Be fair In the distribution of duty hours to your nursing staff.

STAFFING & DUTY SCHEDULING

Pamela M. Veroy RN, MAN

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. Purpose: to provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required.

Factors affecting staffing

1. The type, philosophy and objectives f the hospital and the nursing service 2. the population served or the kind of patients served whether pay or charity 3. the number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the actual care needs of patients

Factors affecting staffing

4. Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position: 5. administrative policies such as rotation, weekends and holiday off-duties 6. standards of care desired which should be available and clearly spelled out.

Factors affecting staffing

7. layout of the various nursing units and resources available within the department such as adequate equipment, supplies and materials. 8. budget including the amount alloted to salaries, fringe benefits, supplies, materials and equipment; 9. professional activities and priorities in nonpatient activities like involvement in professional organizations, formal educational development, participation in research and staff development

Factors affecting staffing

10. teaching program or the extent of staff involvement in teaching activities 11. expected hours of work per annum of each employee. This is influenced by the 40-hr week law; and 12. patters of work schedule-traditional 5 days per week, 8 hours per day; 4 days a week, ten hours per day and three days off; or 3 days of 12 hours per day and 3 days off per week.

Nursing Care hours per patient/day according to classification of patients per units
Cases/Patients 1. General Medicine 2. Medical
NCH/Pt/Day Prof to Non Prof Ratio

3.5 3.4

60:40

60:40
60:40 60:40 70:30 55:45 70:30 80:20

3. Surgical
4. Obstetrics 5. Pediatrics

3.4
3.0 4.6

6. Pathologic Nursery
7. ER/ICU/RR 8. CCU

2.8
6.0 6.0

Patient Care Classification System

It 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. Purpose: 1. Serve in determining the amount of nursing care required, generally within 24 hours. 2. to determine the category of nursing personnel who should provide that care.

Classification Categories
Level I-Self Care or Minimal Care -NCH 1.5/pt/day - Ratio 55:45 Level II Moderate Care or Intermediate Care -NCH 3/pt - Ratio 60:40 -Can take a bath on his own; feed himself; perform his own ADL. -For discharge pt; non-emergency, newly admitted dont exhibit unusual s/s; - requires little treatment and observation -Need some assistance in bathing, feeding, ambulating for short period. -Extreme s/s of illness must have subsided or have not yet appeared -May have slight emotional needs -v/s taking ordered 3x/shift; with IVF/BT; are semiconscious and exhibiting some psychosocial or social problems; - periodic treatments and/or observations and /instructions

Classification Categories
Level III Total, Complete or Intensive Care -NCM 6hrs/pt/day -Ratio 65:35

-Patient are completely dependent upon the nursing personnel. -They are provided complete bath, are fed, may or may not be unconscious, with marked emotional needs; with v/s monitoring more than 3x/shift -Maybe on continuous oxygen therapy, with chest or abdominal tubes -They require close observation at least every 30 minutes for impending hemorrhage, with hypo or hypertension and/ or cardiac arrhythmia

Classification Categories
Level IVHighly Specialized Critical Care -NCH 6-9 or more /pt/day - Ratio 70:30 or 80:20

-Need maximum level of nursing care with a ratio of 80 professionals to 20 non-professionals. -Needs continuous treatment and observation -With many medications, IV piggy backs; v/s monitoring every 15-30 minutes; hourly output. -There are significant changes in doctors orders

Categories of Level of Care of Patients: Nursing Care Hours/Pt/Day & Ratio of Prof-Non Prof
Levels of Care Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level II Total or Intensive Care Level IV Highly Specialized or Critical Care NCH Needed Per Pt./Day 1.50 3.0 Ratio of Prof to Non-Prof 5:45 60:40

4.5 6.0 7 or higher

65:35 70:30 80:20

Percentage of patients at various levels of care per type of hospital

Type of Hospital Minimal Care Moderate Care Intensive Care Highly Spl. Care

Primary Hospital Secondary Hospital Tertiary Hospital

70 65 30

25 30 45

5 5 15

10

Special Tertiary Hospital

10

25

45

20

Computing for the number of nursing personnel needed

- should ensure that there is sufficient staff to cover

all shifts, off-duties, holidays, leaves, absences, and time for staff development programs.
- The Forty-Hour Week Law (Republic Act 5901)- for 100 bed capacity and up -Granting of the 3-day special privilege to govt. employees by the Civil Service Commission as per Memorandum Circular No. 6 series of 1996 (birthdays, weddings, anniversaries, funerals (mourning), relocation, enrollment or graduation leave, hospitalization, and accident leave.

