a.

The nurse can better see and attend to the

STAFFING total needs of clients and the continuity of
Staffing is the process of assigning competent care can be facilitated with ease.
people to fill the roles designated for the b. The client's interaction and rapport with the
organizational structure through nurse are well developed, and the client's
recruitment, selection and development. needs are monitored carefully, with the
result that both the client and his or her
STEPS IN STAFFING relatives feel secure.
Disadvantage:
The R N spend some time doing tasks that
Staffing follows a predictable pattern before a could be done more cost-effectively by less-
nurse can be hired: skilled persons
Preparing to recruit This adds to the expense of using a total
Attracting Staff patient care delivery system.
Recruiting and Selecting staff through The Functional Method
interview The needs of a group of patients are
Induction or Orient broken down into tasks, which are assigned
Job offer to R.Ns, LPNs, or UAPs or nursing aides so
that the skill and licensure of each caregiver
Step 1. DETERMINE THE NUMBER AND TYPES is used to best advantage.
OF PERSONNEL NEEDED The advantages of this system are:
Step 2. RECRUIT PERSONNEL a. nurses who are oriented this way become
Step 3. INTERVIEW skilled in performing assigned tasks;
Step 4. INDUCT OR ORIENT THE PERSONNEL b. individual aptitude and experience
Step 5. JOB OFFER improves;
c. less equipment is needed;
STAFFING PATTERN d. time is saved; and
1. Benchmarking e. task-oriented approach improves both
2. Regulatory Requirements productivity and organization
3. Skill Mix Team Nursing
4. Staff Support
5. Historical information
FACTORS AFFECTING TIME REQUIREMENTOF
NURSING CARE a. The RN leads a large group of many people,
Acuity of the patient’s illness including and students.
Degree of dependence of the patients on the b. This small group is centered through
caregivers participation efforts.
Communicability of the ailment c. The personnel work together to identify,
Rehabilitation needs and special treatments plan, implement and evaluate
and procedures comprehensive client-centered nursing care
Patient Classification System toward a common goal of providing quality
Patient care is classified according to: client care. .
Self care or minimal care patients d. It is oriented towards the decentralization of
Intermediate or moderate care a nursing unit and of the Head Nurse's
Total care patients authority.
Intensive care patients e. Comprehensive nursing care becomes the
responsibility of the entire team.
Nursing Care models
Framework for nursing care delivery in any There are several advantages to be found in
setting, or design that meets the particular this system relative to other methods.
needs of a group of Health care givers and a. The constant group work fosters a feeling of
clients. The case method or total patient participation and belongingness.
care b. The workload is balanced and shared with
Patient care is classified according to: the division of labor.
“Self care” or minimal care patients c. Each member of the team has the
Intermediate or moderate care opportunity to learn from colleagues.
Total care patients d. There is also a variety in the daily
Intensive care patients assignment.

