STAFFING

PREPARED BY: ANTHONY S.

CALDITO
STAFFING
• Unit Managers Responsibility in meeting Staffing
needs
• Mandates in Staffing
• Factors affecting Staffing
– Patient Care Classification System
– Classification Categories
• Percentage of Nursing Hours
• Computing for the number of personnel needed
• Shift Distribution
• Staffing Formula
• Placement
• Scheduling Factors and Types
• Recruitment/Selection/Placement/Indoctrination
and more
• Staffing and Scheduling option
STAFFING
the process of determining and providing
the acceptable number and mix of nursing
personnel to produce a desired level of
care to meet the patients’ demands
to provide each nursing unit with an
appropriate number of each category of
worker to perform the required task to give
care and comfort to patients in the unit
Unit Managers Responsibility in
meeting Staffing needs

Requirement for night, evening, holiday work that

is frequently necessary in health care
organization.
It is definitely stressful and frustrating for some
nurses.
Inflexible and extended work schedule are major
contribution to job dissatisfaction.
Solution is that staff should be involved & have
“SOME” control and option in scheduling.
CENTRALIZED OR
DECENTRALIZED???????
Decentralized = Unit Managers are
responsible in making schedule
decision
Centralized = Human Resources
Department decide on scheduling
matters.
STAFFING MANDATES
Bill that had been made to
STANDARDIZED Staffing Ratio between
NURSES/PATIENT.
US setting only
Assembly Bill 394 passed in 1999 by
California Nurses Association.
(Massachuset, New York,Florida,
Michigan are also planning to enact
legislation)
ASSEMBLY BILL 394 TABLE
UNIT Nurse-Patient Ratio

Critical Care/ICU/NICU/DR 1:2

OR 1:1
Antepartum/Postpartum couplets/ 1:4
Pediatrics/Oncology/
ER/Telemetry
Postpartum Women Only 1:6
Medical Surgical (Initial)
Medical Surgical/ 1:5
Oncology Initial
Reaction towards Assembly Bill 394

Skill levels are not all the same

Staffing abuses and the resultant declines
in quality of patient care not occurred in the
past
Mandatory staffing ratios create significant
opportunity costs that may restrict
employers and payers from responding to
market forces; they may be unable to take
advantage of improved technological
support or respond to changes in patient
acuity
Staffing is a complex function
Identifying the type and amount of nursing care
to be given.
Predicting the number of each category of
personnel that will be needed to deliver care.
Recruiting personnel to fill available positions.
Selecting and appointing personnel from
available applicants.
Arranging available nursing personnel into
desired configurations, by unit and shift.
Assigning responsibilities for patient care.
Factors affecting Staffing:
The type, philosophy and objectives of the hospital
and the nursing service;
The population served or the kind of patients
served whether pay or charity;
The number of patients and severity of their
illnesses
Availability and characteristics of the nursing staff,
including education level of preparation, mix of
personnel, number and position;
Administrative policies such as rotation, week-
ends and holiday of duties;
Factors affecting Staffing:
Standards of care desired which should be
available and clearly spelled out.
Institutions may utilize the ANSAP’s
Standard of Nursing Practice; PRC-
ANSAP’s Standards of Safe Nursing
Practice and/or the hospitals themselves
may formulate or develop their own
standards;
Layout of the various nursing units and
resources available within the department
such as adequate equipment, supplies,
and materials;
Factors affecting Staffing:
Budget including the amount allotted
to salaries, fringe benefits, supplies,
materials and equipment;
Professional activities and priorities in
non-patient activities like involvement
in professional organizations, formal
educational development,
participation in research and staff
development;
Factors affecting Staffing:

Teaching program or the extent of

staff involvement in teaching
activities;
Expected hours of work per annum of
each employee. This is influenced by
the 40-hour week law; and
Hospital nursing service
administration manual of DOH
Cases NCH/Pt. Prof to Non
/day
Prof Ratio
General Medicine 3.5 60:40
Medical 3.4 60:40
Surgical 3.4 60:40
Obstetrics 3.0 60:40
Pediatrics 4.6 70:30
Pathologic Nursery 2.8 55:45
ER/ER/ICU 6.0 70:30
CCU 6.0 80:20
WORKLOAD MEASUREMENT
TOOL
Simplest formula in use where all nursing and
ancillary staff are treated equally for
determining hours of nursing care.
No differentiation is made for differing acuity
levels of patients

