CHAPTER V

STAFFING
LEARNING OBJECTIVES

Upon completion of this chapter, the student should be able to:

1. Define staffing.

2. Discuss the staffing process.

3. Discuss the importance of orientation.
4. Explain the guidelines in scheduling of nursing staff.
5. Describe the various categories of patients according to level of care
needed.
6. Given a situation, identify which system of assigning nursing personnel
is appropriate.
7. Given a situation, compute for the number of staff needed.

 Selection of Personnel
 Staff Development
 Systems of Assignment
 Scheduling
 Scheduling
 Patient Classification System
 Staffing Formula
 Discussion Questions and Learning Activities
 Works Cited
INTRODUCTION

One of the major functions of a nurse manager is staffing, a complex management activity
that requires much planning. It involves deciding what type of and how many personnel are
needed to provide adequate and quality patient or client are 24 hours a day, 7 days a week and
52 weeks a year.

Staffing is the process of determining and providing the acceptable number and mix of
nursing personnel to produce a desired level of care and to meet the patient’s demand for care.

The staffing process involves the selection of qualified and competent personnel, a system
of assignment and staffing schedules.

SELECTION OF PERSONNEL

Recruitment

The first step in the selection of personnel is recruitment. It is described as the process of
enlisting personnel for employment. Methods of recruitment include the following:
 Advertising, this is the most common method of informing the public of vacant positions.
Advertisements in the local newspapers, professional publications, bulletins, newsletters, radio,
or television offer the employer a broader field for selecting personnel.

Word of Mouth. This can be a very effective method of recruitment. However, it may lead
to hiring of friends and relatives, a practice which may foster favouritism and nepotism.

Employee Recommendation. Nurses who are already employed in the institution recruiting
personnel may recommend fellow nurses whom they have previously worked with in the past and
whom they know are competent and reliable.

Screening

Following the recruitment process is the screening of the staff. It is best to keep in mind
three philosophies during the screening process:

1. Screen ut applicants who do not fit the image of the agency.

2. Try to fit the job to a promising applicant.

3. Usually, try to fit the applicant to the job.

During the screening process, the applicants submit their biographical data that include
information on personal history, educational background, and work experience. The recruiter can
use the data to determine whether the applicant is qualified and meets the minimum
requirements.

Interview

As soon as the recruiter screens the most qualified applicants, a pre-employment interview
is conducted. The purpose of the interview is to obtain further information about the applicant,
to give information, and to determine if the applicant qualifies for the position.

During the interview process, the interviewer observes the applicant. Does the applicant
show genuine interest in the job, willingness to work and assume the responsibilities? Is she/he
well-mannered? Etc.

Some institutions may requires may require the applicants to take a series of tests to
assess their general intelligence; personality; mental, perceptual and psychomotor abilities.

Orientation

After choosing from among the qualified applicants, you should take the responsibility to
assist and introduce the nurse to her new job. Orientation is a process of becoming familiar with
a new environment and adapting well to it. Orientation is a part of staff development and one of
your important functions. When policies, regulations and job description are communicated to
the newly employed nurse, uncertainties are diminished, anxiety is reduced and
misunderstanding are prevented.

All newly employed personnel are entitled to be oriented during the first few days of
employment. A well-designed orientation program would include:

 A tour of the physical facilities

 Introduction to co-workers
 Description of the organizational structure of the institution
 Information on the philosophy, goals, policies, and standards of the institution
 Functions of the members o the health team

In service education training programs may also be conducted to prepare the beginning
nurse practitioner to assume bigger responsibilities.

STAFF DEVELOPMENT

Once employed, the nurse should continue to develop his or her potentials to the fullest.
The nurse should engage in professional education activities such as attending conferences,
seminar workshops, in-service training programs; reading professional publications; and engaging
in other activities that will enhance his or her aesthetic sense and personality.

Your role as a nurse manager in staff development is to support the program of the
institution, review the goals and provide a budget for the activities. Nurse Managers actively
participate in identifying the needs of the personnel to determine what programs to offer. The
quality of rendered nursing services related to personnel’s education, training and competence,
can be further enhanced through attendance in continuing activities.

