizing present patients according to care needs that a nurse can clinically observe.

Purposes of Patients Purposes of Patients Classification Systems (PCSs)Classification Systems (PCSs)

1. Staffing: The system will establish a unit of measure for nursing time. This unit of measure will be used to determine both the numbers and kinds of staff needed. Perceived patient needs can be matched with available nursing resources.

2. Program cost and formulation of the nursing budget: A prescribed unit of time will be used to determine the actual cost of nursing service.

3. Tracking changes in patient-care needs: A PCS gives nurse mangers the ability to moderate and control delivery of care services, adjusting intensity and cost.

4. Determining values for the productivity equation: which is output divides by Input. In the prospective payment system (PPS), this output measure has been the discharged patient.

5. Determining quality: Once a standard time element is established staffing is adjusted to meet the aggregate times. A nurse manger can elect to staff below the standard time to reduce costs.

Purposes of Patients Purposes of Patients Classification Systems (PCSs)Classification Systems (PCSs)

Desirable characteristics of Patients classification systemsDesirable characteristics of Patients classification systems

1. Measure and quantify care to develop a management engineering standard.

2. Match nursing resources to patient-Care requirements.

3. Relate item 3 to time and effort spent on the associated activity.

4. Be economical and convenient to report and use.

5. Be open to audit.

Elements of Patients Elements of Patients classification systemsclassification systems

1. An objective method to validate the amount of care given to each category or type of patient on each unit and shift.

2. An objective method to predict nursing care requirements for individual patients.

3. An Objective method to evaluated the patterns of care delivered by each unit, shift, and staff level.

4. A mechanism to revalidate on a periodic basis the amount of care by patient category of care delivery.

Types (methods) of Patients Types (methods) of Patients classification systems:classification systems:

There are two types of PCSs evolved; prototype evaluation and factor evaluation. Both types of PCSs are developed from critical indicators.

A critical indicator is a specific task that is commonly needed for the clients on that unit. Indicators vary, some depending upon the type of unit and some on the type of patient being treated.

I -Prototype Evaluation

•A prototype evaluation PCS is a way to rate clients simultaneously in several related aspects of their nursing care.

•These rating systems are usually easy to implement and do not require extensive training to be understood.

•Once the clients on a unit are rated and classified, the information can be used to determine the number of nurses needed to care for the group of the clients.

II. Factor Evaluation

•A factor evaluation method rates the client separately on various critical indicators instead of simultaneously.

•Each category of client needs (i.e., assessment, mobility, hygiene, etc.) is given a separate score.

•A total overall rating or score is then computed.

•This method is more time consuming to complete, It is less ambiguous and more objective than the prototype evaluation method.

•The numerical values assigned to each section of the acuity tool can then be summed and utilized in one of two methodologies: in checklist format or as relative value units (RVUs). Studies have determined that client can be categorized into classed based upon the following point system:

• - Class I, 0-10 total points - Class II, 11-25 total points.• - Class III, 26-40 total points - Class IV, 41 total points or more

Patient classification categories

•Category 1: Self-care

•Category 2: Minimal care

•Category 3: Moderate care

•Category 4: Extensive care

•Category 5: Require one-to-one observation or continuous monitoring each shift.

Uses of Patients classification systems

Determine staffing

Because clients have higher acuity ratings while they are hospitalized. The hours of nursing care necessary to meet the clients needs have also increased.

Generally, facilities within a local area tend to maintain similar nurse to patient ratios, so community standards are, fairly uniform.

To identify the necessary number of staff for a 24-hour period, staffing ratios for nursing care have traditionally been determined by following formula: HPPD x Number of patients = Hours of staff assigned/24hours

where HPPD is the hours per patient day, or the average amount of time spent providing nursing care to each patient per day; the number of patients is the number on the unit at given point in time (usually at midnight), and the hours of staff is the hours available for the 24-hour.

The number of staff is calculated by dividing the hours of staff assigned in 24 hours by the length of the shift. Based upon the hypothetical time and motion study conducted for 1 year on the unit, it has been determined that the following average times per class are reasonable.

• Class 1= 2 hours of nursing care/24-hour shift

• Class 11= 3 hours of nursing care/24 hour shift.

• Class III = 4.5 hours of nursing care/24 hour shift.

• Class IV = 6 hours of nursing care/24 hour shift.

Determine Nursing Care HoursDetermine Nursing Care Hours

NCHs: patient workload trends are analyzed for each day of the week (each hour in critical care) or for a specific patient diagnosis to determine staffing needs.

E.g. if 26 patient with the following acuities required 161 nursing care hours, then an average of 6.19 nursing hours per patient per day (NHPPD) are required. NHPPD are calculated by dividing dividing the total nursing care hours by the total the total nursing care hours by the total census (number of patients).census (number of patients).

Number of patients

Acuity Level

Associated Hours of

Care

Total Hours of

Care

3 1 2 6

10 2 3 30

11 3 4.5 49.5

2 4 6 12

Total 26 97.597.5

There are no specific standards for nursing care hours (NCHs) for any of patient or patient care unit.

NCHs may vary on the average from 5 to 7 5 to 7 hours of care for patient on medical and/ or surgical unit, to 10 to 24 10 to 24 hours of care for selected patient, such as new, severely burned patient.

Determining Full Time EquivalentDetermining Full Time Equivalent

• FTEs equals 40 hours of work per week for 52 weeks, or 2080 hours per year.

• For computational purposes, one FTE can be filled by one person or a commination of staff with comparable expertise. For example, one nurse may work 24 hours per week, and tow other nurses may each work 8 hours per week. Together, the three nurses fill one FTE (24+8+8=40).

• Several methods are available for determining the number of FTEs required to staff a unit 24 hours a day, 7 days a week.

• One technique incorporates information regarding the hours of work for the staff for 2 weeks, average daily census, and hours of care.

• The average daily census can be determined by dividing the total patient days (obtained from daily census counts for the year) by the number of days in the year.

Example

• One person working full time usually works 80 hours (ten 8 hour shift) in 2 week period.

• However, to staff an 8-hour shift takes 1.4 FTES, One person working tenten 8-hour shift (100% FTE) and another person working fourfour 8-hour shifts (40% FTE) in order to provide for the full time persons 2 days off every week.

Determining Staffing Mix

The same data used to determine FTEs are used to identify staffing mix.

For example, for patient care need involving general hygiene care, feeding, transferring, or turning patient, licensed practical nurses (LPNs) or unlicensed assistive personnel (UAPs) can be used.

• For patient care needs involving frequent assessments, patient education, or discharge planning, RNs will be needed because of the skills required.

• A high RN skill mix allows for greater staffing flexibility.

• Again, information on typical or usual patient needs is obtained by using trends from the patient classification system.

Determining Distribution of Staff

For many patient care unit , the distribution of staff varies from shift and by days of week. patient census on a surgical unit will probably fluctuate throughout the week, with a higher census Monday through Thursday and a lower census over the weekend.

labor and delivery and emergency department areas cannot predict when patient care needs will be most intense. Thus, labor and delivery and emergency department areas must rely on block staffing to ensure that adequate nursing staff are available at all time.

Block Staffing

Involves scheduling a set staff mix for every shift.

However, there may be trends in peak work load hours in emergency departments, when additional staff (RN, UAP, or secretary) beyond the block staff are necessary department may be from 6:00 pm to 10:00 pm to accommodate patient needs after physicians offices close or from 10:00 am to 3:00 am to accommodate alcohol related injuries.

Summary Summary