NCH/PPD=Nursing Hours worked in 24 Hours

Patient Census
CALCULATING STAFFING NEEDS
(Walsh,2003)

Category I Category II Category III Category IV

Acuity Level Acuity Level Acuity Level Acuity
Level

NCH/PPD AM 2.3 2.9 3.4 4.6

Shift

NCH/PPD PM 2.0 2.3 2.8 3.4

Shift

NCH/PPD 0.5 1.0 2.0 2.8

Night Shift
CALCULATING STAFFING NEEDS
(Walsh,2003)

When you came on duty this morning you had the

following patients;

1 patient in category l acuity level

2 patients in category ll acuity level
3 patients in category lll acuity level
1 patient in category IV acuity level

Note that you must be overstaffed or understaffed

by more than half of the hours a person is working
to reduce or add staff. For Example, nurses
working 8 hours shift, the staffing must be over or
under more than 4 hours to delete or add staff.
Seatwork!!!!!
Calculate the staffing needs for a day shift. You
have one RN and one LPN working 8 hours
shift and a ward clerk for 4 hours. ARE YOU
UNDERSTAFFED OR OVERSTAFFED???
2 patients in category acuity level I
3 patients in category acuity level II
2 patients in category acuity level III
0 patient in category acuity level IV
PATIENT CARE
CLASSIFICATION SYSTEM
Level I – Self Care or Minimal Care
Requires minimal medical treatment.
Requires minimal nursing intervention but
close observation. Average amount of
nursing care hours per patient per day is
1.5. Ratio of professional to non
professional nursing personnel is 55:45.
Examples: stable vital signs and
psychological status, one intravenous line,
good renal and hepatic function, can
perform activities of daily living (ADL)
PATIENT CARE
CLASSIFICATION SYSTEM
Level II – Moderate Care or Intermediate Care
Requires minimal medical treatment. Requires
moderate nursing observation and intervention.
Average nursing care hours per patient per day is 3
and the ratio of professional to non-professional is
60:40.
Examples: Need some assistance in performing ADL
in a short period of time, IVF therapy, arterial line in
place, stable vital signs and psychological status
PATIENT CARE
CLASSIFICATION SYSTEM
Level III – Total, Complete or Intensive Care
Requires frequent, close nursing observation and
intervention. Requires moderate medical
intervention. The nursing care hours per patient per
day is 6 with a professional to non professional ratio
of 65:35.
Examples: Completely dependent on nursing
personnel, may or may not be unconscious with
marked emotional needs, on continuous oxygen
therapy or on respirator but on weaning process,
with chest or abdominal tubes, with arterial line or
CVP line in place, frequent intravenous medications,
fluids, vital signs every hour.
PATIENT CARE
CLASSIFICATION SYSTEM
Level IV – Highly Specialized Critical
Care
Requires continuous treatment and
observation. The nursing care hours per
patient per day may range from 6-9 or more
and the ratio of professionals to non
professionals also range from 70:30 to
80:20.
Examples: Maintained continuously on
respirator, respiratory muscles paralyzed or
reflexes obtunded by narcotics, receiving
transfusions, multiple IVFs, unstable vital
signs, coagulation problems or impaired
renal and hepatic function.
 LEVELS OF CARE NCH Ratio of
Needed Prof to
Per Pt. Non-
Per Day Prof

