Staffing philosophy , norms

staffing philosophy and norms

1. STAFFING PHILOSOPHY , NORMS : STAFF INSPECTION UNIT (SIU), BAJAJ COMMITTEE, HIGH POWER COMMITTEE, INDIAN NURSING COUNCIL. ESTIMATION OF NURSING STAFF REQUIREMENT – ACTIVITY ANALYSIS AND VARIUOS RESEARCH STUDIES Princy Francis M IInd year MSc Nursing JMCON

2. CENTRAL OBJECTIVE At the end of the seminar, learner acquires in depth knowledge and understand the staffing philosophy, norms and estimation of nursing staff requirement and apply in the practical setting with a positive attitude.

3. SPECIFIC OBJECTIVE At the end of the seminar, learner will be able to, define staffing. describe philosophy of staffing. explains norms of staffing. explain staff inspection unit, Indian Nursing Council, Bajaj and High power committee. estimate various nursing staff requirement. 

4. STAFFING Staffing is 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 demand. Staffing is the function by which managers build an organization through recruitment, selection, and development of individuals as capable employees. - Mc Farland

5. NORMS Norms are standards that guide, control, and regulate individuals and communities.

6. FEATURES Staffing is management of manpower or human resource Staffing function is related to employment of nursing personnel of all types It includes variety of activities to get right type of nurses on right job at right time. It is concerned with filling various positions or jobs in the nursing organization with a suitable nursing personnel It is every nurse manager’s job .

7. FUNCTIONS IN STAFFING Identifying the type and amount of service needed by agency client. Determining the personnel categories that have the knowledge and skill to perform needed service measures. Predicting the number of personnel in each job category that will be needed to meet anticipated service demands. Obtaining, budgeted positions for the number in each job category needed to service for the expected types and number of clients.

8. FUNCTIONS IN STAFFING cont … Recruiting personnel to fill available positions. Selecting and appointing personnel from suitable applicants. Combining personnel into desired configurations by unit and shift. Orienting personnel to fulfill assigned responsibilities. Assigning responsibilities for client services to available personnel

9. 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.

10. 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.

11. PHILOSOPHY OF STAFFING IN NURSING Nurse administrators believe that: ¶ It is possible to match employees competency to patient care needs in a manner that optimizes job satisfaction and care quality ¶ The technical and humanistic care needs of critically ill patients are so complex that all aspects of that care should be provided by professional nurses ¶ The health teaching and rehabilitation needs of chronically ill patients are so complex that direct care for chronically ill patients should be provided by professional and technical nurses.

12. ¶ Pati ent assessment, work load and job analysis should be used to determine the number of personnel in each category to be assigned to care for patients of each type(such as coronary care, renal failure, chronic arthritis, paraplegia, cancer, etc ) ¶ A master staffing plan and policies to implement the plan in all units should be developed centrally by the nursing heads and staff of the hospital ¶ The staffing plan details such as shift duty rotation plan, number of staffs assigned on holidays and number of employees assigned to each shift can be calculated to accommodate the units workload and workflow.

13. COMPONENTS / STEPS OF STAFFING Manpower planning: It is concerned with determining number and type of nursing staff required for different types of hospitals. Job analysis : It is for finalizing the job specification and job description; thereby help in developing the recruitment policies. Recruitment :Recruitment refers to identification of sources of nursing manpower availability and making of efforts to secure or attract applicants for various job positions.

14. Selection :. It includes receiving and screening of applications, employment tests, interview and medical examination of candidate. Placement : Placement ensures the right staff is placed or assigned the unit or hospital as per her capability. Induction and orientation : It is the process of inducting or orienting a new employee to the organization and job. Training and development : In order to keep skills and knowledge of the staff in doing the job, various methods of training can be used.

15. Remuneration : It is a kind of compensation provided monetarily to the employees for their work performances. Performance appraisal : This function of staffing guides the staff as per performance. Promotion and transfer

16. STAFFING NORMS Staff Inspection Unit ( S.I.U) Bajaj Committee High power committee Indian Nursing Council

17. STAFF INSPECTION UNIT (S.I.U.) It recommended the nursing norms in the year 1991-92. As per this S.I.U. norm the present nurse-patient ratio is based and practiced in all central government hospitals.

