Staffing –nursing,staffing

norms, staff estimation and

scheduling

Submitted by: Ligi Xavier

Second year Msc nursing

Staffing

• Definition• Is the process of determining and

providing the acceptable numberand mix of nursing personnel toproduce a desired level of care tomeet the patient’s demand.

• Purpose: to provide each nursingunit with an appropriate andacceptable number of workers ineach category to perform thenursing tasks required

Functions in staffing

1. Identifying the type and amount of service needed byagency client.

2. Determining the personnel categories that have theknowledge and skill to perform needed service measures.

3. Predicting the number of personnel in each job categorythat will be needed to meet anticipated service demands.

4. Obtaining, budgeted positions for the number in each jobcategory needed to service for the expected types andnumber of clients.

5. Recruiting personnel to fill available positions.6. Selecting and appointing personnel from suitable

applicants.7. Combining personnel into desired configurations by unit

and shift.8. Orienting personnel to fulfill assigned responsibilities.9. Assigning responsibilities for client services to available

personnel

Steps of staffing

• 1. Determine the number and types of personnelneeded to fulfil the philosophy, meet fiscal planningresponsibilities, and carryout the chosen patient care

• 2. Recruit, interview, select, and assign personnelbased on established job description performancestandards.

• 3. Use organizational resources for induction andorientation

• 4. Ascertain that each employee is adequatelyoriented to organizational values and unit norms.

• 5. Use creative and flexible scheduling based onpatient care needs to increase productivity

• 6. Develop a program of staff education that willassist employees meeting the goals of theorganization.

Factors affecting staffing

• 1. The type, philosophy and objectives of thehospital and the nursing service

• 2. the population served or the kind of patientsserved whether pay or charity

• 3. the number of patients and severity of theirillness-knowledge and ability of nursing personnelare matched with the actual care needs of patients

• Availability and characteristics of the nursing staff,including education, level of preparation, mixof personnel, number and position

• 5. administrative policies such as rotation, weekendsand holiday off-duties

• 6. standards of care desired which should beavailable and clearly spelled out

• 7. layout of the various nursing units and resourcesavailable within the department such as adequateequipment, supplies and materials.

• 8. budget including the amount alloted to salaries, fringebenefits, supplies, materials and equipment;

• 9. professional activities and priorities in non-patientactivities like involvement in professional organizations,formal educational development, participation in researchand staff development

• 10. teaching program or the extent of staff involvement inteaching activities

• 11. expected hours of work per annum of each employee.This is influenced by the 40-hr week law; and

• 12. patters of work schedule-traditional 5 days per week,8 hours per day; 4 days a week, ten hours per day andthree days off; or 3 ½ days of 12 hours per day and3 ½ days off per week.

Objectives of staffing in nursing

• Provide an all professional nurse staff in critical care units, operating rooms,

labour and emergency room

• Provide sufficient staff to permit a 1:1 nurse- patient ratio for each shift in every

critical care unit

• Staff the general medical, surgical, obstetrics and gynaecology, paediatric and

psychiatric units to achieve a 2:1 professional- practical nurse ratio.

• Provide sufficient nursing staff in general, medical, surgical, obstetrics and

gynaecology, paediatric and psychiatric units to permit a 1:5 nurse patient ratio

on a day and afternoon shifts and 1:10 nurse- patient ratio on night shift.

• Involve the heads of the nursing staffs and all nursing personnel in designing the

department’s overall staffing program.

• Design a staffing plan that specifies how many nursing personnel in each

classification will be assigned to each nursing unit for each shift and how

vacation and holiday time will be requested and scheduled.

