OBJECTIVES OF STAFFING IN NURSING:-

 Provide -professional nurse staff in critical care units, operating rooms, labour & delivery units, &
emergency room.

 Provide sufficient staff to permit a 1:1 nurse-patient ratio for each shift in every critical care unit.

 Provide sufficient nursing staff in general medical, surgical. Obstetric, pediatric & psychiatric units

 Involve the heads of nursing & all nursing personnel in designing the department’s overall staffing
programme.

 Design a staffing plan that specifies how many nursing personnel in each classification will be assigned
to each nursing unit for each shift & how vacation & holiday time will be requested & scheduled.

 Inform each nursing employee that requests for specific vacation or holiday time will be honoured within
the limits imposed by patient’s care & labour contract requirement.

 To plan and provide in-service education as per the need.

 To foster job satisfaction among nurses

IMPORTANT FACTORS OF STAFFING AND STAFFING REQUIREMENTS IN THE NURSING

SERVICES UNIT.

 The type, philosophy, objectives of the Institution.

 Availability and characteristics of the nursing staff, including education, number and position.

 Administrative policies such as rotation, weekends, and holiday off- duties.

 Standards of services should be available and clearly spelled out.

 Layout of various nursing departments and resources available within the department.

 Budget including the amount allotted to salaries, benefits, supplies, materials and equipment.

 Expected hours of work per annum of each employee.

 Patterns of work schedule.

 Staff factors, for example, job descriptions, education level of staff, experience and expectations from
the organisation.

 Patient factors, including variety of patient conditions, length of stay, the patient population, care needs
and fluctuation in numbers.
 Health care organisation factors, including policies and procedures, financial resources available,
number of beds per unit, staffing norms and nursing assignment systems.

 SOURCES OF RECRUITMENT

Some Internal Sources of Recruitments are given below:

1. Transfers
The employees are transferred from one department to another according to their efficiency and
experience.

2. Promotions
The employees are promoted from one department to another with more benefits and greater
responsibility based on efficiency and experience.

3. Others are Upgrading and Demotion of present employees according to their performance.

4. Retired employees may also be recruited once again in case of shortage of qualified personnel or
increase in load of work. Recruitmenting such people save time and costs of the organisations as the
people are already aware of the organizational culture and the policies and

Some external sources of recruitments are given below:

Press advertisements
Advertisements of the vacancy in newspapers and journals are a widely used source of recruitment. The
main advantage of this method is that it has a wide reach.

Educational institutes
Various management institutes, engineering colleges, medical Colleges etc. are a good source of
recruiting well qualified executives, engineers, medical staff etc. They provide facilities for campus
interviews and placements. This source is known as Campus Recruitment.

Placement agencies
Several private consultancy firms perform recruitment functions on behalf of client companies by
charging a fee. These agencies are particularly suitable for recruitment of executives and specialists. It is
also known as RPO (Recruitment Process Outsourcing)
Employment exchanges
Government establishes public employment exchanges throughout the country. These exchanges provide
job information to job seekers and help employers in identifying suitable candidates.

labour contractors
Manual workers can be recruited through contractors who maintain close contacts with the sources of
such workers. This source is used to recruit labour for construction jobs.

Unsolicited applicants(walk-ins)
Many job seekers visit the office of well-known companies on their own. But can help in creating the
talent pool or the database of the probable candidates for the organisation.

Employee referrals / recommendations

Many organisations have structured system where the current employees of the organisation can refer
 their friends and relatives for some position in their organisation. In some organizations these are formal
agreements to give priority in recruitment to the candidates recommended by the trade union.

ROLE AND RESPONSIBILITIES OF NURSING MANAGER IN STAFFING, SCHEDULING

AND PATIENT ASSIGNMENT.

1. Organizes, directs and supervises the nursing services both day and night.
2. Coordinates assignments of staff.
3. Establishes the general pattern of delegation of responsibilities and authority.
4. Ensures appropriate allocation of duties and responsibilities to all nursing staff working under
her.
5. Formulates nursing policies to ensure quality patient care and adequate attention at all times.
6. Responsible for efficient functioning of the nursing staff.
7. Evaluates the personal performance of the nursing staff.
8. Identify creative and flexible staffing method to meet the needs of patient, staff and organization.
9. Should have knowledge regarding proper method of scheduling and staffing.
10. Assumes responsibility toward staffing that build trust and encourage a team approach.
11. Is alert to factor that have impact to staffing
12. Is accountable to patients and employees for adequate and safe staffing.
13. Plan for staffing shortages so patient care goals will be meet.

