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MODULE V

STAFFING RATIONALE: Staf ing is certainly one of the major problems of any nursing organization, whether it be a hospital, nursing home, home health care, agency, ambulatory care agency, or another type of facility. Aydelatte has stated, Nurse staf ing methodology should be an orderly, systematic process, based upon sound rationale, applied to determine the number and kind of nursing personnel required to provide nursing care of a predetermined standard to a group of patient in a particular setting. The end result is prediction of the kind and number of staff required to give care to patients. KEY TERMS: Career mapping- strategic plan for ones career. Career path it is a progression of jobs linked together, each of which furnishes the skills and/or experience necessary for advancement to the next job. Collaborative practice cooperative interdisciplinary practice. Orientation familiarization with and adaptation to an environment. Recruitment- process of enlisting personnel for employment. Retention the capacity to retain employees once they are hired. Staffing the process of determining and providing the acceptable number and mixture of nursing personnel to produce a desired level of care and to meet the patients demand for care. Staff development training and continuing education of the employee to develop his potential fully.

PRE TEST: Answer to the following questions comprehensively. Define staffing as a nursing management function. What are the major parts of staffing? What are the different factors which may affect staffing? Name at least three (3) most common methods of recruiting new employees? Explain the meaning of career mapping. What are the different modalities of nursing practice? Differentiate centralized scheduling from decentralized scheduling. Explain Patient Classification System and its importance to Staffing. What are the three underlying philosophies you have to bear in mind during the screening process? 10. What are the important factors to consider during orientation of new employees? Note: After you have answered the test item, check your answers against the Feedback found on the next page. 1. 2. 3. 4. 5. 6. 7. 8. 9.

FEEDBACK ON PRE-TEST 1. Staffing is the process of determining and providing the acceptable number and mixture of nursing personnel to produce a desired level of care and to meet the patients demand for care. 2. a. Planning b. Execution of implementation c. Evaluation or Maintenance 3. a. type, philosophy and objectives of the hospital b. population served c. number of patient and acuity of their illness. d. availability and characteristic of the nursing staff. e. administrative policies. f. standards of care desired. g. budget h. resources availability 4. a. advertising b. word of mouth c. employee recommendation 5. Career mapping is a strategic plan for ones career which provides direction for formal education, experience, continuing education, professional associations, and networking. 6. a. Case Method b. Functional nursing c. Team Nursing d. Primary Nursing e. Collaborative or Joint practice f. Case Management g. Modular or District Nursing h. Managed Care 7. Centralized scheduling is based on a Master staf ing pattern that is carried out but one person who plans and coordinates the schedule of the nurses while decentralized scheduling allows the nurse manager to staff her own unit. 8. Patient classification system is a means of categorizing present patients on the basis of certain care needs that can be clinically observed by the nurse. The system can serve as a basis for planning the staffing needs of patients. 9. a. screen out applicants who do not fit the agencys image. b. try to fit the job for a promising applicant/ c. try to fit the applicant to the job. 10. a. Information of the philosophy, goals, policies, and standards of the institution. b. description of the organizational structure of the institution c. job description d. introduction to co-workers e. a four of the physical facilities