Nursing staffing in government hospital

• Usually the staffing is based on the vacancies reportedfrom the institutions to PSC.( public servicecommission ) kerala.psc makes bulletin and publish thenotification in the newspapers and the internet viahome page of PSC. The notifications usually containcategory number of the post, the no. of posts,reservation, by transfer,. Based on the notificaction thecandidates has to apply for the required post viaonline. After the verification of the application form,PSC invites the eligible candidates for the writtenexam. Based on the results PSC publishes the list, fromthis rank list the candidates are invited to attend theinterview . After qualifying the interview theCandidates are selected based on the vacanciesavailable. The selected candidates have to undergo themedical checkups and brief orientation programme.

KERALA SERVICE RULES (KSR)

• The Kerala Service Rules were issued by the Governorof Kerala and published on 10th November 1959 in theKerala Gazette.Later, on 17th September 1968, KeralaLegislative Assembly passed ‘Public Service Act-19’, forthe conditions of service of Government employeesand since then the Kerala Service Rules have beengoverned by that Act.

• KSRs are divided into three parts.• Part I Rules 1 to 159 - General conditions of service

and rules on Pay, Leave, Joining Time, and ForeignService

• Part II Rules 1 to 116 - Travelling Allowance Rules,and

• Part III Rules 1 to 151 - Pension Rules

Nursing staffing in private hospitals

• Recruitment

• Recruitment procedures includethe process and the methods bywhich vacancies are notified,post are advertised, applicationsare handled and screened,interviews are conducted andappointments are made.

Sources of recruitment:

The sources of recruitment are:

• I) Internal sources:

• Internal sources include present employees, employee referrals, former employee and former applicants.

External sources:

• Sources external to an organization are advertisements, college/university/institute placement services, walk-ins and writer-ins, consultants

• Advertisements: these constitute a popular method of seeking recruits as many recruiters; prefer advertisements because of their wide reach. For highly specialized recruits, advertisements may be placed in professional journals. Newspaper is the most common medium.

Advertisement must contain

the following information:

• The job content ( primary tasks and responsibilities)

• A realistic description of working conditions

• the location of the job• the compensation, including the

fringe benefits • job specifications

• To whom one applies.

SELECTION

• Selection is the process of choosingfrom among applicants the best-qualified individual or individuals fora particular job or position. Thisprocess involves verifying theapplicant’s qualifications, checkinghis or her work history, and decidingif a good match exists between theapplicant’s qualifications and theorganization’s expectations.

• Educational and Credential Requirements

• Reference Checks

• Preemployment Testing

• Physical Examination as a Selection Tool

• Making the Selection

• Finalizing the Selection

Finalizing the Selection• Once a final selection has been made, the manager is responsible for closure

of the pre employment process as follows:

• Follow up with applicants as soon as possible, thanking them for applying and informing them when they will be notified about a decision.

• Candidates not offered a position should be notified of this as soon as possible. Reasons should be provided when appropriate (e.g., insufficient education or work experience), and candidates should be told whether their application will be considered for future employment or if they should reapply.

• Applicants offered a position should be informed in writing of the benefits, salary, and placement. This avoids misunderstandings later regarding what employees think they were promised by the nurse-recruiter or the interviewer.

• Applicants who accept job offers should be informed as to pre employment procedures such as physical examinations and supplied with the date to report to work.

• Applicants who are offered positions should be requested to confirm in writing their intention to accept the position.

NORMS OF STAFFING

• Norms are standards that guide, control,

and regulate individuals and

communities. For planning nursing

manpower we have to follow some

norms. The nursing norms are

recommended by various committees,

such as; the Nursing Man Power

Committee, the High-power Committee,

Dr. Bajaj Committee, and the staff

inspection committee, TNAI and INC.