SYSTEMS OF ASSIGNMENT

There are five systems or methods of assigning nursing personnel. These are:

a) Case method. In this method each patient is assigned to a nurse for total patient care including
medicines and treatment.
b) Functional method. In the functional method nurses are assigned to perform specific tasks based
on the employee’s education and experience. For example, nursing aides give baths, responsible
for the patient’s medications, treatments and procedures. The head nurse is responsible for the
overall direction and supervision of the nursing unit personnel.
c) Team method. Professional, technical, and ancillary nursing personnel are grouped together as a
team to give total care to a selected group of patients. The team consists of a senior professional
nurse as team leader and its members are other staff nurses, nurse assignments, conducting
rounds throughout the shift, conducting team conferences and updating nursing care plans.
d) Primary method. The primary nurse is given the full responsibility of planning, implementing and
evaluating the nursing care for four or five patients. The primary nurse plans for a 24-hour
continuity in nursing care utilizing a written nursing care plan, communicate with other members
of the health team and plan for the discharge of his or her patients.
e) Modular method. The nurse is assisted by non-nursing members of the health team such as nurse
aides and assistants to give nursing care 8-12 patients. It is a combination of primary and team
nursing.

These methods are discussed in Chapter 4.

SCHEDULING

The objectives of scheduling and allocation procedures are to assign working days and
days off to individual members of the nursing staff in order to:

 Provide adequate patient care while avoiding overstaffing

 Achieve a desirable distribution of off days
 Treat individual members of the nursing staff fairly
 Let the personnel know well in advance what their schedules are
 In preparing the schedule, the following guidelines should be observed:

1. Let it represent a balance between the needs of the employee and the employer. When conflicts
arise, patient care should have priority.
2. Distribute fairly the “good” and “bad” days off among all employees.
3. Make all employees adhere to the established rotation. Exceptions should be rare and granted
only if the employee is requesting two weekdays off (working every weekend). All requests and
exceptions should be in writing and should specify the period of time off requested.
4. Advance posting of time schedules so as to allow employees plan their personal lives. Doing so
reduces absenteeism and request for changes.
5. Do not make time schedules a mystery nor use them as a tool of control or discipline.
6. Come up with a mechanism for emergency changes to accommodate both employee and
employer.
7. Make schedule conform to all labour laws, and hospital and department policies.
8. Provide correct numbers and mix of personnel, allowing continuity, which is essential for quality
care.
9. Be consistent in scheduling to enable work groups develop teamwork, which contribute to quality
care.

Centralized Scheduling

Centralized scheduling is based on a master staffing pattern that is carried out by one
person who plans and coordinates the schedule of the nurses. The coordinator knows how many
staff make necessary changes in the rotation in case of illness or emergencies that may
unexpectedly arise.

Centralized scheduling relieves the charge or head nurse from non-nursing functions,
freeing her or him for more important administrative or nursing responsibilities.

De-centralized Scheduling

Decentralized scheduling allows the nurse manager to staff his or her own unit. Nursing
personnel feel that they get personalized attention because you are aware of their clinical and
personal needs and take these into consideration when planning for staffing.

Since decentralized scheduling is time-consuming, you should spend more time in non-
nursing functions rather than purely nursing activities.

Self-Scheduling

Self-scheduling is the process by which staff nurses in a unit collectively decide and
implement the monthly work schedule. Given the criteria for adequate unit staffing for each 24-
hour period by head nurse, each staff nurse chooses which day and shift he or she will work.

PATIENT CLASSIFICATION SYSTEM

A patient classification system is a means of categorizing present patients on the basis of

certain care needs that can be clinically observed by the nurse.

This system can serve as a basis for planning the staffing needs of patients. There are
three methods of classifying patients: the descriptive method, checklist of nursing tasks method
and the patient needs method. In the descriptive method, which is the most common means of
patient classification, the nurse classifies or assigns the patient to a category that closely describes
the level of care needed.
 The patient classification system is described as follows:

Category I: Minimal Care

Minimal care is given to patients who are convalescing and who no longer require
intensive, moderate or maximum care. These patients still may need supervision by a nurse in the
course of a includes patients who require diagnostic studies, minimal therapy, who are awaiting
elective surgery or have difficulty arranging transportation between home and hospital, or whose
home environment temporarily makes discharge undesirable or impractical.

CATEGORY II. Moderate Care

Moderate care is given to patients who are moderately ill or are recovering from the
immediate effects of a serious illness and/or an operation. These patients require nursing
supervision or some assistance related to ambulating and caring for their own hygiene. They may
be ambulatory for short periods.

CATEGORY III. Maximum Care

Maximum care is given to patients who need close attention throughout the shift, that,
is, complete care for patients who require nursing to initiate, supervise, and perform most of their
activities or who require frequent evaluation with adjustment of therapy.