Evaluation: A total score of 15 points (82%) is satisfactory. It indicates adequate knowledge of the subject. You may now read Module V. LEARNING CELL: Staffing Defined Staf ing is de ined as illing, and keeping illed, positions in the organization structure through identifying work force requirements, inventorying the people available, recruiting, selecting, placing, promoting, appraising, planning the careers, compensating, and training ot otherwise developing both candidates and current job holders to accomplish their tasks effectively and ef iciently. It is clear that staf ing must be closely linked to organizing, that is, to the setting up of intentional structure of roles and positions. Nature and Purpose of Staffing Staf ing is the third managerial function. Having planned and organized, the manager must now staff to accomplish the goals of the organization. Staf ing involves the selection of personnel and assignment systems and the determination of staf ing schedules. There are many variables to be considered when planning for staf ing. The more accurate the assessment, the higher the probability of containing costs while providing high-quality care. Many writers on management theory discuss staf ing s a phase of organizing. However, several reasons have been identi ied by the writer why staf ing is a separate managerial function. First, the staf ing organizational roles include knowledge and approaches not usually recognized by practicing managers, who often think of organizing as just setting up a structure of roles, and give little attention to filling these roles. Second, making staf ing a separate function allows us to give even greater emphasis to the human element in selection, appraisal, career planning, and manager development. Third, an important body of knowledge and experience has been developed in the area of staf ing. Fourth, managers often overlook the fact that staf ing is their responsibility not that of the personnel department. To be sure, this department provides valuable assistance, but it is the job of managers to ill the positions in their organization and keep them filled with qualified people. The Three Parts of Staffing: Staffing can be divided into three major parts, each consisting of a number of important activities. The three parts are: 1. Planning it involves forecasting of the needed human resources or people ever a period of times. It also means an analysis must be done of the job to be done or task required. This way the job description can be matched against suitable applicants. It is also the basis for formulating policies and programs on staffing. 2. Execution or Implementation this involves various steps such as recruitment, selection, placement, training, and post-training development. 3. Evaluation or Maintenance- this involves performance appraisal, information, and evaluation of the program. All these information in turn is fed back to planning so that

planning can improve its forecasting, job analysis and policies. The cycle then repeats itself as shown in this figure:

EXECUTION/IMPLEMENTATION Recruitment Selection Placement Training Development

STAFFING

A PLANNING

C EVALUATION/MAINTENANCE

- Human resources forecasting - Human resource accounting - Job analysis - Performance appraisal - Policies and programs formulation - Human resource information - Program evaluation Nurses may recommend fellow nurses whom they have previously worked within the past and who they know are competent ad reliable. Screening of Staff Following the recruitment process is the screening of the staff. It is best to keep in mind the three underlying philosophies during the screening process and these are: a. Screen out applicants who do not fit the agencys image b. Try to fit the job to a promising applicant c. Try to fit the applicant to the job During the screening process, the applicants submit their biographical data that include

information on personal history, educational background, and work experience. The recruiter can us the data to determine whether the applicant is quali ied and meets the minimum requirements. Interview As soon as the recruiter screens the most quali ied applicants, a pre-employment interview is conducted. The purposes of the interview are to obtain information, to give information, and to determine if the applicant meets the requirements for the position. During the interview process, the interviewer judges the applicants dependability, willingness to assume responsibility for the job, willingness and ability to work with other, interest in the job, adaptability, consistency of goals with available opportunities, and conformance of managers and appearance to job requirements. Some institutions may require the applicant to take a series of tests in assess their general intelligence, personally, mental, perceptual and psychomotor abilities. Orientation After choosing from among the quali ied applicants, you should take the responsibility to assist and introduce the nurse to her new job. Orientation is a process of becoming familiar with a new environment and adapting well to it. Orientation is a part of staff development and one of your important functions. When policies, regulations, and hob descriptions are diminished, anxiety is reduced and misunderstandings are prevented. All new employees are entitled to the oriented during the irst few days of employment. A well-designed program would include the following: Information of the philosophy, goals, policies, and standards of the institution. Description of the organizational structure of the institution Job description/responsibilities Introduction to co-workers A tour of the physical facilities In-service education training programs may also be conducted to prepare the beginning nurse practitioner to assume bigger responsibilities. Staff Development Staff development is a continuing liberal education of the whole person to develop his potentials to the fullest. The nurse should engage in professional education activities such as attending conferences, seminar workshops, in-service training programs, reading professional publications, and engaging in other activities that will enhance his competencies as a nurse and develop his aesthetic sense and personality. Nurse managers play an important role in the support of staff development and have a responsibility to review the goals and provide a budget for the activities. They must actively participate in identifying the needs of the personnel to determine what programs to offer. The quality of rendered nursing services related to personnels education, training, and competence, could be further enhanced through attendance in continuing activities.