Total No. working-Non working days & hours of nursing personnel per year
Rights & Privileges Given Each Personnel Per Year
1. Vacation Leave 2. Sick Leave 3. Legal Holidays 4. Special Holidays 5. Special Privileges 6. Off-Duties as per R.A. 5901 7. Continuing Education Program Total Non-working Days per year Total working days per year Total working hours per year Working Hours Per Week 40 hours 15 15 10 2 3 104 3 152 213 1,704 48 hours 15 15 10 2 3 52 3 100 265 2,120

Relievers Needed - To compute for relievers needed, the following should

be considered; 1. Average number of leaves taken each year------ 15 a. vacation 15

b. sick leave 5
2. Holidays -----------------------------------------------------12 3. Special Privileges as per CSC MC#6 s. 1996-------3 4. Continuing Educ. Prog. For professionals------------3 Total Average Leave-------33

To determine the relievers needed

- divide 33 by number of working days per year
each employee served (whether 213 or 265) - result will be 0.15 per persons works for 40 hour/week - result will be 0.12 per persons works for 48 hour/week - multiply the computed reliever per person by the computed number of nsg personnel - this will give you the total number of relievers

Staffing Formula
To illustrate: Find the number of nursing according to levels of care needed. 1. Categorize the patients according to levels of care needed 250 pts x 0.30 = 75 pts needing minimal care

250 pts x 0.45 = 112.5

250 pts x 0.15 = 37.5 250 pts x 0.01 = 25 250

pts needing moderate care

pts needed intensive care pts need highly specialized nsg care

2. Find the number of nursing care hours (NCH) needed by patients at each level of care per day. 75 pts x 1.5 (NCH needed at Level I) = 112.5 MCH/day

112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day 37.5 pts x 4.5 (NCH needed at Level II) = 168.75 NCH/day

25 pts x 6 (NCH needed at Level IV)

Total

= 150

NCH/day

768.75 NCH/day

3. Find the total NCH needed by 250 patients per year. 768.75 x 365 (days/yr) = 280,593.75 NCH/year

4. Find the actual working hours rendered by each nursing personnel per year. 8 (hrs/day) x 213 (working days/year) = 1,704 (working hours/year) 5. Find the total number of nursing personnel needed. a. Total NCH per year = 280,593.75 = 165 Working hrs/year 1,704

b. relief x total nsg. Personnel = 165 x 0.15 = 25

c. total nursing personnel needed 165 + 25 = 190

6. Categorize to professional and non-professional personnel ratio of prof to non-prof in a tertiary hospital is 65:35 190 x .65 = 134 professional nurses 190 x .35 = 66 nursing attendants 7. Distribute by shifts 124 nurses x .45 = 56 nurses on AM shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x .18 = 22 nurses on night shift Total 124 nurses 66 nsg attendants x .45 = 30 nsg. attendants on AM shift 66 nsg attendants x .37 = 24 nsg attendants on PM shift

66 nsg attendents x .18 = 12 nursing attendants on noc

Total = 66 nursing attendants

Assessing a Scheduling System

1. Ability to cover the needs of the unit
2. quality to enhance the nursing personnel's knowledge, training and experience 3. fairness to the staff fair share of weekends, holiday offs, rotation patters for the whole year including assignment to difficult or light or undesirable units or shifts

4. stability the schedule must be harmonized with their family or social activities of the nurse staff
5. flexibility ability to handle changes brought by emergency leaves.

Make a schedule in a weekly or monthly basis and do cycle system with the staff under the area assigned for fairness and flexibility.

A one-week cyclical schedule

Personnel 7/3 Headnurse/Senior Nurse Staff Nurse Nsg. Att. 3/11 Staff Nurse x x S x x x x M T W T x x F S

Nsg. Att.
11/7 Staff Nurse Nsg. Att. Gen. Rel. 3/11; 11/7 S. nurse N. Att.

x
x x
3/11 3/11 11/7 x

x
x x
x 3/11 11/7

3/11

11/7

7/3

3/11

11/7