18. Recommendations 10% leave reserve (maternity leave, earned leave and days off as nurses are entitled for 8 days off per month and 3 national holidays per year when doing 3 shift duties) and 45% posts reserve where services are provided for 365 days in a year/24 hours. The post of nursing sister and staff nurses are clubbed together. Both will perform nursing care work.

19. • 30% posts may be sanctioned as nursing sister. The nursing sister to staff nurse ratio will be 1:3.6 . • The ratio of assistant nursing superintendent to nursing sisters is recommended as 1:4.5. They will work in shift duty. • The ratio of Deputy nursing superintendent to assistant nursing superintendent is recommended as 1:7. • Nursing superintendent: 1 for 250 beds or more. • Chief nursing officer: 1 for 500 beds or more.

20. BAJAJ COMMITTEE, 1986 An "Expert Committee for Health Manpower Planning, Production and Management" was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS. Manpower is one of the most vital resources for the labour intensive health services industry. Health for all (HFA) can be achieved only by improving the utilization of these resources.

21. recommendations Formulation of National Medical & Health Education Policy. Formulate on of National Health Manpower Policy. Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of UGC. Establishment of Health Science Universities in various states and union territories. Establishment of health manpower cells at centre and in the states. Vocationalisation of education at 10+2 levels as regards health related fields with appropriate incentives, so that good quality paramedical personnel may be available inadequate numbers. Carrying out a realistic health manpower survey.

22. Hospital Nursing Services 1. Nursing superintendents-1:200 beds 2. Deputy nursing superintendents-1:300 beds 3. Departmental nursing- 7:1000 + 1 Additional: 1000 beds 4. Ward nursing -8:200 + 30% leave reserve supervisors/sisters 5. Staff nurse for wards 1:3 (or 1:9 for each shift)+30 leave reserve 6. For OPD, Blood Bank, X-ray, Diabetic clinics, CSR, etc 1:100 (1:5 OPD)+30%leave reserve 7. For intensive units 1:8 (1:3 for each shift)(8 beds ICU/200 beds) + 30% leave reserve 8. For specialized depts. and clinics, OT, Labour room 8:200 + 30% leave reserve

23. HIGH POWER COMMITTEE, 1987 The High Power committee on Nursing was appointed by Government of India, ministry of Health and Family welfare on 29th July, 1987 (under the chairmanship of Smt. Sarojini vardappan ) to review the roles, functions, status, preparation of nursing personnel, nursing services and other issues related to the development of the profession and to make suitable recommendations to the government.

24. Recommendations on Nursing and Nursing Profession Employment : Uniformity in employment procedures to be made. Job description : Job description of all categories of nursing personnel is prepared by the central government to provide guidelines. Working hours : The weekly working hours should be reduced to 40 hrs per week. Extra working hours to be compensated either by leave or by extra emoluments depending on the state policy. Nurses to be given weekly day off and all the gazette holidays as per the government rules.

25. Work load/ working facilities : Nursing norms for patient care and community care to be adopted Pay and allowances: Uniformity of pay scales of all categories of nursing personnel is not feasible. However special allowance for nursing personnel, i.e.; uniform allowance, washing, mess allowance etc should be uniform throughout the country.

26. Promotional opportunities : The committee recommends that along with education and experience, there is a need to increase the number of posts in the supervisory cadre, and for making provision of guidance and supervision during evening and night shifts in the hospital. Each nurse must have 3 promotions during the service period. Promotion is based on merit cum seniority .

27. Career development: Provision of deputation for higher studies after 5 yrs of regular services is made by all states. The policy of giving deputation to 5 -10 % of each category be worked out by each state. Accommodation : As far as possible, the nursing staff should be considered for priority allotment of accommodation near to work place. Transport: During odd hours, calamities etc arrangements for transport must be made for safety and security of nursing personnel.

28. Special incentives : Scheme of special incentives in terms of awards, special increment for meritorious work for nurses Occupational hazards: Medical facilities as provided by the central govt. by extended by the state govt to nursing personnel till such times medical services are provided free to all the nursing personnel. Risk allowance to be paid to nursing personnel working in the rural & urban area. Other welfare services : Hospitals should provide welfare measures like crèche facilities for children of working staff, children education allowance.