Preceptorship Preceptorship may be used to help recruit, retain, orient, and develop staff. They may be used before students graduate to orient them to the agency and to recruit them for hire. During the preceptorship, faculty facilitates, monitor, and evaluate student learning. The preceptorship is responsible for the quality o patient care and facilitates the students learning. Preceptors are liaisons between students and the agency. They help students learn skills and how to organize their work. They provide real-life experiences for students before graduation to help reduce the difficulties of transition from school to work. Mentorship Preceptors are role models who may become mentors. Mentors give their time, energy, and material support to teach, guide, assist, counsel and inspire a younger nurse. The mentor is a con idante who personalizes role modeling and serves as a sounding board for decisions. The mentor is a resource person who supports the development of the young person through influence and promotion. Mentorship should provide an opportunity to share information, review work, provide feedback, explore issues, plan strategies and solve problems. It helps socialize services into professional norms, values and standards. Career advancement and success are promoted, this increasing self-confidence, self-esteem, and greater personal satisfaction. Career Mapping Career mapping is a strategic plan for ones career. It provides direction for formal education, experience, continuing education, professional associations and networking. The individual nurse needs choose an area of specialization. Nurses need to assess their own values and de ine success for themselves. Job securities, sense of accomplishment, and opportunities for professional advancement are often considered important. Other issues to consider are work hours, salary, fringe bene its, retirement plans organizational and geographical climate, and location. Assignment Systems for Staffing Changes in assignment systems are response to changing needs. In the 1920s, the case method and private duty nursing were popular. By 1950, functional nursing was predominant in response to the shortage of nurses. During the decade, team nursing was introduced to maximize use of the knowledge and skills of professional nurses and to supervise auxiliary workers. The late 1960s and 1970s witnesses a shift back to care of the patient by a professional nurse through a primary nursing. Managed competition emerged as an economic strategy guiding health care reform during the 1980s. Each systems has advantages and disadvantages. The Different Modalities of Nursing Practices are: 1. CASE METHOD In the case method each patient is assigned to a nurse for total patient care while that nurse is on duty. The patient has a different nurse each shift and no guarantee of having the

same nurses the next day. The patient care coordinator, with no obligation to assign nurses to the same patient, supervises and evaluates all of the care given on the unit. Popular during the 1920s along with private duty nursing, the case method emphasized following physicians orders. Disadvantage: a. Many ignore other patients that are not under your care. 2. FUNCTIONAL NURSING It can best be described as a task-oriented method in which a particular nursing function is assigned to each staff member. In the 1950s when few registered and only some practical nurses were available nurses aides gave much patient care. In functional method hierarchical structure predominates. The medication nurse, treatment nurse and bedside nurse are all products of the system. The functional method implements classic, scienti ic management, which emphasizes ef iciency division of labor, and rigid controls. Procedural descriptions are used to describe the standard of care, and psychological needs typically are slighted. Registered nurses keep busy with managerial and non-nursing duties, and nurses aides deliver the majority of patient care.

Advantages: a. it is efficient and may be the best system when confronted with a large patient load and a shortage of professional nurses. 1. it accomplishes the most work in the shortest amount of time. May work satisfactorily during critical staffing shortages. Disadvantages: a. it fragments nursing care b. it decrease the nurses accountability and responsibility. 2. It makes the nurse-client relationship difficult to established, if it is ever achieved. Little communication is done. 3. It gives professional nursing low status in terms of responsibility for patient care. 4. Patient does not feel a sense of belongingness. 3. TEAM NURSING METHOD Team nursing was introduced during the 1950s to improve nursing services by using the knowledge and skills of professional nurses and to supervise the increasing numbers of auxiliary nursing staff. The result was an improvement in patient and staff satisfaction. Team nursing is based on a philosophy that supports the achievement of goals through group action. Each team members see their suggestions implemented, their job satisfaction increases and they are motivated to give even better care. The team is led by a professional nurse who plans, interprets, coordinates, supervises and evaluates the nursing care. Team leaders assign team members to patients by matching