PROJECTING STAFFING NEEDS IN NURSING SERVICES

Nursinghoursneededbyper categoryofpatientin24hoursassessedasgiven below:

Category of Patient Morning Shift Evening Shift Night Shift Total

I Completely 3.27 2.50 1.47 7.24

Dependent

II Partially 1.62 0.91 0.55 3.08

Dependent

III Ambulatory 1.20 0.70 0.17 2.07

  Now,wewilll earn how to allocate nurses in eachunit.
 Suppose a ward having 30 patients in which 10 patients are ambulatory, 15 patient’s partially
dependentand5patientsarecompletelydependent.
 There are 3 equal hours shifting duty and we need to allocate nurses for 24 hours.
 We know workload as well as classification of patients. It is very simple to calculate.
 Thefollowingtableisselfexplanatorytothe known method ofcalculation:

Category of Daily average time Total patient Calculationper category Total

patient perpatient in 24 of patient
hours
ICompletely 7.24 5 7. 24×5 36.20
dependent
IIPartially 3.08 1 3.08 ×15 46.20
dependent 5
IIIAmbulatory 2.07 1 2.07 ×10 20.70
patient 0
Total work load for 30 patients = 103 hours 103.10 hours

• Eachnurseisexpectedtowork= 8 Hrs/day
• TotalnumberofNursesrequired=103/8=13
=13nursesapproximately
• Provisionofdayoff,Casualleave,Earnedleave and other permitted Gazetted about 116
days/year.Tomeetleavevacanciesextranurses required;= 116/365×103/8= 4.09nurses
• Total nurses required=13+4=17 Nurses
•
This is the projection of nurse per day. Based on this we can project staffing need throughout the year.

NURSING POLICY
 Nepal Nursing Association-registered nurses or midwives’ must engage in the care and management of
health of patients, must pay due respect to the manager or senior health workers, treat health consumers’
and subordinate health workers and other staffers equally, must behave in a courteous manner so as to
positively impact the psychological state of health consumers and their families.

 In the same way, nurses or midwives must use high conscience to improve the condition of health
consumers and relieve pain and suffering and patients’ lives, respect the rights and dignity of health
consumers, maintain privacy and confidentiality and employ professional conscience during emergency.
 Legal implications of nursing policies
LEGAL IMPLICATIONS OF NURSING POLICIES

 Torts: Torts are civil laws that address the legal rights of patients and the responsibilities of the nurse in
the nurse patient relationship. Some torts specific to nursing and nursing practice include things like
malpractice, negligence and violations relating to patient confidentiality.

 Unintentional Torts: Unintentional torts include things like malpractice and negligence.

 Intentional Torts: Intentional torts include things like false imprisonment, assault, battery, breaches of
privacy and patient confidentiality, slander and libel.

 Liability: Liability is vulnerability and legal responsibility, simply stated. For example, nurses are liable
when they fail to carry out doctor's orders.

 Respondeat Superior: Respondeat Superior is the legal doctrine or principle that states that employers
are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not,
however, relieve the nurse of legally responsibility and accountability for their actions. They remain
liable.

 Negligence: Negligence is a nonintentional tort. Negligence occurs when the nurse fails to follow
established policies, procedures and standards of care in the same manner that another "reasonable" nurse
would do in the same situation.

 Malpractice: Malpractice, also a nonintentional tort, has six elements. The elements of malpractice
include a duty, a breach of duty as a nurse, reasonable foreseeability that the nurse's act has a connection
with the patient injury that occurred, the patient was harmed, the link that act directly led to the harm and
the patient has the right to financial compensation or damages.

 Assault: Assault, an intentional tort, is threatening to touch a person without their consent.

 Battery: Battery, another intentional tort, is touching a person without their consent.

 False Imprisonment: False imprisonment is restraining, detaining and/or restricting a person's freedom
of movement. Using a restraint without an order is considered false imprisonment.

BEHAVIOUR FAVOURING CHANGE

 Communication
 Supportive culture
 Participative management style
 Leadership readiness
 Standardized policies,
 Proper span of control,
 Coordination among different departments,
 Cooperation between line & staff
 Abundance of resource in organization
 Fiscal Planning

Fiscal means financial or pertaining to the treasury or revenue parts of the government.
 The term fiscal planning means being accountable for the finances departments.

 Fiscal Planning is process of framing objectives, policies, procedures, programmes and budgets
regarding the financial activities of a concern. This ensures effective and adequate financial and
investment policies.

Importance of Fiscal Planning:

The importance can be outlined as-

1. to ensure adequate funds

2. Financial Planning helps in ensuring a reasonable balance between outflow and inflow of funds so
that stability is maintained.
3. ensures that the suppliers of funds are easily investing in companies
4. helps in making growth and expansion of programmes which helps in long-run survival of the
company.
5. reduces uncertainties with regards to changing market trends which can be faced easily through
enough funds.