Level I – Self Care or 1.5 55:45

Minimal Care
Level II – Moderate or 3.0 60:40
Intermediate Care
Level III – Total or 4.5 65:35
Intensive Care
Level IV – Highly 6.0 70:30
Specialized or Critical
Care
Table 1. Categories or levels7.0
of care of
patients, nursing care or
hours needed
higher 80:20
per patient per day and ratio of
professionals to non professionals.
 TYPE OF MINIM MODER INTENSIVE HIGHLY SPL.
HOSPITAL AL ATE CARE CARE
CARE CARE
Primary 70 25 5 -
Hospital
Secondary 65 30 5 -
Hospital
Tertiary 30 45 15 10
Hospital
Special Tertiary 10 25 45 20
Hospital
ble 2. Percentage of patients at various levels of
re per type of hospital.
COMPUTING FOR THE NUMBER
OF PERSONNEL NEEDED
one should ensure that there is
sufficient staff to cover all shifts, off-
duties, holidays, leaves absences and
time for staff development programs.
The Forty-Hour Week Law (Republic
Act 5901) provides that employees
working in hospitals with 100 bed
capacity and up will work only 40
hours per week.
COMPUTING FOR THE NUMBER
OF PERSONNEL NEEDED
Employees working in institutions with less than
one hundred bed capacity or those located in
communities with less than one million population
will work 48 hours a week and therefore will get
only one off-duty a week.
The latest is the granting of the 3-daY special
privilege to government employees by the Civil
Service Commission as per Memorandum Circular
No. 6, series of 1996, which may be spent for
birthdays, weddings, anniversaries, funerals,
relocation, enrolment or graduation leave,
hospitalization or accident leaves.
STAFFING FORMULA
To compute for the staff need in the in-patient
units of the hospital, the following steps
are considered.
Categorize the number of patients according
to the levels of care needed. Multiply the
total number of patients by the percentage
of patients at each level of care (whether
minimal, intermediate, intensive or highly
specialized).
STAFFING FORMULA
Example:
250(patients) x .30 = 75 patients
needing minimal care
250(patients) x .45 = 112.5 patients
needing moderate care
250(patients) x .15 = 37.5 patients
needing intensive care
250(patients) x .10 = 25patients
needing highly specialized care
STAFFING FORMULA
1. Find the total number of nursing care
hours needed by the patients at each
category level.
2. Find the number of patients at each level
by the average number of nursing care
hours (NCH) needed per day.
3. Get the sum of the nursing care hours
needed at various levels.
4. Find the actual number of nursing care
hours.
STAFFING FORMULA

Example:

75 patients x 1.5 (Level I) = 112.5 NCH/day

112.5patients x3 (Level II) = 337.5 NCH/day
37.5patients x 4.5 (Level III) = 168.75NCH/day
25patients x6 (Level IV) = 150 NCH/day
768.75NCH/day
STAFFING FORMULA

Find the actual number of nursing care

hours needed by the given number
of patients. Multiply the total nursing
care hours needed per day by the
total number of days in a year.
Example:
768.75 x 365(days/year) = 280,593.75
NCH/year
STAFFING FORMULA

Find the actual number of working

hours rendered by each nursing
personnel per year. Multiply the
number of hours on duty per day by
the actual working days per year.
Example:
8(hrs/day) x 213(working days/year)
= 1,704 (working hours /year)
STAFFING FORMULA
Find the total number of nursing personnel needed.
Divide the total number of nursing care needed
per year by the actual number of working hours
rendered by an employee per year.
Total NCH per year = 280,593.75 = 165
Working hours/year 1,704
Note: Constant values: 0.15 for 40 hours per
week ; 0.12 for 48 hours per week
Find the number of relievers. Multiply the
number of nursing personnel needed by 0.15
(for those working 40 hours per week) or by 0.12
(for those working 48 hours per week).
Relief x Total Nsg Personnel = 165 x 0.15 =25
Add the number of relievers to the number of
nursing personnel needed.
Total Nursing Personnel needed: 165+25=190
STAFFING FORMULA
Categorize the nursing personnel into
professionals to non professionals.
Multiply the number of nursing personnel
according to the ratio of professionals to
non professionals.
(65:35 ratio)
Example:
190 x .65 = 124 professional nurses;
190 x .35= 66 nursing attendants
STAFFING FORMULA
Distribute by shifts.
*Note: morning shift: 45% nursing personnel;
afternoon shift- 37% nursing personnel; night
shift-18% of nursing personnel
Example:
124 nurses x .45 = 56 nurses in AM shift
124nurses x .37 = 46nurses in PM shift
124 nurses x .18 = 22 nurses on nightshift
Total: 124 nurses

66NA x .45 = 30NA in AM shift

66NA x .37 = 24 NA in PM shift
66NA x .18 = 12 NA in night shift
Total: 66 NA
STAFFING FORMULA
It should be noted that computed nursing
personnel are only for in-patients. Therefore,
additional personnel should be hired for those in
supervisory and administrative positions and for
those in special units such as Operating Room,
Delivery Room, Emergency Room, and Out-
Patient Department.
A Head Nurse is provided for every nursing unit.
Likewise, a Nursing Superior is provided 1.) to
cover every shift in each clinical department or
area specialty unit; 2.) for each geographical area
in hospitals beyond 100 beds and; 3.) for each
functional area such as Training, Research,
Infection Control and Locality Management.
Hospitals now are also wellness centers.
Therefore, additional personnel are necessary for
health education classes both at the in-patient and
out-patient units.
SALAMAT PO AND GOD BLESS!!!