patient needs with staffs knowledge and skills. They set goals and priorities for patient care; centralizes information through the use of a Kardex; direct the planning of care by directing care conferences and developing care plans; ix responsibility for the work and provide for coverage during absences. One of the main features of team nursing is the nursing care conference. Its primary purpose is the development and revision of nursing care plans by providing an opportunity to identify and solve problems. Precision in the identi ication of problems is increased through information sharing. Team conferences also provide the opportunity to identify and work through staff educational needs. Nurses can review standards of care by comparing the actual patients condition to the textbook example. Team conferences also provides an opportunity to discuss and resolve interpersonal problems and the chance to prevent futures ones. Consequently, team spirit is fostered. The nursing care plan is the another main feature of team nursing. A care plan identifying present and potential problems and long and short-term objectives should be developed for each patient. The care plan should be individualized, re lecting the interrelatedness of psychosocial and physiological needs and involving patient and family participation. Advantages: a. it involves all team members in planning patients nursing care, through the use of team conferences and writing nursing care plan. b. It provides the best care at the lowest cost, according to some advocates. Disadvantages: a. it can lead to fragmentation of care if the concept is not implemented totally. b. It can be difficult to find time for team conferences and care plans. c. It allows the RN who is the team leader to have the only significant responsibility and authority. 4. PRIMARY NURSING During the late 1960s and early 1970s, primary nursing was instituted in some hospitals by professional nurses who were unhappy with fragmented care and lack of direct patient contact. Primary nursing features a registered nurse who give total patient care to four to six patients. The RN remains responsible for the care of those patients 24 hours a day through out the patients hospitalization. The associate nurse is expected to contact the primary nurse regarding changes in the care plan. The number of patients assigned to one nurse varies according to length of hospitalization, complexity of care; number of medical and paramedical personnel involved with the patients care, availability of support systems, and the shift worked. Primary nursing is a distinct modality, a one to one relationship and a professional commitment which requires the nurse to practice accountability and full responsibility to the care of group of patients, whom are the central to their focus from admission to his discharge. The success of primary nursing seems to depend on the quality of the nursing staff and administrative support.

Advantages: a. it provides for increased autonomy on the part of the nurse, thus increasing motivation, responsibility and accountability. b. It assures more continuity of care as the primary nurse gives or directs care throughout hospitalization. c. It makes available increased knowledge of the patients psychosocial and physical needs, because the primary nurse does the history. d. It leads to increased rapport and trust between nurse and patient that will allow formation of a therapeutic relationship. e. It improves communication of information to physicians. f. It eliminates nurse aides from the administration of direct patient care. g. It frees the clinical nurse manager to assume the role of operational manager, to deal with staff problems and assignments and to motivate and support the staff. Disadvantages: a. it requires the entire staff to the RNs which increases staffing and costs. 5. COLLABORATIVE OR JOINT PRACTICE Collaborative practice can include interdisciplinary teams, nurse-physician interaction in joint practice, of nurse-physician collaboration in care-giving in care giving. Collaboration is a cooperative and assertive. The interaction between nurses and physicians or other health team members in collaborative practice should enable the knowledge and skills of the professions to in luence the quality of patient care provided synergistically. The elements needed to established successful joint practice in a hospital setting are: a. a committee of physicians and nurses with equal representation and equal voice in establishing the objective and ground rules of operation. b. An integrated patient record. c. Primary nursing and case management. d. Collaborative practice with honest communication and encouragement of clinical decision making by nurses. e. Joint education of physician and nurses. f. Joint nurse-physician evaluation of patient care. g. Trust 6. CASE MANAGEMENT This is a system of patient care delivery that focuses on the achievement of outcomes within effective and appropriate time frames and resources. Case management focuses on an entire episode of illness, crossing all settings in which the patient receives care. Care is directed by a case manager who ideally is involved in a group practice. Case management incorporates the principle of managed care. 7. MANAGED CARE Managed care is a unit-based care that is organized to achieve specific patient outcomes within fiscally responsible time frames (length of stay) utilizing resources that are appropriate in amounts and sequence to a specific case type and to the individual patient. Care is structured by case management plans and critical paths which are based on