PERFORMANCE APPRAISAL

Performance appraisal is a method of evaluating the behavior of employees in the work spot, normally
including both the quantitative and qualitative aspects of job performance. Performance here refers to
the degree of accomplishment of the tasks that make up an individual's job. It indicates how well an
individual is fulfilling the job demands. Often the term is confused with effort, but performance is
always measured in terms of results and not efforts.

Performance appraisal is a systematic, periodic and so far as humanly possible, an impartial

rating of an employee‘s in matters pertaining to his present job and to his potentialities for a better job.

OBJECTIVES OF APPRAISAL.
1. To determine the effectiveness of employees on their present jobs so as to decide their benefits.

2. To identify the shortcomings of employees so as to overcome them through systematic guidance and
training.

3. To find out their potential for promotion and advancement.

 METHODS OF PERFORMANCE APPRAISAL
1. Ranking method
This method is very old and simple form of performance appraisal. An employee is ranked one against
the other in the working group under this method. Example: if there are ten workers in the working
group, the most efficient worker is ranked as number one and the least efficient worker is ranked as
number ten.

2. Paired Comparison Method

This method is a part of ranking method. Paired comparison method has been developed to be used in a
big organization. Each employee is compared with other employees taking only one at a time.

3. Grading
Certain categories of abilities or performance of employees are defined well in advance to fall in certain
grades under this method. Such grades are very good, good, average, poor and very poor. Here the
individual traits and characteristics are identified.

4. Checklist

The appraisal of the ability of an employee through getting answers for a number of questions is called
the method of check list.

5. Critical Incident method

The performance appraisal of an employee is done on the basis of the incidents occurred really to the
concerned employee. Some incidents occurred due to the inability of the employee, but the rating is
done on all the events occurred in a particular period.

MONITORING/EVALUATION

 Monitoring is the recording

 “Whether right thing is being delivered to the right people at the right time in a right way (process)”

What to Monitor
 Inputs
 Process
 Outcomes

Purpose of Monitoring:
 Monitoring helps to provide constructive suggestions like.
 Rescheduling the project (if the project run behind the schedule)
 Re budgeting the project (appropriating funds from one head to another)
 Re – assigning the staff (shifting the staff from one area to other; recruiting temporary staff to meet the
time schedule)

STEPS IN MONITORING:
 Identifying the different units involved in planning & implementation.
 Developing proforma/ Criteria for reporting.
 Determining the periodicity of reporting.
 Fixing the responsibility of reporting at different levels.
 Processing and analyzing the reports.
 Identifying the critical / unreliable areas in implementation.
 Providing feedback to corrective measures.

Indicators for Monitoring:

 Projects are usually monitored against Whether the projects are:
 -Running on schedule
 -Running within the planned costs
 -Receiving adequate costs.

MONITORING TOOLS
 Staff meetings – Weekly, Monthly, Annual
 Board meeting
 Survey e.g. field survey
 Participatory Reviews
 Progress reports/Statistics

EVALUATION

 Evaluation means finding out the value of something.

 Evaluation consists of assessments whether or not certain activities and interventions are in conformity
with generally accepted professional standards.

Principles of Evaluation

Evaluation is a continuous process (continuity).

Evaluation should involve minimum possible costs (inexpensive).

Evaluation should be done with minimum hindrance to day to day work.

Evaluation must be done on a co-operative basis in which the entire staff and the board members should
participate (total participation).

The agency should itself evaluate its program but occasionally outside evaluation machinery should also be
made use of (external evaluation).

6. Total overall examination of the agency will reveal strength and weaknesses. (agency / program totality).
7. The result of evaluation should be shared with workers of the agency (sharing).

TYPES OF EVALUATION

• Formative evaluation
Evaluation intended to improve performance, most often conducted during the design
and/or implementation phases of projects or programs.

• Summative evaluation
A study conducted at the end of an intervention to determine the extent to which
anticipated outcomes were produced.

• Participatory evaluation
Evaluation in which representatives of agencies and stakeholders work together in designing, carrying
out and interpreting an evaluation.

• Process based evaluation

An evaluation of the internal dynamics of a project, its policy instruments, its service delivery
mechanisms, its management practices, and the linkages among these.

• Outcome based Evaluation

It facilitates the asking if the organization is doing right activities to bring about the
expected outcomes.

• Goal based evaluation

Evaluating the extent to which projects are meeting predetermined goal / impact

 Peer evaluation
Peer review/Evaluation is a process by which employees of the same rank, profession and setting
evaluate one another’s job performance against accepted standards.

 Self evaluation

Tools and Techniques of Evaluation.

 First hand Information
 Formal reports
 Programme status report
 Programme schedule chart
 Programme financial status Report
 Standing Evaluation Review Committees
 Visit/observations both at field and office
 Meetings reviews
 Studies/Survey
 Audit
 First hand Information :
 Direct observation & hearing about the performance.
 Interview with staff
 Periodic Reports.
 Evaluation is also carried out through reports.