CONTENT I.

Definition of 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. II. Purpose of Staffing Its purpose is to provide a nursing unit with an appropriate and acceptable number of workers in each category to perform the various nursing tasks required. If proper staffing is not done, it will adversely affect the quality and quantity of work done. III. Factors Affecting Staffing Various factors affect staffing and these are !." #he type, philosophy and ob$ectives of the hospital and nursing service% &." #he population served or the kind of patients served whether pay or charity% '." #he number of patients and severity of their illness ( knowledge and ability of nursing personnel are matched with the actual care needs of patients% )." *vailability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position% +." *dministrative policies such as rotation, weekends and holiday off,duties% -." Standards of care desired which should be available and clearly spelled out. Institutions may utili.e the *ssociation of /ursing Service *dministrators of the 0hilippiness 1*/S*0" Standard of /ursing 0ractice% 023,*/S*0s Standards of Safe /ursing 0ractice and4or the hospitals themselves may formulate4develop their own standards% 5." 6ayout of the various nursing units and resources available within the department such as adequate equipment, supplies and materials% 7." 8udget including the amount allotted to salaries, fringe benefits 1insurance", supplies and materials% 9." 0rofessional activities and priorities in non,patient activities like involvement in professional organi.ations, formal educational development, participation in research and staff development% !:."#eaching program or the extent of staff involvement in teaching activities% !!.";xpected hours of work per year of each employee. #his is influenced by the ):,hour week law% and IV.

!&."0atterns of work schedule ( traditional + days per week, 7 hours per day% ) days a week, !: hours per day and three days off% or ' < days of !& hours per day and ' < days off per week. Staffing Needs /urse staffing varies on every factor that affects it. #he environment changes as new patients are admitted each day in the hospital. #he effectiveness of a staffing pattern is only as good as the planning that goes into its preparation. Several key concepts were identified according to *nne 8ernat. #hese key concepts are the =ull,#ime ;quivalent 1=#;" and /ursing >ours per 0atient ?ay 1/>00?". Full-Time E ui!alent "FTE# =ull,time equivalent 1=#;" is a measure of the work commitment of a full,time employee. =#; hours are the total paid time and includes the productive and nonproductive time. *n =#; of !.: means that the person is a full,time employee while an =#; of :.+ means that the person is only a part,time employee. * full time employee works for 7 hours a day for + days a week which is equal to ): hours of work per week for +& weeks a year. #his amounts to &,:7: hours of work time per year. + days per week @ ): hours per week @ 7 hours per day A ): hours per week +& weeks per year A &,:7: hours per year

#o get the =#; from the hours per week, the table below can be used to get the =#;. !.: =#; :.7 =#; :.- =#; :.) =#; :.& =#; A A A A A ): hours or five 7,hour shifts per week '& hours or four 7,hour shifts per week &) hours or three 7,hour shifts per week !- hours or two 7,hour shifts per week 7 hours or one 7,hour shift per week

Bn Cune &!, !9-9, there has been an implementation of 2epublic *ct +9:! which is known as an act prescribing forty hours a week of labor for government and private hospitals or clinic personnel who are working in hospitals with over !:: bed capacity. ;mployees working in agencies with less than !:: bed capacity or those in communities with less than one million population will work )7 hours a week. D !:: 8ed 3apacity E !:: 8ed 3apacity A A ): hours a week with & days off )7 hours a week with ! day off

Calculating for Producti!e Time and Nonproducti!e Time *t work, a person has two different types of working time, the productive and nonproductive time. #he productive time is the amount of time the employee works such as patient care and charting. /onproductive hours are benefit hours which are given to employees. #hese benefit hours are vacation leave, sick leave, holidays, special privileges, off duties and training programs. #he ' day special privilege is given to all government employees by the 3ivil Service 3ommission as per Femorandum 3ircular /o. -, series of !99- which can be spent for birthdays, weddings, anniversaries, funerals, relocation, enrollment or graduation leave, hospitali.ation and accident leaves. #he productive time can be taken by subtracting total working hours to the nonproductive time. 0roductive #ime A #otal >ours Gorking , /onproductive #ime