knowledge by case type regarding usual length of stay, critical events and their timing, anticipate outcomes, and resource allocation. 8. MODULAR OR DISTRICT NURSING Modular or district nursing is a modification of team and primary nursing. It is sometimes used when there are not enough registered nurses to practice primary nursing. Each registered nurse, assisted by paraprofessionals, delivers as much care as possible, delivers as much of it as possible, and directs the paraprofessionals for the more technical aspects of care. Modular nursing decreases the sense of isolation and unrealistic expectations often associated with primary nursing. Learning Exercise Try to ind out the types of patient care delivery in the different health care organizations in your own community. You may conduct interview with nurses from a variety of health care delivery is the most widely used? Why? STAFFING SCHEDULES FOR PRODUCTIVITY 1. Centralized Scheduling Two major advantages of centralized scheduling are fairness to employees through consistent, objective, impartial application of policies and opportunities for cost containment through better use of resources. Centralized scheduling alsorelieves head nurse from timeconsuming duties, freeing them from other activities. Lack of individualized treatment of employees in the chief complaint, and centralized scheduling has brought to the surface previously unrecognized organizational and managerial problems. Resistance to centralized scheduling maybe when head prepare and control their own budgets, understand and approve their scheduling policies and have open communications with the scheduler. Line and staff accountability need to be carefully defined to prevent confusion over responsibility when staff personnel makes decisions when line managers are accountable. Line authority is accountable for decisions, and staff provides support to help line make decision. The staff function of the scheduler include scheduling employees according to staffing policies, implementing procedures for position control and reallocation of staff, maintaining record for line managers, gathering information and making reports to help line authority prepare her budgets and maintaining communications in other departments, such as personnel and payroll. Line responsibility of head nurses include developing a master staffing pattern, establishing procedures for adjustment of staff, classifying requirements for each job description and staff positions, living, developing, promoting and disciplining and firing employees when appropriate, and defining and controlling the personal budget. 2. Decentralized Staffing When head nurses are given authority and assume responsibility, they can staff their own units through decentralized staffing. Personnel feel that they got more personalized attention with decentralized staffing. Personnel feel that they got more personalized attention with centralized staffing. Staffing is easier and less complicated when done in a small area. Each

head nurse learns the responsibility and challenges of staffing. With the philosophy of sharing and mutual trust, head nurses can work together in order to solve staffing problems. Because of their knowledge and experience, head nurses can form a support system and offer each other informed advice. Unfortunately, some staff members may receive individualized treatment at the expense of other and work schedules can be based as a punishment-reward system by the head nurse. Staffing, which is very time-consuming, takes the head nurse away from other duties and forces her to do the scheduling while off duty. 3. Self-Scheduling This is a system that is coordinated by staff nurses. It is a process by which staff nurse is a unit collectively decide and implement the monthly work schedule. Given the criteria for adequate unit staffing for each 24 hour period by the head nurse, each staff nurse chooses which day and shift she will work.

PATIENT CLASSIFICATION SYSTEM


A patient classification system is a means of categorizing present patients on the basis of certain care needs that can be clinically observed by the nurse. This system can serve as a basis for planning the staffing needs of patients on the basis of certain care needs that can be clinically observed by the nurse. This system can serve as a basis for planning the staffing needs of patients. There are three methods of classifying patients: the descriptive method, checklist of nursing tasks method and the patient needs method. In the descriptive method, which is the most common means of patient classification, the nurse classifies or assigns the patient to a category that closely describes the level of care needed. The patient classification system is described as follows. Category I: Minimal Care Minimal care is given to patients who are convalescing and who no longer require intensive, moderate and maximum care. This patient still may need supervision by a nurse in the course of a day, even if only at infrequent intervals. This care group also includes patient who require diagnostic studies, minimal therapy, less frequent observations, and daily care for minor conditions, and who are waiting elective surgery or have difficulty arranging transportation between home and hospital, or whose home environment temporarily makes discharge undesirable or impractical. Category II: Moderate Care Moderate care is given to patients who are moderately ill or are recovering from the immediate effects of a serious illness and/or an operation. These patients require nursing supervision or some assistance related to ambulating and caring for their own hygiene. They may be ambulatory for short periods. Category III: Maximum Care Maximum care is given to patients who need close attention throughout the shift, that