STAFFING FORMULA

Studies have shown that the morning shift needs the most number of nursing personnel,
that is 45%, the afternoon shift needs about 37% and the night shift only about 18% because more
nursing care is given during morning and afternoon shifts than during the night shift.

The procedure for computing the number of staff needed in the in-patient areas of the
hospital is as follows:

1. Categorize the number of patients according to the level of care needed by hospital
classification.
a. Total number of patients x percent at each level of care
2. Find the total number of nursing hours needed by patients per day at each categorized level.
a. Number of patients at each level average nursing hours needed per day.
b. Get sum of the nursing hours in the various levels.
3. Find the total number of nursing hours needed by the patients per year.
a. Total number of nursing hours needed per day x 365 days of the year.
4. Fund the total number of working hours rendered by each nursing personnel each year
5. Find the total number of nursing personnel needed.
a. Divide the total number of nursing hours needed by the given number of patients per year by
the actual number of working hours rendered per year.
b. Find the relief. Multiply the number of nursing personnel needed by .095.
c. Add number of relievers to the number of needed nursing personnel.
6. Categorize into professional and non-professional
a. Multiply number of nursing personnel according to ratio of professional to non-professional.
7. Distribute shifts.

Example: find the number of nursing personnel needed for 100 patients in a tertiary hospital.
1. Categorize patients according to levels of care.

o 100 patients x .65 patients needed minimal care

o 100 patients x .30 patients needing moderate/intermediate care
o 100 patients x .5 patients needing intensive care

2. Find the number of nursing care hours (NCH) needed per day at level I, Level II, and Level III.

Given:

LEVEL 1 LEVEL II LEVEL III

Minimal Care Intermediate Intensive

Care Care
1.5 NCH needed per 3.0 4.5
patient per day

3. Find the actual number of NCH needed by 100 patients per year:

o 210x365 = 76,650 total NCH needed per year

4. Find the number of nursing personnel needed.

a) 76,650 NCH per year = 44 nursing personnel

1728 (working hours per year for 216 working days at 40 hours per week)
b) 44 x .95 = 4.18 or4 nursing personnel as relievers
(Note: Total average of absences of an employee is 35 days per year. This includes vacation, sick
leaves, and holidays.) (35 / 365 = .095 relief needed).
44+4=48 total nursing personnel needed

5. Categorize into professional and non-professional

o 44 x .60 = 26 nurses
o 44 x .40 = 17 nursing attendants.

6. Distribute shifts.

26 x .45 = 12 nurses on 7-3 shifts 17 x .45 = 8 nursing attendants

26 x .37 = 10 nurses on 3-11 shift 17 x .37 = nursing attendants
26 x .18 = 4 nurses on 11-7 shift 17 x. 18 = 3 nursing attendants
26 Total 17 Total
 Note: Ratio of professional nurses to non-professional according to level of care.
o Level I – Minimal Care 55-45
o Level II – Intermediate or Moderate Care 60-40
o Level III – Intensive Care 65-35
o Level IV – Highly Specialized Intensive Care 70-30 or 80-20

Discuss your answer in class. Request the assistance of your

facilitator/preceptor if necessary.
 DISCUSSION QUESTIONS AND LEARNING ACTIVITIES:

1. Prepare an interview guide you might use in recruiting personnel

2. What are the guidelines to be observed in scheduling nursing staff?
3. You are the head nurse of the obstetrics unit. You are responsible for the assignment
of nursing personnel to 45 patients with the following cases:
4. 5 – 3 day post Caesarean
5. 20 -1 day post-partum with no complications
6. 3 – scheduled for Caesarean Section
7. 10 – 2 day post-partum with complications
8. 7 – in labour
a. The member of your staff consist of 3 staff nurses, 2 volunteer nurses and 2 nurse
aides. Identify the appropriate system of assigning nursing personnel.
9. Compute for the number of staff needed for 350 patients in a tertiary hospital.

References:
H. S. Rowland., B. L. Rowland., (1992). Nursing Administration Handbook.
Maryland: Aspen Publisher , Inc. p. 261

AM. Tomey., (1996). Nursing Management and Leadership. St. Louis: Mosby-
Year Book, Inc. p. 204

Ibid., p. 206
Rowland & Rowland, op. cit., p. 306
Ibid. p. 307
Ibid. p. 309
D. A. Gilles., (1989). Nursing Management a systems Approach. Philadelphia:
W.B. Saunders Company, p. 306

Rowland & Rowland, op. cit., p. 289

J. Hernando et al., (1990). The Administration of Hospital Nursing Services in
the Philippine DOH. Pp. 33-36