INDIAN NURSING COUNCIL

• ownership of the hospital,

• resources of the hospital,

• type of the hospital and level of care it provides,

• size of the hospital and community it serves,

• hours and pattern of work,

• type of building and premises plan, and

• other variables like level of technology, automation and research

Staffing Norms For Nursing Staff And

Nursing Supervisors

• Nursing Superintendent :1:1per hospital

• Dy. Nursing Supdt. :1 upto 400 beds

• Asst. Nursing Supdt. :1 for every 200 beds

• Ward Sisters :1 for 100-150 beds

• Staff Nurse :1 nurse for 3 beds

• Teaching hospital :1 nurse for 5 beds

• Non-teaching hospital :1 nurse for 3 beds

• For ICU/CCU :1 nurse for 1 beds

The Nurse-patient Ratio as per INC

• The Nurse-patient Ratio as per INC The norms are based on Hospital Beds.

• Chief Nursing Officer :1 per 500 beds

• Nursing Superintendent :1 per 400 beds or above

• D.NS. :1 per 300 beds and 1 additional for every 200 beds

• A.N.S. :1 for 100-150 beds or 3-4 wards

• Ward Sister :1 for 25-30 beds or one ward

• Staff Nurse :1 for 3 beds in Teaching Hospital in general ward& 1 for5 beds in Non-teaching Hospital +30% Leave reserve Extra Nursing staffto be provided for departmental research function.

• For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) + 30%leave reserve

• For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leavereserve.

• It is suggested that for 250 beded hospital there should be One InfectionControl Nurse (ICN).

( S I U- staff inspection unit) Norms

• The Staff Inspection Unit (S.I.U.) is the unit which hasrecommended the nursing norms in the year 1991-92.As per this S.I.U norm the present nurse-patient ratio isbased and practiced in all central government hospitals.

• Recommendations of S.I.U:

• The norm has been recommended taking into accountthe workload projected in the wards and the other areasof the hospital.

• 2. The posts of nursing sisters and staff nurses havebeen clubbed together for calculating the staffentitlement for performing nursing care work whichthe staff nurse will continue to perform even after sheis promoted to the existing scale of nursing sister.

• 3. Out of the entitlement worked out on the basis of the norms,30%posts may be sanctioned as nursing sister. This would further improvethe existing ratio of 1 nursing sister to 3.6.

• 4. The assistant nursing superintendent are recommended in the ratio of1 ANS to every 4.5 nursing sisters. The ANS will perform the dutypresently performed by nursing sisters and perform duty in shift also.

• 5. The posts of Deputy Nursing Superintendent may continue at thelevel of 1 DNS per every 7.5 ANS

• 6. There will be a post of Nursing Superintendent for every hospitalhaving 250 or beds.

• 7. There will be a post of 1 Chief Nursing Officer for every hospitalhaving 500 or more beds.

• 8. It is recommended that 45% posts added for the area of 365 daysworking including 10% leave reserve (maternity leave, earned leave, anddays off as nurses are entitled for 8 days off per month and 3 NationalHolidays per year when doing 3 shift duties).

High power committee on nursing in India

• Recommendations of high power committee on nursing and nursing profession

1. Employment:Uniformity in employment procedures to be made.

2. Job description

3. Working hours: The weekly working hours should be reduced to 4o hrs per week.

4. Work load/ working facilities

5. Pay and allowances

6. Promotional opportunities

7. Career development

8. Accommodation

9. Transport

10. Special incentives

11. Occupational hazards

12. Other welfare services

Norms recommended for nursing service and education

hospital setting.•

1. Nursing Supdt -1: 200 beds (hospitals with 200 or more beds).2. Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are over 200)3. Asst. Nsg . Supdt - 1: 1004. Ward sister/ward supervisor - 1:25 beds 30% leave reserve5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30% leave reserve7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve

• For specialised depts such as operation theatre, labour room etc- 1: 25 30% leave reserve.Community nursing services1 ANM :for 2500 population ( 2 per sub centre)1 ANM :for 1500 population for hilly areas1 health supervisor :for 7500 population( for supervision of 3 ANM's)1 public health nurse :for 1 PHC ( 30000 population to supervise 4 Health Supervisors )1 Public Health Nursing Officer for 100000 population ( community health centre)2 district public health nursing for each district.Teaching staff for schools/colleges of Nsg as per INC1 Nurse Teacher to 10 students for post graduate programmes.

