Staffing for hospital

STAFFING FOR NURSES IN A TERTIARY HOSPITAL WITH 250 BED

1. DEVANGI N SHARMA

2. DEFINATION Staffing is the process of determining and providing the acceptable number of  nursing personnel to produce a desired level of care to meet the patients demand DEVANGI N SHARMA

3. To provide each nursing unit with an appropriate and  acceptable  number   of nurses in  each category to perform the nursing tasks required . To avoid an improper mixture of nursing personnel will adversely affect the quality and quantity of work performed .   To   avoid high  rates of absenteeism and staffs turn-over resulting in low morale and dissatisfaction. DEVANGI N SHARMA

4. POPULATION SERVED PATIENTS NUMBER AND SEVERITY OF ILLNESS AVAILABILITY AND CHARACTERISTICS OF NURSING STAFF ADMINISTRATIVE POLICIES & STANDARD OF CARE LAYOUT OF NURSING UNIT & BUDGET FOR STAFF PATTERN OF WORK SCHEDULE AND PROFESSIONAL ACTIVITIES TYPE PHILOSOPHY OBJECTIVES  TYPE PHYLOSOPHY OBJECTIVE DEVANGI N SHARMA

5. STAFF SCHEDULING SCHEDULE Timetable showing planned work days and shift. SCHEDULING Assigning work and off days to nursing personnel to assure adequate patient care. DEVANGI N SHARMA

6. STAFFING VS SCHEDULING Staffing d etermines : How many people of what specific skills are needed in a specific department . Scheduling determines: Who By name and skill Will do what work and When (specific time period) DEVANGI N SHARMA

7. Criteria for Effective Staffing Coverage: The number of nurses assigned to be on duty should be in relation to the minimum number of nurses required Quality: The total number of patient care should be planned in such a way that trained nurses are available for patient care of 24 hours a day. DEVANGI N SHARMA

8. Contd … Stability: Allocation procedure must be consistent with leave and rotation policy. Each nurse must know her off, privileged leave etc. Flexibility: The allocation policy must provide flexibility. Objectives: There should be fairness in allocation and scheduling shift duties. DEVANGI N SHARMA

9. NURSE MANAGER Number of categories in which patient should be divided Characteristics of patients/category Type and number of care procedures needed by patient category Time needed to perform the procedures DEVANGI N SHARMA

10. STAFFING SCHEDULES DEVANGI N SHARMA

11. PATIENT CLASSIFICATION SYSTEM DEVANGI N SHARMA

12. 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: Serve in determining the amount of nursing care required, generally within 24 hours. To determine the category of nursing personnel who should provide that care. DEVANGI N SHARMA

13. PATIENT CLASSIFICATION SYSTEM E.A. Schmied A patient who requires only minimal amount of nursing care (an average of 2.8 nursing hours per 24 hours) A patient who requires average amount of nursing care (an average of 4.3 nursing hours per 24 hours) A patient who requires above average nursing care (an average of 5.6 nursing hours per 24 hours) A patient who requires maximum nursing care (an average of 8.6 nursing hours per 24 hours) DEVANGI N SHARMA

14. PATIENT CARE CLASSIFICATION USING FOUR LEVELS OF NURSING CARE INTENSITY LEVEL OF CARE TYPE OF CARE NCH/ PPT/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 III TOTAL INTENSIVE CARE 4.5 65:35 LEVEL IV HIGHLY SPECIALIZED OR CRITICAL CARE 6.0 70:30 DEVANGI N SHARMA

15. Can take a bath on his own Perform ADL About to be discharged Non- emergency case No any unusual symptom DEVANGI N SHARMA

16. Needs assistance in bathing, feeding or ambulating for short period of time Extreme symptoms have subsided or yet to appear Have slight emotional needs With IVF or BT Semi- conscious Have some psychosocial problem Periodic treatment, observation DEVANGI N SHARMA

17. Completely dependent on nursing personnel On continuous oxygen therapy With chest or abdominal tubes Requires close observation DEVANGI N SHARMA

18. Needs continuous treatment & observation Vital signs every 15 minutes Input/output chart every hour DEVANGI N SHARMA

19. NURSING CARE HOURS PER PATIENT PER DAY ACCORDING TO CLASSIFICATION OF PATIENTS BY UNITS CASES/PATIENTS NCH/PT/DAY PROF TO NON 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 Pathology nursery 2.8 55:45 ER/ICU/RR 6.0 70:30 CCU 6.0 80:20 DEVANGI N SHARMA

20. PERCENTAGE OF NURSING CARE HOURS PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CARE HOSPITAL TYPE LEVEL I LEVEL II LEVEL III LEVEL IV PRIMARY HOSPITAL 70 25 5 - SECONDARY HOSPITAL 65 30 5 - TERTIARY HOSPITAL 30 45 15 10 SPECIAL TERTIARY HOSPITAL 10 25 45 20 DEVANGI N SHARMA

21. TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR RIGHTS & PRIVILEGES GIVEN TO EACH PERSONNEL WORKING HOURS PER WEEK PER YEAR 40 HOURS 48 HOURS VACATION LEAVE 15 15 SICK LEAVE 15 15 LEAGAL HOLIDAYS 10 10 SPECIAL HOLIDAYS 02 02 SPECIAL PRIVILAGES 03 03 OFF-DUTIES as per R.A 5901 104 52 CONTUNING EDUCATION PROGRAMME 3 3 TOTAL NON WORKING DAYS PER YEAR 152 100 TOTAL WORKING DAYS PER YEAR 213 265 TOTAL WORKING HOURS PER YEAR 1704 2120 DEVANGI N SHARMA

22. RELIVERS Someone who takes the place of another DEVANGI N SHARMA

23. Computing relievers needed… Divide 33 (the average number of working days an employee is absent per year) by the number of working days per year that each employee serves (whether 213 or 265) This will be 0.15 per person who works 40 hours per week and 0.12 per person for those working 48 hours per week Multiply the computed reliever per person by the computed number of nursing personnel. DEVANGI N SHARMA

24. STAFFING FORMULA DEVANGI N SHARMA

25. ESTIMATING THE NURSE PERSONNEL FOR SINGLE UNIT DEVANGI N SHARMA

26. The nursing hours needed by per category of patient in 24 hours assessed as… CATEGORY OF PATIENT MORNING SHIFT EVENING SHIFT NIGHT SHIFT TOTAL Completely Dependent 3.27 2.50 1.47 7.24 Partially Dependent 1.62 0.91 0.55 3.08 Ambulatory 1.20 0.70 0.17 2.07 6.09 4.11 2.10 12.29 DEVANGI N SHARMA

27. Suppose a medicine ward is having 75 patients in which: 30 patients are ambulatory 25 patients are partially dependent 20 patients are completely dependent How to allocate nurses in each unit of hospital … DEVANGI N SHARMA

28. CATEGORY OF PATIENT DAILY AVERAGE TIME PER PATIENT IN 24 HOURS TOTAL PATIENT CALCULATION PER CATEGORY OF PATIENT TOTAL Completely dependent 7.24 20 7. 24 ×20 144.8 Partially dependent 3.08 2 5 3.08 × 25 77 Ambulatory patient 2.07 30 2.07 × 30 62.1 Total work load for 75 patients = 284 hours 283.9 hours DEVANGI N SHARMA

29. Working hours of 1 nurse per day= 8 Hrs/ day Total number of Nurses required: =284/8 = 36 nurses app. Calculating reliever when the leaves per nurse is 116 days / year. = 116/365 ×284/8 = 11 nurses Total nurses required = 36 + 11 = 47 Nurses DEVANGI N SHARMA

30. ESTIMATING THE NURSE PERSONNEL FOR A HOSPITAL DEVANGI N SHARMA

31. Categorize the number of patients according to the level of care needed Multiply total number of patient by % of patient at each level of care DEVANGI N SHARMA

32. Find the total number of nursing care  hours needed by the patients at each category level Find the number of patients at each level by the average number of NCH needed/day Get sum of NCH needed at various level DEVANGI N SHARMA

33. Find the actual number of nursing care hours needed by the given number of patients/bed capacity per year Total NCH needed/day x Total number of days in a year DEVANGI N SHARMA

34. Find the actual number of working hours rendered by each nursing personnel per year DEVANGI N SHARMA

35. Find the total number of nursing personnel needed Total NCH/year = TNP Working hrs/year Find the number of reliever Total nursing personnel x 0.15(for 40hrs/week) Total nursing personnel x 0.12(for 48 hrs/week) Add no. of relievers to number of nursing personnel needed DEVANGI N SHARMA

36. Categorize the nursing personnel into professionals and non-professionals DEVANGI N SHARMA

37. Distribute by shifts DEVANGI N SHARMA

38. Find the number of nursing personnel needed for 250 bed capacity in a tertiary hospital DEVANGI N SHARMA

39. REFERENCE Basavanthappa.B.T .,“ Nursing Administration,'' Jaypee brothers, medical publishers, New Delhi, first edition, 2000, pp. no.511-523. Ernst.S.Nora & et al, "Nursing home staff development , "A guide for in-service programs, Springer publishing company, New York, copy rights (c), 1983, pp. no.6-7. Marquis.L.Bessie , ‘’Leadership roles and management functions in nursing’’, Theory and applications, Lippincott, Philadelphia, Third edition, 2000, pp no.252-256. Barrett.Jean , ‘’Ward management and teaching’’, Konark publications, New Delhi, ninth reprint edition, 1998, pp. no.346-347. Wise. Yoder ‘Leadership and management in nursing’’, Mosby’s, printed at USA, first edition, 1995, pp. no.301-309. https://www.scribd.com/doc/25102504/Staffing-in-Nursing-Management https://www.scribd.com/doc/49818065/Staffing-Nursing-management DEVANGI N SHARMA

40. ABILITY is what you’re capable of doing MOTIVATION determines what you do ATTITUDE determines how well you do THANK YOU!!! DEVANGI N SHARMA