STAFFING & DUTY

SCHEDULING

Pamela M. Veroy RN, MAN

“Be fair In the distributionof duty hours to your nursingstaff.”

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 patient’s demand.

• Purpose: to provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required.

Factors affecting staffing

• 1. The type, philosophy and objectives f the hospital and the nursing service

• 2. the population served or the kind of patients served whether pay or

charity

• 3. the number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with

the actual care needs of patients

Factors affecting staffing

• 4. Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position:

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

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

Factors affecting staffing• 7. layout of the various nursing units and

resources available within the department such as adequate equipment, supplies and materials.

• 8. budget including the amount alloted to salaries, fringe benefits, supplies,

materials and equipment;• 9. 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

• 10. teaching program or the extent of staff involvement in teaching 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 and three days off; or 3

½ days of 12 hours per day and 3 ½ days off per week.

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

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 5:45

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

6.07 or higher

70:3080:20

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

Computing for the number of nursing personnel needed

- 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)- for 100 bed capacity and up

-Granting of the 3-day special privilege to govt. employees by the Civil Service Commission as per Memorandum Circular No. 6 series of 1996 (birthdays, weddings, anniversaries, funerals (mourning), relocation, enrollment or graduation leave, hospitalization, and accident leave.

Total No. working-Non working days & hours of nursing personnel per year

Rights & Privileges Given Each Personnel Per Year

Working Hours Per Week

40 hours 48 hours

1. Vacation Leave2. Sick Leave3. Legal Holidays4. Special Holidays5. Special Privileges6. Off-Duties as per R.A. 59017. Continuing Education Program Total Non-working Days per year Total working days per year Total working hours per year

15151023

1043

152213

1,704

15151023

523

100265

2,120

Relievers Needed

- To compute for relievers needed, the following should be considered;

1. Average number of leaves taken each year------ 15

a. vacation 15

b. sick leave 5

2. Holidays -----------------------------------------------------12

3. Special Privileges as per CSC MC#6 s. 1996-------3

4. Continuing Educ. Prog. For professionals------------3

Total Average Leave-------33

To determine the relievers needed

- divide 33 by number of working days per year each employee served (whether 213 or 265)

- result will be 0.15 per persons works for 40 hour/week

- result will be 0.12 per persons works for 48 hour/week

- multiply the computed reliever per person by the computed number of nsg personnel

- this will give you the total number of relievers

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

Total = 66 nursing attendants

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.

Make a schedule in a weekly or monthly basis and do cycle system with the staff under the area assigned for fairness and

flexibility.

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