Bajaj committee ( 1985):

• Bajaj committee ( 1985) Formulation of National Medical & Health Education Policy. Formulation of National Health Manpower Policy. Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of UGC.

ESTIMATING OF

NURSING STAFF

REQUIREMENT

Staff estimation

Guide to staffing nursing services1. Projecting Staffing Needs

Some steps to be taken in projecting staffing needs include:

1. Identify the components of nursing care and nursing service.

2. Define the standards of patient care to be maintained.

3. Estimate the average number of nursing hours needed for the required

hours.

4. Determine the proportion of nursing hours to be provided by registered

nurses and other nursing service personnel

5. Determine polices regarding these positions and for rotation of personnel.

2. Computing number of nurses required on a YearlyBasis

1. Find the total number of general nursing hours neededin one year.

Average patient census X average nursing hours perpatient for 24 hours X days in week X weeks in year.

2. Find the number of general nursing hours needed in oneyear which should be given by registered nurses andthe number which should be given by ancillary nursingpersonnel.

a. Number of general nursing hours per year X percent tobe given by registered nurses.

b. Number of general nursing hours per year X percent tobe given be ancillary nursing personnel.

Nursing Care hours per patient/day according to classification of patients

per units

Cases/Patients NCH/Pt/Day Prof to Non Prof 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. Pathologic Nursery 2.8 55:45

7. ER/ICU/RR 6.0 70:30

8. CCU 6.0 80:20

Patient Care Classification System

• It is a method of grouping patients according to the

amount and complexity of their nursing care

requirements and the nursing time and skill they

require.

• Purpose:

• 1. Serve in determining the amount of nursing care

required, generally within 24 hours.

• 2. to determine the category of nursing personnel who

should provide that care.

Classification CategoriesLevel I-Self

Care or Minimal Care

-NCH 1.5/pt/day

- Ratio 55:45

-Can take a bath on his own; feed himself; perform his own ADL.

-For discharge pt; non-emergency, newly admitted don’t exhibit unusual s/s;

- requires little treatment and observation

Level II –Moderate Care or

Intermediate Care

-NCH 3/pt

- Ratio 60:40

-Need some assistance in bathing, feeding, ambulating for short period.

-Extreme s/s of illness must have subsided or have not yet appeared

-May have slight emotional needs

-v/s taking ordered 3x/shift; with IVF/BT; are semi-conscious and exhibiting some psychosocial or social problems;

- periodic treatments and/or observations and /instructions

Classification CategoriesLevel III –

Total, Complete or

Intensive Care

-NCM 6hrs/pt/day

-Ratio 65:35

-Patient are completely dependent upon the nursing personnel.

-They are provided complete bath, are fed, may or may not be unconscious, with marked emotional needs; with v/s monitoring more than 3x/shift

-Maybe on continuous oxygen therapy, with chest or abdominal tubes

-They require close observation at least every 30 minutes for impending hemorrhage, with hypo or hypertension and/ or cardiac arrhythmia

Classification CategoriesLevel IV-Highly

Specialized Critical Care

-NCH 6-9 or more /pt/day

- Ratio 70:30 or 80:20

-Need maximum level of nursing care with a ratio of 80 professionals to 20 non-professionals.

-Needs continuous treatment and observation

-With many medications, IV piggy backs; v/s monitoring every 15-30 minutes; hourly output.