NURSING CARE MODELS e. It is also helps maintain interest in client’s

The Case Method or Total Patient Care well being and is cost effective.
The Functional Method f. The patient is able to identify personnel due
Team Nursing to the continuity.
Primary Nursing Method g. Barriers between the nurses and clients can
Progressive Client Care be minimized.
Managed Care Method h. Everyone gets to contribute to the care plan.
Practice Partnership
Case Management Method
Modular Method 4. Primary Nursing Method
The Case Method or Total Patient Care Primary Nursing was designed to place
The goal of this system is to have RN back at the patient’s bedside.
one nurse give all care to the same patient's a. This method represents total nursing care
for the entire shift. directed by a nurse on a 24-hour basis, from
the moment of admission to discharge with
Advantages: ARA.
b. It is accomplished through decentralization,
autonomy and independently competent Total Nursing Care Hours x days in a year
nursing care. Total annual hours per one FTE
2. Forty-Hour Week Law
ABO x NCH
The advantages of this method are: No. of Working Hours
a. The nurse sees the client and family as one
system and ARA is increased. Where,
b. The nurse uses a wide range of skills ABO = Average Bed Occupancy
knowledge and expertise and develops NCH = Nursing Care Hours
creativity. a. Standard Value for NCH
c. This, in turn increase trust and satisfaction
by the client.
d. There is excellent communication between b. Percentage (%)of Professional and Non-
the primary nurse and associate nurses. Professional( In Ratio)
e. Primary nurses are able to hold associate
nurses accountable for implementing the c. Distribution per shift
nursing care as prescribed. Shifts:
A.M = 45%
5. Progressive Client Care P.M = 37%
In the progressive client care method, different Night = 18%
areas or units provide various levels of care
Clients are evaluated with respect to the level
or intensity of care needed. There is d. 40 hour / week
increased reliant behavior, and staff is For personnel working in hospitals with
trained to provide the best of care. 100 bed capacity or over or which are
located in a 1 M population
6. Managed Care Method e. 48 hour / week
The managed care method involves unit-based For personnel who work in agencies with
care that is organized to achieve specific lesser bed capacity or which are located in
patient outcomes with in her stay in the communities with less than 1 M.
unit. GUIDELINES FOR DETERMINING THE NURSING
7. Practice Partnership PERSONNEL NEEDED
In this model, an RN and an assistant – UAP, Step 1. Determine type of hospital whether it is
LPN or less experienced RN- agree to be primary, secondary, tertiary.
practice partners
They work together with the same schedule Step 2. Categorize patients according to level
and the same group of patients. The senior of care.
and junior staff members share patient care
responsibilities. (Sullivan, 2006) 100 patients x 65% = 65 patients needing
minimal care
100 patients x 30% = 30 patients needing
intermediate care
Compared to team nursing, 100 patients x 5% = 5 patients needing
Practice Partnership offer more continuity of intensive care
care and accountability for patient care. Step 3. Find the NCH needed by patients per
Compared to primary nursing, day and get the SUM
Partnerships are less expensive for the
organization and more satisfying personally Minimal care = 1.5 hours
for the partners. Intermediate care = 3 hours
Intensive care = 4.5 hours
The two main disadvantages of this model are
that:
a. It tends to decrease the ratio of professional
nurses to non- professional staff, and
b. there is the potential for the junior member Minimal care = 65 x 1.5 hours =
of the team to assume more responsibility 97.5 NCH
than may be appropriate Intermediate care = 30 x 3 hours =
Figure 36: Practice Partnership 90 NCH
Case Management Method Intensive care =5 x 4.5 hours =
This is a model for identifying, coordinating and 22.5 NCH
monitoring the implementation of services Total = 210 NCH /
needed to achieved desired patient care day
outcomes within a specified period of time Step 4. Find the Total NCH x 365 days.
( Zander,1988 ). Confrontation
Figure 37: Case Management the nurse manager should determine whether
Caregivers the employee is aware of the policy.
Modular Method The employee should have received policy
the RN provides direct nursing care with information at orientation, and an
assistance of aides. This is a modified updated policy manual should be readily
team and primary nursing method where accessible to all employees.
RN provides leadership, support and The policy should have been enforced strictly
instruction. and consistently.
FORMULA TO DETERMINE STAFFING PATTERNS The nurse manager should then describe the
1. Full Time Equivalent ( FTE) behavior that constitutes the violation un
 a manner that relays the concern to the
employee regarding the issue, while
avoiding making the interaction a
personal issue.
The manager should solicit the employee's
reason for the behavior, allowing
sufficient time for the employee to
respond.
The manager should convey to the employee
that she cannot continue breaking an
established policy.
The manager should explore alternative
solutions to the problem so that negative
outcomes will be avoided.
The manager and employee should agree on a
course of action.
They should set up a reasonable date to follow-
up in order to check if she is adhering to
established policy.

Disciplinary conference
Steps of progressive discipline
1. counseling
2. verbal reprimand
3. written reprimand
4. short suspension
5. longer suspension
6. discharge/dismissal

Tools for terminating staff

Inform the human resources department and
administration beforehand.
State the offending behavior and the reason for
termination.
Explain the termination process.
Remain calm.
Arrange for employee to be escorted out.
Report bac to the human resources
department and administration.

Parameters of nursing practice:

Safety and quality nursing care
Management of resources and environment
Health education
Legal responsibility
Ehtico-moral responsibility
Personal and professional development
Quality improvement
Research
Records management
Communication
Collaboration and team work