29. Nursing superintendent 1:200 beds(hospitals with 200 or more beds) Deputy nursing superintendent 1:300 beds(wherever beds are over 200) Assistant nursing superintendent 1:150 beds(wherever beds are over 150)(7:1000 beds) Ward sister/ ward supervisor 1:25 beds+30% leave reserve Staff nurse for wards 1:3(or 1:9 for each shift)+30% leave reserve Staff nurses for OPD and emergency etc 1:100 patients (1 bed:5 out patients)+ 30% leave reserve For ICU 1:1(or 1:3 for each shift)+30% leave reserve For specialized depts. such as operation theatre, labour room, etc 1:25+30% leave reserve

30. INDIAN NURSING COUNCIL (INC) The Indian Nursing Council is an Autonomous Body under the Government of India and was constituted by the Central Government under the Indian Nursing Council Act, 1947 of parliament. It was established in 1949 for the purpose of providing uniform standards in nursing education and reciprocity in nursing registration throughout the country.

31. INC staffing norms in Hospital 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.

32. The Nurse-patient Ratio as per INC 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 for 5 beds in Non-teaching Hospital +30% Leave reserve Extra Nursing staff to be provided for departmental research function

33. The Nurse-patient Ratio as per INC

34. INC Staffing pattern in nursing colleges Principal cum Professor 15 years experience with M.Sc (N) out of which 12 years should be teaching experience with minimum of 5 years experience in collegiate programme . Ph.D (N) is desirable Vice – Principal cum Professor 12 years experience with M.Sc (N) out of which 10 years should be teaching experience with minimum of 5 years’ experience in collegiate programme . Ph.D (N) is desirable. Professor 10 years experience with M.Sc (N) out of which 7 years should be teaching experience. Ph.D (N) is desirable Associate Professor / Reader M.Sc (N) with 8 years including 5 years teaching experience. Ph.D (N) is desirable Assistant Professor / Lecturer M.Sc(N) with 3 years teaching experience. Ph.D(N) is desirable Tutor / Clinical Instructor M.Sc (N) or B.Sc (N) / P.B.B.Sc (N) with 1year experience

35. Sl. No Designation BSc(N) 61 - 100 students PBBSc(N) 20 – 60 students 1 Professor cum Principal 1   2 Professor cum Vice Principal 1   3 Professor 1   4 Asso. Professor 4   5 Asst. Professor 6 2 6 Tutor 19 – 28 2 - 10 Teacher student Ratio 1:10

36. Sl. No Designation MSc(N) (10 - 25) students 1 Professor cum Program coordinator 1 2 Asso. Professor 1 3 Asst. Professor / Lecturer 2

37. ESTIMATION OF NURSING STAFF REQUIREMENT

38. PATIENT CLASSIFICATION SYSTEMS Patient classification system (PCS), which quantifies the quality of the nursing care, is essential to staffing nursing units of hospitals and nursing homes. The primary aim of PCS is to be able to respond to constant variation in the care needs of patients. The patient classification system supplies the tool necessary to provide and justify adequate nursing staff to meet the standards for quality and appropriateness of nursing care.

39. According to Indian Health Service, the classification system will be used to: measure productivity of nursing staff. compare nursing resources with patient care needs within and between facilities. provide equitable staffing and allocation of resource.

40. Levels of Patient classification System Level of care with definition Level – I Minimum Nursing care 2hrs / 24 hrs Level – 2 Partial Nursing care 4hrs / 24 hrs Level – 3 Full Nursing care 6hrs / 24 hrs Level – 4 Complex Nursing care 8hrs / 24 hrs Definitions of level of care for intensive care patients Level – I Minimum Nursing care 6hrs / 24 hrs Level – 2 Partial Nursing care 12 hrs / 24hrs Level – 3 Full Nursing care 18hrs / 24hrs Level – 4 Complex ICU care 24hrs / 24hrs

41. Formula for day to day and shift to shift calculation No. of staff required to work per 24hrs = Required hours of patient care No. of hours staff actually work each shift = Sum of standard times of each level of care x No. of patients in the level No. of hours staff actually work each shift Total hours of care needed = number of employees per 24 hrs

42. Employee Mix Professional (RN) 70% of total staff Non professional (LPN, NA) 30% of total staff Distribution per shift Day shift 43%of total staff Evening shift 32% of total staff Night shift 25% of total staff