-There are significant changes in doctor’s orders

Percentage of patients at various levels of care per type of hospital

Type of Hospital Minimal Care

Moderate Care

Intensive Care

Highly Spl. Care

Primary Hospital 70 25 5 -

Secondary Hospital 65 30 5 -

Tertiary Hospital 30 45 15 10

Special Tertiary Hospital

10 25 45 20

Categories of Level of Care of Patients: Nursing Care Hours/Pt/Day & Ratio of Prof-

Non Prof

Levels of Care NCH Needed Per Pt./Day

Ratio of Prof to Non-Prof

Level I – Self-Care or Minimal Care

1.50 55:45

Level II Moderate or Intermediate

Care

3.0 60:40

Level II Total or Intensive Care

4.5 65:35

Level IV Highly Specialized or Critical Care

6.0

7 or higher

70:30

80:20

Computing number of nurses assigned on weekly

basis • 1. Find the total number of general nursing hours

needed in one week. Average patient censes X average nursing hours per patient in 24 hours X days in week.

• 2. Find the number of general nursing hours needed in the week which should be given by registered nurses and the number which could be given by ancillary nursing personnel.

• a. Number of general nursing hours per week X percent to be given by registered nurses.

• b. Number of general nursing hours per week X percent to be given by ancillary nurses

One method for determining the nursing staff

of a hospital

• 1. To determine the number of nursing staff for staffing

a hospital involves establishing the number of work

days available for service per nurse per year.

•

• Example: Analysis of how the days are used; Days in

the year 365 Days off 1 day/week 52 Casual leave 12

Privilege leave 30 1 Saturday /month 12 Public

Holidays 18

• Public Holidays 18 Sick Leave 8 Total non-working

days 132

• Total working days /nurse/year 233 So 1 nurse = 233

working days /year Example, 20 nurse means 20X233=

4660 hours 4660/365= 12.8 (13

Staffing FormulaTo illustrate: Find the number of nursing according to levels of care needed.

1. Categorize the patients according to levels of care needed

250 pts x 0.30 = 75 pts needing minimal care

250 pts x 0.45 = 112.5 pts needing moderate care

250 pts x 0.15 = 37.5 pts needed intensive care

250 pts x 0.01 = 25 pts need highly specialized 250 nsg care

2. Find the number of nursing care hours (NCH) needed by patients at

each level of care per day.

75 pts x 1.5 (NCH needed at Level I) = 112.5 MCH/day

112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day

37.5 pts x 4.5 (NCH needed at Level II) = 168.75 NCH/day

25 pts x 6 (NCH needed at Level IV) = 150 NCH/day

Total 768.75 NCH/day

3. Find the total NCH needed by 250 patients per year.

768.75 x 365 (days/yr) = 280,593.75 NCH/year

• 4. Find the actual working hours rendered by each nursing personnel per year.

• 8 (hrs/day) x 213 (working days/year) = 1,704 (working hours/year)

• 5. Find the total number of nursing personnel needed.

• a. Total NCH per year = 280,593.75 = 165

• Working hrs/year 1,704

• b. relief x total nsg. Personnel = 165 x 0.15 = 25

• c. total nursing personnel needed 165 + 25 = 190

• 6. Categorize to professional and non-professional personnel ratio of prof to non-prof in a tertiary hospital is 65:35

• 190 x .65 = 134 professional nurses

• 190 x .35 = 66 nursing attendants

• 7. Distribute by shifts

• 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

• Total 124 nurses

• 66 nsg attendants x .45 = 30 nsg. attendants on AM shift

• 66 nsg attendants x .37 = 24 nsg attendants on PM shift

• 66 nsg attendents x .18 = 12 nursing attendants on noc

Staff scheduling

• Assessing a Scheduling System

• 1. Ability to cover the needs of the unit

• 2. quality to enhance the nursing personnel's knowledge, training and experience

• 3. fairness to the staff – fair share of weekends, holiday offs, rotation patters for the whole year including assignment to “difficult” or “light” or “undesirable” units or shifts

• 4. stability – the schedule must be harmonized with their family or social activities of the nurse staff

• 5. flexibility – ability to handle changes brought by emergency leaves

•

Cyclic scheduling

• Cyclic scheduling is one way of staffing to meet the requirements of equitable distribution of hours of work and time off. A basic pattern for a certain number of weeks is established and then repeated in cycles. There are several advantages in cyclic scheduling

• Once developed , it is permenant schedule, requires only temporary adjustments.

