DEFINITION Staffing is the function by which managers build an organization through recruitment, selection, and development of individuals as capable employees. (Mc Farland) Staffing is the systematic approach to the problem of selecting, training, motivating and retaining professional and non-professional personnel in any organization. STAFFING NORMS/POLICIES * Norms are standards that guide, control, and regulate individuals and communities. ¢ For planning nursing manpower we have to follow some norms. ¢ The nursing norms are recommended by various committees: Nursing Manpower Committee, High Power Committee, Dr. Bajaj Committee, Staff Inspection committee, TNAI and INC.INDIAN NURSING COUNCIL RECOMMENDATION * For every 100 beds and to cover 24 hours period, the staff should be in the proportion of: = | sister incharge to 25 beds. = | staff nurse to 3 beds in teaching hospitals. = | staff nurse to 5 beds in non-teaching hospitals. = 1 Nursing superintendent. = 1 Deputy Nursing superintendent when the bed strength is 150-400, and additional assistant when the bed strength is 401-700. = There should be separate staff for special departments with a Sister In Charge of OT and Casualty department. = OPD should have 1 sister in charge and a minimum of one staff nurse for each OPD clinic operated daily, with not less than a total of two in department.Recommendation staffing norms for hospital nursing services (teaching hospital) Nursing 1 for every hospital with 150 beds. Superintendent Deputy Nursing | 1 for every hospital with 150 beds. Superintendent Assistant 2 for every hospital with 150 beds. Nursing For every additional 50 bed, 1 ANS Superintendent DEPARTMENT | STAFFNURSE | SISTERPER | DEPARTMENTAL SHIFT SISTERS/ ASSISTANT NURSING SUPERINTENDENT MEDICAL WARD i 1:25 1 for 3-4 wards, SURGICAL WARD. 13 1:25 1 for 3-4 wards. ORTHOPAEDIC WARD arf Es 1 for 3-4 wards. PAEDIATRIC WARD 13 1:25 1 for 3-4 wards, GYNAECOLOGICAL 13 1:25 1 for 3-4 wards, WARD MATERNITY WARD 13 1:25 1 for 3-4 wards. ICU (24 hrs) 1 Teach shift | 1 departmental sisters/ ANS Coronary Care unit (24 Ll 1 each shift for 3-4 units clubbed together hrs) Nephrology (24 hrs) Ll Leach shiftDEPARTMENT STAFF NURSE SISTER PER DEPARTMENTAL SHIFT SISTERS/ ASSISTANT NURSING SUPERINTENDENT Neurology ad 1:1 1 each shift Neurosurgery (24 hrs) Special ward: 1 1 each shift Eye, ENT, etc. (24hrs) OT (24hrs) 3 for 24 hours | 1 each shift [1 Departmental per bed sister/ANS for 4-5| (OT ty and | 2-3 dependi 1 each shift Casualty an ; 3 depending each sl h Departmental Emergency unit upon the sister/ANS number of beds. STAFFING PATTERN FOR HOSPITAL NURSING SETVICES AS PERT RECOMMENDATION BY BAJAJ COMMITTEE, 1987 CATEGORIES BASIS FOR CALCULATION Nursing Superintendent 1:200 beds Deputy Nursing Superintendent —_| 1:300 beds Departmental Supervisor/Sisters Nursing 7:1000 + 1 additional 1000 beds (991 x 7 +991) Ward Nursing Supervisors/ Sisters 8:200 + 30 % leave reserve. Staff Nurse for wards 1:3 + 30 % leave reserve. For OPD, Blood bank, X-ray, Diabetic clinic. 1:100 patients + 30 % leave reserve. ICU 1:1 + 30 % leave reserve. For specialized departments and clinics such as OT, Labour room 8:200 + 30 % leave reserve.HIGH POWER COMMITTEE Nursing Superintendent 1:200 beds Deputy Nursing Superintendent 1:300 beds ASSISTANT Nursing 1:150 Superintendent Ward sister/ ward supervisor 1:25 beds + 30 % leave reserve. staff nurse for wards 1:3 + 30 % leave reserve. Staff Nurse for OPD and 1:100 + 30 % leave reserve. Emergency ICU 1:1 + 30 % leave reserve. For specialized departments and clinics such as OT, Labour room 1:25 + 30 % leave reserve. ***PATIENT CLASSIFICATION SYSTEMS ¢ Patient classification quantifies the quality system (PCS), which of the nursing care, is essential to staffing nursing units of hospitals and nursing homes. In selecting or implementing a PCS, a representative committee of nurse manager can include a representative of hospital administration, which would decrease skepticism about the PCS. ¢ The primary aim of PCS is to be able to respond to constant variation in the care needs of patients.Characteristics . Differentiate intensity of care among definite classes. . Match nursing resources to patient care requirement . . Relate to time and effort spent on the associated activity. . Be economical and convenient to repot and use . Be mutually exclusive, continuing new item under more than one unit. Be open to audit. Be understood by those who plan, schedule and control the work. Separate requirement for registered nurse from those of other staff.Purposes 1. The system will establish a unit of measure for nursing, that is, time, which will be used to determine numbers and kinds of staff needed. 