is, complete care for patients who require nursing to initiate, supervise, and perform most of their activities or who require frequent and complex medication or treatments. Category IV: Intensive Care Intensive care is given to acutely ill patients who have a high level of nurse dependency, including those requiring intensive therapy and/or intensive nursing care and whose unstable condition requires frequent evaluation with adjustment therapy. MODIFIED APPROACHES TO NURSE STAFFING AND SCHEDULING Many different approaches to nurse staffing and scheduling are being tried in on effort to satisfy the needs of employees and unit workload demands for patients care. This include modified work weeks (10 or 12) Alternating or Rotating Work Shifts Although straight shifts are used by some institutions or for some personnel within institutions, rotating work shifts are common among staff members. The frequency of alternating between days and evening or days and nights are rotating through all shifts varies among institutions, sooner nurses may work all three shifts within 7 days. Alternating or rotating work shifts affects the health of the nurses and the quality of their work. The rapid shift or work schedules causes stress. Nurses complains of restlessness and nervousness while trying to sleep, wakefulness and sleeplessness at inappropriate times, fatigue slower time reaction, changes in urine excretory cycles and many more cause meditations errors, equipment failures and errors in problem solving are probable. To guarantee that the nurse works her share of weekends, holidays and unpopular evening and night hours, alternating and rotating assignments currently focus on the time patterns of an individual nurse rather than on an integrated work groups. Permanent Shifts Permanent shifts relives the nurses from stress and health related problems associated with the alternating and rotating work shift. When the nurse is able to choose the shift that best suits her personal life and can participate in her social activities, can continue her education by planning courses around her work schedule. The nurse may develop a sense of belonging to a shift and feel and work better because the shift suits her. The only disadvantage of permanent shifts is that nurses may not develop an appreciation for the workload or problems of other shifts. Block or Cyclical Scheduling Block or cyclical scheduling uses the same schedule repeatedly with the six day forward rotations, personnel are scheduled to work six successive days followed by at least two days off. The schedule repeats itself every six weeks. Personnel can be scheduled with every other weekend off and one day during the week so that there are no more than for consecutive days of work. Variable Staffing Variable staffing is a method that uses patients needs to determine the number of mix staff. Time measures are done for direct and indirect patient care. A patient classification system is develop and tables are designed to determine the numbers of nursing hours required depending on the number of patients in each category.

Eight (8) Shifts, 5 days Workweek The 5-day forty hour workweek became popular during the late 1940s. the shifts are usually 7 am to 3:30 pm, 3 pm to 11:30 pm and 11 pm to 7:30 am, allowing a half an hour lunch break and a half an hour overlap time between shifts to provide a continuity of care. Ten (10) hour day, 4 days workweek The shifts are 7 am to 5 pm, 1 pm to 11:30 and 9 pm to 7:30 am. A cyclical schedule is used that allows at least 14 hours off between the shifts and a 4 day weekend every 6 weeks for those who rotate. Ten (10) hour shift, 7 day workweek Two teams alternate weeks from Tuesday through Monday, there is no rotation of shifts. Each team consists of permanent day, evening, and night shifts. Twelve (12) hour shift, 7 day workweek The twelve hours shift starting at 7 or 7:30 am and ending 7 or 7:30 pm has been adopted by some institutions. The better utilizations of nursing personnel lowers staffing requirement. The consequently lowers the cost for patient day. Nurses find it fulfilling because they get to know their patients more frequently. They find that they are fewer communications gaps and better continuity of care and improve nurses patient relationship. Based on R.A. 5901- FORTY HOUR PER WEEK LAW 40 hr/week for personnel working in hospitals with 100 bed capacity or over or which are located in 1 m population. 48 hr/week for personnel who work in agencies with lesser bed capacity or which are located in communities with less than 1 m populations. Rights/Privilages Working Hours Per Week Given Each Personnel 40 hrs. 48 hrs. 1. Vacation leave 15 15 2. Sick leave 15 15 3. Holidays (legal and special) 12 12 4. Continuing Educations 3 3 5. Off duties R.A. 5901 104 52 Total non-working days/year 149 97 Total working days/year 216 268 Total working hours/year 1,728 2,144 Steps In Determining Number of Nursing Personnel Needed (DOH) 1. Determine type of hospital- primary, secondary or tertiary 2. Categorize according to levels of care: Primary Secondary Tertiary a. Minimal Care 70% 65% 35% b. Intermediate Care 25% 30% 45% c. Intensive Care 5% 5% 20% 3. Find the NCH Needed by patients per day and get the sum Minimal = 1.5 hours Intermediate = 3 hours Intensive care = 4.5 hours 4. Total NCH x 365 days 5. Find # of working hours per year