organi.ation. In order to attain the />00?, first solve for the number of staff available over &) hours and multiply the sum by 7 hours, then divide the result by the number of patients in a unit. K of Staff @ ' Shifts A K of Staff available for &) hours K of Staff4&)hours @ 7 hours A K of /ursing >ours available in &) hours K of /ursing >ours L K of 0atients A />00? * standard was developed by the ?epartment of >ealth about the amount of nursing care hours should be given to patients in various units of a hospital. #his standard can be found in the >ospital /ursing Service *dministration Fanual. 3ases40atients !. Heneral Fedicine &. Fedical '. Surgical ). Bbstetrics +. 0ediatrics -. 0athologic /ursery 5. ;24I3J422 7. 33J /3>40t4?a y 1/>00?" '.+ '.) '.) '.: ).&.7 -.: -.: 0rof. to /on 0rof. 2atio -: ): -: ): -: ): -: ): 5: ': ++ )+ 5: ': 7: &:

#o get the nonproductive hours of an employee, there would be a need to get the sum of all benefits given to him. 2ights and 0rivileges Hiven 0ersonnel per Iear !. Vacation 6eave &. Sick 6eave '. 6egal >olidays ). Special >olidays +. Special 0rivileges -. Bff, ?uties 12.*. +9:!" 5. #raining #otal /on,Gorking ?ays 0er Iear #otal Gorking ?ays 0er Iear #otal Gorking >ours 0er Iear ;ach Gorking >ours 0er Geek ): hours )7 hours Jnit !+ !+ !+ !+ !: !: ? & & * ' ' I !:) +& S ' ' ,,,,,,,,,, ,,,,,,,,,,, !+& !:: ?ays &!' &-+ ?ays !5:) &)9>ours

V.

Patient Care Classification S%stem "PCCS# 0atient care classification system 1033S" 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. 1Ven.on, &::'". 8ernat defines the 033S as a measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. *s defined by the two authors, 033S is a tool used to classify patients according to the amount of care they need. #he amount of care is generated for each patient through patient acuity. 0atient acuity is the determination of level of care needed by a certain patient and is mainly used for staffing purposes. Purposes of t&e PCCS' In order to fully understand the 033S, there would be a need to know its purpose to make the 033S effective. Its purposes are the following !." Staffing &." 0rogram costing and formulation of the nursing budget '." #racking changes in patient care needs.

/ote Bne working day is equal to 7 hours as stated in the 2.*. +9:!. Nursing $ours per Patient Da% "N$PPD# /ursing hours per patient day 1/>00?" is a standard measure that quantifies the nursing time available to each patient by available nursing staff. #his measure is useful in quantifying nursing care to both nurses and financial staff in an

)." ?etermining values for the productivity equation. +." ?etermining quality. C&aracteristics of an effecti!e PCCS' #he following characteristics are desirable of 033S, which should !." ?ifferentiate intensity of care among definitive classes. &." Feasure and quantify care to develop a management engineering standard. '." Fatch nursing resources to patient care requirements. )." 2elate to time and effort spent on the associated activity. +." 8e economical and convenient to report and use. -." 8e mutually exclusive, counting no item under more than one work unit. 5." 8e open to audit. 7." 8e understood by those who plan, schedule, and control the work. 9." 8e individually standardi.ed as to the procedures needed for accomplishment. !:."Separate requirements for registered nurses from those of other staff. Factors Affecting t&e PCCS'

&." 3hecklist #he checklist,style acuity table divides descriptions of care routines into activity categories such as eating and bathing. *ctivity levels are described in each category. 6evels in the eating category might be self,care, help setting up, feed, frequent feedings. ;ach activity is assigned to an activity level point score. *fter the nurse totals the points for each patient, the level of care can then be determined according to a range of points per category. '." #ime or 2elative Value Jnit Standard In time or relative value unit standard system, it assigns a value unit to various activities of patient care. #hose activities are usually clustered according to categories, such as diet, bathing and mobility. )." Fedicus #he medicus is one of the first 033S developed. It clusters patients into five categories with + being the greatest intensity of care. Indicators and the average hours of nursing care required determine the level. Classification Categories'