43. Example Level of care No of patients / level I 2 II 8 III 10 IV 2

44. Calculations   Method of calculating the working hours per week per nurse Method of calculating nurse patient ratio or number of patients per bedside nurse Method of calculating maximum nursing time available per patient per nurse per shift

45. Calculating the working hours per week per nurse No: of average working days/ year = 365 - Average number of leave days Number of available nurses per day throughout year = No. of average days × Number of Bed-side nurses in position in that unit 365 3. Find out the number of nurses working in morning, evening and night duty. 3:2:1 or 1:1:1 Number of nurses available in morning shift= Total no: of nurses-Number of nurses in evening and night duty

46. 4. The total available working hours per shift per year ( 8hrs/ shift or 6, 6,12hrs ) Total available working hours in the morning shift in a year=No of hours in morning shift × No of nurses available in morning shift ×365 5. Total available working hours in a year=total available working hours in morning shift + evening shift + night shift in a year 6. Average number of working hours per week per nurse = Available working hours in a year 52 × No of available nurses per day throughout year

47. Calculating nurse patient ratio or number of patients per bedside nurse Step1, step 2 step 3 as above STEP 4: Find out the nurse patient ratio for each shift. Nurse patient ratio in morning shift = No: of nurses in morning shift: Total no: of patients Nurse patient ratio in evening shift = No: of nurses in evening shift: Total no: of patients Nurse patient ratio in night shift = No: of nurses in night shift: Total no: of patients

48. Method of calculating maximum nursing time available per patient per nurse per shift Calculate nurse patient ratio Maximum nursing time (in minutes) available per patient per nurse in morning shift = Duration of morning shift × 60 No: of patient per nurse in morning shift

49. Staffing requirement for 250 bedded tertiary hospital 1 . Categorize patients according to level of care: 250×20% = 75 Minimal care 250× 45% = 112.5 Moderate care 250×15% = 37.5 Intensive care 250× 10 % = 25 Highly specialized nursing care

50. 2. Find the nursing care hours needed: 75 × 2 (NCH @ level 1) = 150 NCH/day 112.5×4(NCH @ level 2) =450 NCH/day 37.5 × 6 (NCH @ level3) = 225 NCH/day 25× 10 (NCH @ level 4) = 250 NCH/day TOTAL = 1075 NCH/day

51. 3. Find NCH /year 1075×365 = 392375 NCH/year 4. Find actual working hours needed by each nursing personnel 6hrs/day × 213 (working days/year) = 1278 working hours /year 5. Find the total number of nursing personnel needed: Total NCH/year = 392375 = 307.02 = 307 Working hours/year 1278

52. Number of relievers needed = Total nursing personnel × 15% (15% is constant for 40hrs/ week and 10% for 45 hrs /week). So relievers = 307 × 15% = 46. So total personnel needed = 307 + 46 = 353 6. Determine professional and non professional personnel: (Tertiary hospital) 353 × 70% = 247 professional 353× 30% = 106 non professional personnel

53. 7. Distribute per shift:   Prof (247) Non prof (106) Morning (43%) 106 46 Evening (32%) 79 34 Night (25%) 62 26

54. Staffing requirement for 150 bedded hospital Step 1: Calculate the average nursing staff requirement throughout a 24-hour period Total nursing requirement for each 24-hour period = average nursing needs of patients (6hrs) X bed utilization (150beds) + additional workload (7hrs) = 907 nursing hours for each 24-hour period.

55. Step 2: Determine required ward nursing staff establishment and shift allocation Skill mix = 70% RN & 30% NURSING ASSISTANTS Nursing staff required each day = 907/6 = = 151 nursing staff . So 106 registered nurse and 45 healthcare assistant.

56. Average number of hours a full time nurse is anticipated to provide = 1608 hours Full-time working (6 x 6=36 hours per week) equates to a maximum of 1872 working hours per year (36 x 52), excluding any leave or absence. Anticipated absence such as sick leave or maternity leave, was an average of 44 days or 264 hours (44 x 6) per year for each member of the nursing team. On average, a full time existing member of the nursing team could therefore provide an anticipated 1608 hours per year (1872– 264).