40 hr/week - 216 x 8 hrs. = 1,728 working hrs./yr 48 hr/week 268 x 8 hrs. = 2,144 working hrs./yr 6. Find the nursing personnel needed: a.) NCH / year = number of personnel Working hrs./year b.) Nursing Personnel x 30 = number of relievers 216 or 268 7. Categorize into Professional and Non-Professionals Primary = 55:45 Secondary = 60:40 Tertiary = 65:35 8. Distribute by Shifts: AM - 45% PM - 37% Night - 18% Example: Step 1: Computations for 150 patients in a tertiary hospital. Step 2: Categorize according to levels of care Minimal care = 150 x .35 = 52.5 Intermediate care = 150 x .45 = 67.5 Intensive care = 150 x .20 = 30___ 150.0 Step 3: Find the NCH needed by patients/day and get the sum Minimal = 1.5 hrs. x 52.5 = 78.75 or 79 Intermediate = 3 hrs x 67.5 = 202.5 or 203 Intensive = 4.5 hrs. x 30 = _______135 417 total NCH/day Step 4: Total NCH x 365 days 417 x 365 = 152,205 NCH/yr Step 5: Find # of working hours per year 40 hrs/wk = 216 x 8 = 1,728 working hrs/yr. Step 6: Find the nursing personnel needed. a.) NCH / year = 152,205 = 88.08 personnel Working hrs./year 1,728 b.) Nursing Personnel x 30 = 88 x 30 = 12.22 = 12 relievers 216 216 c.) Add nursing personnel and relievers 88 + 12 = 100 personnel Step 7: Categorize into professional and Non- professional Tertiary = 65:35 100 x .65 : 100 x 35 Professional 65 : 35 Non-professional Step 8: distribute by shifts AM = 45% PM = 37% N = 18% PROFESSIONAL NON PROFESSIONAL

65 x .45 = 29.25 = 29 AM 35 x .45 = 15.75 = 16 AM 35 x .37 = 24.05 = 24 PM 35 x .37 = 12.95 = 13 PM 65 x .18 = 11.7 = 12 N 35 x .18 = 6.3 = 6 N 65 35 FACTORS AFFECTING STAFFING 1. Type, philosophy and objectives of the hospital and the nursing service. 2. Population served kind of patients served whether pay or charity. 3. Number of patient and acuity of their illness knowledge and ability of nursing personnel are matched to the actual care needs of patients. 4. Availability and characteristics of the nursing staff Education, level of preparation, mixture of personnel, number and position. 5. Administrative policies. 6. Standards of care desired. 7. Lay-out of the various nursing units and resources available within the department. 8. Budget amount allotted for salaries, fringe benefits, supplies, materials and equipment. 9. Professional activities and priorities in non- patient activities- involvement in professional organizations, formal educational development, participation in research and staff development. 10. Teaching program extent of staff involvement to teaching activities. 11. Expected hours of work per annum of each employee.

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