#here are certain factors that mainly affect the 033S, and these are !." #he number of categories into which the patients should be divided% &." #he characteristics of patients in each category% '." #he type and number of care procedures that will be needed by a typical patient in each category% and )." #he time needed to perform these procedures that will be required by a typical patient in each category. T%pes of PCCS' #here are various types of 033S, the main difference of these types is on how each patient is categori.ed. #he different types are !." ?escriptive In the descriptive style, the nurse classifies the patient in the category that most closely describes the care received. #he tool used is a narrative on a concise acuity table. #he nurse chooses the category that best describes the patient. #he main problem with this style is interrater reliability, caused by the sub$ectivity of the interpretation of the patients degree of care. #he descriptive style is a quick,check guide, but the poor interrater reliability leads to a wide range of requested nurse,patient ratios.

3ertain units in the hospital may develop their own classification system. Ven.on gives a good example of a classification system that has only four classifications. Level I ( Self Care or Minimal Care. 0atient can take a bath on his own, feed himself, feed and perform his activities of daily living. =alling under this category are patients about to be discharged, those in non,emergency, the newly admitted, does not exhibit unusual symptoms, and requires little treatment, observation and4or instruction. *verage amount of nursing hours is !.+. 2atio of professional to non, professional nursing personnel is ++ )+. Level 2 Moderate Care or Intermediate Care. 0atients under this level need some assistance in bathing, feeding, or ambulating for short periods of time. ;xtreme symptoms of their illness must have subsided or have not yet appeared. patients may have slight emotional needs, with vital signs ordered up to three times per shift, intravenous fluids or blood transfusion% are semiconscious and exhibiting some psychosocial or social problems% periodic treatments, and4or observations and4or instructions. *verage nursing hours is ' and the ration of professional to non, professional personnel is -: ):.

Level 3 Total, Complete or Intensive Care. 0atients under this category are completely dependent upon the nursing personnel. #hey provided complete bath, are fed, may or may not be unconscious, with marked emotional needs, with vital signs more than three times per shift, may be on continuous oxygen therapy, and with chest or abdominal tubes. #hey require close observation at least every ': minutes for impending hemorrhage, with hypo or hypertension and4or cardiac arrhythmia. #he nursing hours is - with a ratio of -+ '+. Level 4 Highly Spe iali!ed Criti al Care. 0atients under this level need maximum nursing care with a ratio of 7: &: in terms of personnel. 0atients need continuous treatment and observation% with many medications, IV piggy backs% vital signs every !+,': minutes% hourly output. #here are significant changes in doctors orders and the nursing hours rangers from -,9 or more. 6evels of 3are 6evel ! Self 3are Finimal 3are 6evel & Foderate Immediate 3are 6evel ' #otal Intensive 3are 6evel ) >ighly Speciali.ed 3ritical 3are Percentage of Nursing Care $ours #he percentage of nursing care hours at each level of care depends on the setting in which the care is being given. In some hospitals, such as that of the primary hospitals, they can only cater basic illnesses and cannot cater more severe cases that secondary and tertiary hospitals can provide. #ype of >ospital 0rimary Secondary #ertiary Special #ertiary Finimal 3are 5: -+ ': !: Foderate 3are &+ ': )+ &+ Intensive 3are + + !+ )+ 3ritical 3are , , !: &: />00? !.+: '.: ).+ -.: or higher 2atio ++ )+ -: ): -+ '+ 7: &:

VI.