57. Ward nursing staff establishment (full time equivalents) = 144 registered nurses and 62 healthcare assistants The ward’s total nursing requirement of 907 nursing hours for each 24-hour period equates to 331055 nursing hours per year (907 x 365). On the basis that an average each full time equivalent member of the nursing team can provide 1608 hours per year, the number of full time equivalent nursing staff required is 206 (331055/1608). Based on the skill mix assessment that 70% need to be registered nurses, 144 registered nurses and 62 healthcare assistants were required in the ward nursing staff establishment.

58. ACTIVITY ANALYSIS Activity analysis or task analysis of each person and how long he does each task is another approach to allocate nurses. Activity analysis is a way of estimating or evaluating the size and mix of ward nursing teams. It is especially useful in wards where patient numbers and mix fluctuate.

59. ACTIVITIES There are four main activities: The patient’s care plan is completed or updated each day. The total hours for all patients generated by all the care plans in the ward are aggregated. All wards’ nursing hours are collated enabling the manager to distribute nursing staff equitably. Validity checks are done by experienced staff to ensure consistency in the selection and recording of nursing interventions .

60. STRENGTHS Generates results that can be corroborated by other methods Easily computerized so that the method becomes part of a nursing information system. Commercial systems, such as GRASP, are readily available The base information is easily updated by periodic reviews of nursing interventions. Adopting the system in other care settings is possible without destroying its integrity.

61. DRAWBACKS This method is time hungry and time spent on the preparation and maintenance of detailed care plans may add considerably to the overall nursing workload. The effort needed to maintain detailed care plans for each patient in every shift adds considerably to the ward ‘overhead’. Commercial systems are the most expensive of all the methods described, but are largely capital rather than recurrent costs. Systems are time consuming to set up and implement. The system does not lend itself to application across a variety of ward settings and does not accommodate diversity within a ward well

62. A GUIDE TO STAFFING NURSING SERVICES 1. Projecting Staffing Needs Identify the components of nursing care and nursing service. Define the standards of patient care to be maintained. Estimate the average number of nursing hours needed for the required hours. Determine the proportion of nursing hours to be provided by registered nurses and other nursing service personnel. Determine polices regarding these positions and for rotation of personnel.

63. 2. Computing number of nurses required on a Yearly Basis Find the total number of general nursing hours needed in one year. Average patient census X average nursing hours per patient for 24 hours X days in week X weeks in year. Find the number of general nursing hours needed in one year which should be given by registered nurses and the number which should be given by ancillary nursing personnel. Number of general nursing hours per year X percent to be given by registered nurses. Number of general nursing hours per year X percent to be given be ancillary nursing personnel.

64. 3. Computing number of nurses assigned on weekly basis 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. 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. Number of general nursing hours per week X percent to be given by registered nurses. Number of general nursing hours per week X percent to be given by ancillary nurses .

65. 4. Computing number of nurses required on daily basis Find the fraction of the registered nurse and ancillary nursing personnel regularly assigned to the unit on a weekly basis who are on duty daily. Days working each week divided by total days in a week. Find the number of registered nurses and number of ancillary nursing personnel on duty daily. Number of registered nurses assigned to the unit weekly x fraction of registered nurse personnel on duty daily. Number of ancillary nursing personnel assigned to the unit of weekly basis x fraction of ancillary nursing personnel on duty daily.

66. FACTORS INFLUENCING STAFFING REQUIREMENT IN THE NURSING SERVICE UNIT The client to be served The hospital Policies and composition of medical staff Use of nursing skills Supportive services Administrative policies Presence /absence of clerical assistance Factors inherent in the nursing staff Allocation of personnel

67. ROLE AND FUNCTIONS OF ADMINISTRATOR / MANAGER IN STAFFING SCHEDULES Roles Identifies creative and flexible staffing methods to meet the needs of the patients, staff and the organization. Knowledgeable regarding contemporary methods of scheduling and staffing Assumes a responsibility towards staffing that builds trust and encourages team approach. Periodically examines the unit standard of productivity to determine if changes are needed. Is alert to extraneous factors that impact on staffing Is ethically accountable to patients and employees for adequate safe staffing

68. Functions Provides adequate staffing to meet patient care needs according to the philosophy of the organization Uses organizational goals and patient classification tools to minimize under staffing and overstaffing as patient census and acuity fluctuate Schedules staff in a fiscals responsible manner. Develops fair and uniform scheduling policies and communicates clearly to all staff Ascertains that scheduling policies are not in violation of local and national labour laws, organizational policies and union contracts. Assumes accountability for quality and fiscal control of staffing. Evaluates scheduling and staffing procedures and policies on a regular basis.