2. Program costing and formulation of the nursing budget. 3. Tracking changes in patients care needs. It helps the nurse managers the ability to moderate and control delivery of nursing service 4, Determining the values of the productivity equations. 5. Determine the quality: once a standards time element has been established, staffing is adjusted to meet the aggregate times. #**PATIENT CARE CLASSIFICATION ‘Area of Category I Category II Category III Category IV care Eating |Feeds self Needs some help in]Cannot feed self|Cannot feed self| preparing but is able to chew/any may have and difficulty swallowing swallowing Grooming | Almost _ entirely|Need some help in]Unable to do much| Completely self sufficient bathing, oral | for self dependent. hygiene. Excretion |Up and _to|Needs some help in|In bed, _ needs| Completely bathroom alone getting ‘bedpan / urinal dependent up to| placed; bathroom/urinal Comfort | Self sufficient Needs some help|Cannot tum | Completely with adjusting | without help, get dependent position/ bed. drink, adjust position. of extremities,‘Area of care | Categoryl | Category I | Category II | Category IV Treatment [Simple —|Any Treatment/Any treatment| Any —elaborate/ supervised, more than once] more than twice] delicate simple dressing. |per shift, foley] /shift. procedure catheter care, requiring two 1&0. nurses, vital signs more often than every two hours. Health Routine follow up| Initial teaching|More intensive} Teaching of education and |teaching of care of items; teaching] resistive teaching ostomies; new] of apprehensive/| patients. diabetics; mildly resistive patients —_with| patients. mild adverse reactions to their illness. General health |Good Mild symptoms | Acute Critically ill sym toms Calculating Staffing Needs * The following are the hours of nursing care needed for each level patient per shift: Area | CategoryI | Category II | Category III | Category IV of care DAY 2.3 29 3.4 46 EVENI 2.0 23 2.8 3.4 NG NIGHT 0.5 1.0 2.0 2.8ESTIMATION OF NURSING STAFF REQUIREMENT FOR 20 BEDED ICU STAFFING FORMULA 1. Categorize the patients according to level of care needed. —Total patients: 20 —Category III: 10 or 50% (0.5) —Category IV: 10 or 50% (0.5) Therefore, — 20 patients x 0.5 = 10 patients needed intensive care. — 20 patients x 0.5 = 10 patients needed highly specialized Nursing care.2. Find the number if Nursing Care Hours (NCH) at each level of care per day. >NCH needed at level III: 4.5 hours Therefore, —10 patient x 4.5 : 45 NCH/day. >NCH needed at level IV: 6 hours Therefore, — 10 patient x 6 : 60 NCH/day Total : 45 + 60 = 105 NCH/day 3. Find the total NCH needed by 20 patients per year. NCH needed by patient at each level of care per day x No. of days per year 105 x 365 = 38325 NCH/year4. Find the actual working hours rendered by each nursing personnel per year. —Total working hours/day x Working days/year = 8 (hours/ day) x 233 (working days/year) = 1864 hours/year Therefore, the actual working hours rendered by each nursing personnel per year= 1864 hours/year 5. Find the total number of nursing personnel needed Total NCH per year _ 38325 working hours/year 1864 = 20.5 b. Relief (30%) leave reserve x Total nursing personnel 20.5 =— x30 100 =6.15 =6c. Total nursing personnel needed =20.54+6 = 26.5 =27 Therefore, the total number of Nursing personnel needed for a bedded ICU is 27 Staff Nurse. * In an ICU —Nursing In-charge: 1 —Shift In-charge: 4 —Staff Nurse: 27 Total Staff in ICU = 326. Distribute by shifts: “27 x 0.40 = 10.8 or 11 staff in Morning shift. 27 x 0.35 = 9.45 or 9 staff in Evening shift. 27 x 0.25 = 6.75 or 7 staff in Evening shift. Total staff = 27 PER RATIO * Total bed: 32 Level IV: —60 % : 1:1 (20 beds) —40% : 1:2 (12 beds) 32 —_x 100 60 = 19.2 Therefore, 20 beds: 20 Nurses (1:1) 12 beds: 6 Nurses (1:2) = 26= 26 * Therefore, 26 x 3 shifts =78 * Relief (30%) leave reserve x Total nursing personnel = x30 =23.4 Therefore, the required Nursing personnel is = 78 + 23 =101 * Ina 32 bedded ICU = Nursing In-charge: 1 =Shift In-charge: 4 (3+1 leave reserve) = Staff Nurse: 101 Total Nursing Staff in ICU = 106