Computing for t&e Num(er of Nursing Personnel Needed In 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 1/onproductive >ours". )elie!ers Needed 2elievers are the personnel who replace the absentees or people on leave. #o get the number of personnel needed, divide the average number of days an employee is absent per year by the number of workings days per year that each employee serves. #his will be :.!+ per person who works ): hours per week and :.!& per person on a )7 hour week $ob. ): >ours 0er Geek '' L &!' A :.!+)9&9+55)-)5775'&'9)'--!95!7'! or :.!+ )7 >ours 0er Geek '' L &-+ A :.!&)+&7':!77-59&)+&7':!77-59&)+&7 or :.!& It will be noted that although an employee is entitled to !+ days sick leave and !+ days vacation leave, !& holidays, ' days of continuing education, plus ' days of special privileges which totals to )7 days, an employee gets only an average of '' days leave per year. Distri(ution (% S&ift Studies have shown that morning or day shift needs the most number of nursing personnel at )+ to +! percent% for the afternoon shift, ') to '5 percent% and for the night shift !+ to !7 percent. In the 0hilippines, the distribution of )+, '5 and !7 percent is usually followed. )+M for the morning shift '5M for the afternoon shift !7M for the night shift

T&e Staffing Formula #o compute for the staff needed in all units of a certain level of hospital, there are certain steps to be followed !." 3ategori.e the number of patients according to level of care needed. 5." ?istribute by shifts. K of 0atients x constant for minimal care A K of 0atients needing minimal care K of 0atients x constant for moderate care A K of 0atients needing moderate care K of 0atients x constant for intensive care A K of patients needing intensive care K of 0atients x constants for special care A K of 0atients needing special care &." =ind the total number of nursing hours1/>" needed by the number of patients per day. K of 0atients needing minimal care x /> at level ! A />00?! K of 0atients needing moderate care x /> at level & A />00?& K of 0atients needing intensive care x /> at level ' A />00?' K of 0atients needing special care x /> at level ) A />00?) #otal /umber of />00? A />00?! N />00?& N />00?' N />00?) '." =ind the total />00? needed by the patients per year. #otal /umber of />00? x '-+ 1days4year" A K />4year )." =ind the actual workings hours rendered by each nursing personnel per year. K of working hours4day x #otal Gorking ?ays4year A K of working hours4year +." =ind the total number of nursing personnel needed. a." #otal />4year L K of working hours4year A #otal /ursing 0ersonnel b." 2elief x #otal /ursing 0ersonnel A 2elievers c." #otal /ursing 0ersonnel /eeded A #otal /ursing 0ersonnel N 2elievers -." 3ategori.e to professional and non,professional personnel. 2atio of professionals to non,professionals by the level of hospital. Oelly,>eidenthal, 0atricia. /ursing 6eadership and Fangement. #homson ?elmar. *ustralia. &::'. 0g. &'9,&)!. #omey, *nn Farriner. Huide to /ursing Fanagement. 5th ;dition. Fosby. St. 6ouis. &::). 0g. '9+,'9-. Swansburg, 2ussell and 2ichard Swansburg. Introductory Fanagement and 6eadership for /urses. &nd ;dition. Cones and 8arlett 0ublishers. Fassachusetts. !995. 0g. !&7, !'). nd Ven.on, 6ydia. /ursing Fanagement #owards Puality 3are. & ;dition. 3Q; 0ublishing Inc. 0hilippines. &::'. 0g. +-,--.
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#otal /umber of 0ersonnel /eeded x ratio of professionals A K of 0rofessionals #otal /umber of 0ersonnel /eeded x ratio of nonprofessional A K of /on, 0rofessional

K of 0rofessional x *F Shift A K of 0rofessionals on *F Shift K of 0rofessional x 0F Shift A K of 0rofessionals on 0F Shift K of 0rofessional x /ight Shift A K of 0rofessionals on /ight Shift #otal /umber of 0rofessionals /eeded A *F N 0F N /ight shift professional personnel K of /on,prof x *F Shift A K of /on,prof on *F Shift K of /on,prof x 0F Shift A K of /on,prof on 0F Shift K of /on,prof x /ight Shift A K of /on,prof on /ight Shift #otal /umber of /on,0rofessionals /eeded A *F N 0F N /ight shift non, professional *i(ligrap&%