• Nurses no longer have to leave in anticipation of their time off duty, because it is scheduled 6 months advance.

• Personal plans can be made in advance• It can be modified to fit known or anticipated periods of

heavy workloads and can be temporarily adjusted to meet emergencies or unexpected shortage of personnel.

• Because cyclic scheduling is relatively inflexible , it works only with astaff that rotates by policy and personnalchoice.

A one-week cyclical schedule

Personnel S M T W T F S

7/3 Headnurse/Senior Nurse x x

Staff Nurse x x

Nsg. Att. x x

3/11 Staff Nurse x x

Nsg. Att. x x

11/7 Staff Nurse x x

Nsg. Att. x x

Gen. Rel. 3/11; 11/7 S. nurse 3/11 3/11 11/7 x x 3/11 11/7

N. Att. 3/11 11/7 x 7/3 3/11 11/7 x

Self scheduling

• Self scheduling is an cativity that may make a staff happier , more cohesive, and more committed. It should be planned on a unit basis with a written policy as a guideline. Planning may use either a self directed work team or quality circle technique approach. personnel are scheduled to work

Flex time

• Nurses often want flexible scheduling to

better to accommodate their personal

lives. Such scheduling options have,

infact become an essential component of

the job satisfaction.it resulted in

improved attitudes and increased

productivity as employees have gained

more more control over their work

environment.

Modified work week:

• This using 10 and 12 hour shifts and other methods are common place. A nurse administrator should be sure work schedules are fulfilling the staffing philosophy and policies, particularly with regard to efficiency. Also, such schedules should not be imposed on the nursing staff but should show a mutual benefits to employer, employees and the client served.

• One modification of the worksheet is four 10 hour shifts per week in organized time increments. One problem with this model is time overlaps of 6 hours per 24 –hour day. The overlap can be used for patient –centered conference, nursing care assessment and planning and staff development. It can be done by hour or by a block of 3-4 hours

The weekend alternatives:

• another variation of flexible scheduling is the weekend alternative. Nurses work two 12 hour shifts and are paid for 40 hours plus benefits. They can use the weekdays for continued education or other personal needs. The weekend scheduled has several variations. Nurses working Monday through Friday have all weekends off.

Other modified approaches

• Premium day weekend: nursing

staffing is a scheduling pattern that gives

the nurse an extra day off duty, called a

premium day, when he/she volunteers to

work one additional weekend worked

beyond those required by nurse staffing

policy. This technique does not add

directly to hospital costs.

Reference

Basavanthappa BT. Nursing administration. Ist edn. New Delhi: Jaypee

brothers medical publishers (p) ltd; 2000.

• 2. Wise PS. Leading and managing in nursing. Ist edn. Philadelphia: Mosby publications; 1995.

• 4. Koontz H, Weihrich H. Management a global perspective. 1st edn. New Delhi: Tata Mc. Graw Hill publishers;2001.

• 5. Anthony MK, Theresa S, Glick J, Duffy M, Paschall F. Leadership and nurse retention, the pivotal role of nurse managers. JONA. Vol 35, Mar 2005.

• 6. Beyers Marjorie. Nurse executives’ perspectives on succession planning. JONA. Vol 36. June 2006.

• 7. Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide staffing. JONA.vol 37, no.3 mar 2007.

• 8. Blegen MA, Goode C J& Reed L. Nurse staffing and patient outcomes. Nurs res. 1998; 47(1):43-50.

• 9.currentnursing.com/nursing_management/staffing_nursing

• 10. KSR volume

• 11.Nursing world.org

• 12.,www.national nurses united. Org

• 13.www.mn nurses.org

Discussion

• Discuss the staffing scheduling patterns in the government hospitals and private hospitals

• Merits and demerits.