69. RESEARCH STUDIES 1. A study to calculate the nursing staff requirement for the Maternity Ward of Medical College Hospital, Kolkata Applying WISN method. Dr. Saikat Das, Dr. Nirmalya Manna. Journal of Dental and Medical Sciences. 2015. July; 16(3): 209 For adequate and appropriate distribution of health services, together with increasing financial pressures in the public sector, determination of staffing levels in the health facilities are important. The Workload Indicators of Staffing Need (WISN) method is one such method.

70. It uses a form of activity analysis (activity standards), together with measures of utilization and workload to determine staffing requirements. The present study was conducted to calculate the nursing staff requirement and their work pressure in maternity ward of Medical College Kolkata. WISN method provides a useful mechanism for assessing priorities to address staff overloads or staff under-utilization.

71. 2. Estimation of direct cost and resource allocation in intensivecare : correlation with omega system. Sznajder M1, Leleu G, Buonamico G, Auvert B, Aegerter P, Merlière Y, Dutheil M, Guidet B, Le Gall JR. Intensive Care Med. 1999 Feb; 25(2):245-6. The aim of this study was to propose an instrument able to estimate the direct costs of stays in Intensive Care Units(ICUs) simply would be very useful for resource allocation inside a hospital, through a global budget system. Data base has collected standard data of intensive care such as the Omega Score, Simplified Acute Physiologic Score, length of stay, length of ventilation, main diagnosis and procedures. On the sample of 121 patients, medical expenditure and nursing time associated with interventions were measured through a prospective study.

72. The correlation between Omega points and direct costs was calculated, and regression equations were applied to the 12,000 stays of the data base, leading to estimated costs. The Omega Score is strongly correlated to total direct costs, medical direct costs and nursing requirements. The discrepancy of estimated costs through Omega Score and actual costs may result from drugs, blood product underestimation and therapeutic procedures not involved in the Omega Score. The Omega system appears to be a simple and relevant indicator with which to estimate the direct costs of each stay, and then to organise nursing requirements and resource allocation.

73. 3. Impact of shift work on the health and safety of nurses and patients. Berger AM, Hobbs BB. Clin J Oncol Nurs . 2006 Aug;10(4):465-71. Shift work generally is defined as work hours that are scheduled outside of daylight. Shift work disrupts the synchronous relationship between the body's internal clock and the environment. The disruption often results in problems such as sleep disturbances, increased accidents and injuries, and social isolation. Physiologic effects include changes in rhythms of core temperature, various hormonal levels, immune functioning, and activity-rest cycles. Adaptation to shift work is promoted by re-entrainment of the internally regulated functions and adjustment of activity-rest and social patterns.

74. Nurses working various shifts can improve shift-work tolerance when they understand and adopt counter measures to reduce the feelings of jet lag. By learning how to adjust internal rhythms to the same phase as working time, nurses can improve daytime sleep and family functioning and reduce sleepiness and work-related errors. Modifying external factors such as the direction of the rotation pattern, the number of consecutive night shifts worked, and food and beverage intake patterns can help to reduce the negative health effects of shift work. Nurses can adopt counter measures such as power napping, eliminating overtime on 12-hourshifts, and completing challenging tasks before 4 am to reduce patient care errors.

75. REFERENCES Vati J. Nursing Management and administration. Newdelhi : Jaypee Brothers Publication; 2013. p.p 316- 326 Clement I. Management of nursing services and education. Second edition. Newdelhi : Elsevier publication; 2005. p.p 48- 54 Basvanthappa B T. Nursing Administration. 2nd edition. Newdelhi : Jaypee Brothers Publication; 2009. p.p 184 – 188, 202- 210. Raj BED, Anbu T, Venkatesan B, Loganathan G. managemen of nursing services and education. Bangalore : Emmess medical publishers; 2012. p.p 70-74, 78-81