Patient classification

system
:Prepared by
Ahmed Mohammed Zinhom- 1
Amira El Sayed- 2

:Under supervision
Prof: Nehad Fekry
1. Define:
staffing
staffing pattern
staffing plan
staff mixes

2-Enumerate the goal

of staffing.
3-List objectives of
 3-List types of staffing.

4-Identify methods for use of supplementary staff.

5-Identifiy factors affecting staffing pattern

determination.

6-Defferentiate between the two types of staffing

component.

7-Compare between tow types of patient

classification system.
: Out Lines
Introduction
Definition of pcs
. Purpose of pcs
. Importance of pcs
. Types &styles of pcs
.Prototype evaluation system
.Factor evaluation system
. Categories of pcs
Formula for nursing workload standard
: Definitions-
staffing
staffing pattern
staffing plan
staff mixes

.The goal of staffing-

.Objectives of staffing-
. Types of staffing pattern-
Factors affecting staffing pattern-
.determination
Definition of staffing
- Staffing refers to the number and mixture of
personnel assigned to work in nursing units at a
given time.

- Is defined as human resources planning to fill positions on

organization with qualified personnel.

- Is process of determining and providing the acceptable

number and mix of nursing personnel to met and produce
desired level of care to meet the patient's demand for care .
- Filling position in the organization structure through
identifying work force requirements , inventorying the
people available ,recruitment, selection, placement,
promotion, appraisal, compensation, and training of
needed people.
Staffing pattern:

Is a written plan that specifies the number and

classification type of staff personnel who are needed
to implement a care delivery model for each unit .
Staffing plan:

Indicates how many persons of what job

classification should be on duty per each unit
per shift .
Staff mixes:

Is the skill level of individual delivering the

required care ,In nursing it include : technical
nurses and practical nurses.
: THE GOAL OF STAFFING
- To provide adequate numbers of the
right mixture of nursing personnel to
give proper care to patients housed in
the unit at a particular time.
 STAFFING:
- Establish a balance between the nursing staff available with
the manpower required ,according to the patients and their
care needs

- Provide sufficient staff to permit a1:1 nurse-patient ratio for

each shift in every critical care unit.
; OBJECTIVES OF STAFFING CONT

- Provide sufficient nursing staff general medical-

surgical ,obstetrics ,pediatrics, and psychiatric units to
permit a 1:5 nurse-patient ratio on day and afternoon
shifts and 1:10 nurse-patient ratio on night shifts.

- Summarize the data on actual versus required staff.

- Improve moral, job satisfaction and quality care with

decrease in turnover and vacancies.
 OBJECTIVES OF
; STAFFING CONT
- Evaluate staffing practices periodically.

- Recruit qualified personnel.

- Provide new employees with orientation period.

- Develop personnel policies that attract and provide

effective staff member.

STAFFING PROCESS
Staffing is logical operation that consist of
several interdependent actions, such as:
Identifying the type and amount of services(1
.needed by organization client
Determining the personnel categories that( 2
have the knowledge and skill to perform needed
.services measures
Predicting the number of personnel in each( 3
job category that will be needed to meet
.anticipated services demands
Obtaining budgeted points for the numbers in(4
each job category needed to service for the
expected types and number of clients.
5) Recruiting personal to fill available positions.
6) Selecting and appointing personnel from
.suitable applicant
Combing personnel into desired( 7
configuration by unit and shift.
8) Orienting personnel to fulfill assigned
responsibilities.
9) Assigning responsibilities for client services to
.available personnel
Staff classification
1-Professional nurse: Baccalaureate degree.
2-Technical nurse: Secondary Technical
Nursing School . ( Diploma degree).

3-Auxiliary: messenger and transport

personnel.
Components of Staffing
1- Staffing pattern:
it is the number and mix of personnel that should
be on duty per each unit per shift, per day.

2- Staffing plan:
It determines the number of nursing personnel that
must be hired to deliver nursing care on the
nursing units.
: TYPES OF STAFFING PATTERN- 5

There are three essential methods of nurse staffing

: pattern

I. The traditional fixed staffing pattern.

II. The controlled variable staffing pattern.

III. The semi-flexible staffing pattern.

25/11/2010 16
I. The traditional fixed staffing pattern:
In this method the staffing pattern is built around a fixed

projected maximum workload requirement.

Limitation of this method: it ignores the fluctuation in the work

load(patients condition and number) or staff member

condition(shortage ,absenteeism)

25/11/2010
17
:II. The controlled variable staffing pattern
In this method, the units are staffed below the maximum
workload conditions and staff is then supplemented as
needed.

Although this is very effective method for staffing , it creates

dissatisfaction among staff.

Method for use of supplementary staff:

1. Borrowing method

2. Floating method

3. On call staff
25/11/2010 18
 Methods used in supplementary staff :

A) Borrowing method
This common method of borrowing staff from unit to
.unit .to help those who have too little staff

The problem with this method is that:

the staff often resent being transferred from unit to unit- 1

. the head nurse never admits that she has more nurses- 2
B) Floating method

This is a better method for managing staffing needs . Nurses who are
permanent workers but don't belong to any special units are used to
fill any shortage in staff

:-Advantage
.help to manage the day to day variations in work volume - 1

.some nurses like this method to gives her chance to work with different types of patient - 2

C) on-call staff

Usually on-call staff is filled with fixed staff that receive extra pay for being on call
whether they are called or not .

This method is useful in OR , ICU

: III. The semi-flexible staffing pattern

In this method , about 10% to 15% of staff are fixed

and the rest flexible (supplementary) and the

volume is adjusted to match workload needs.

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FACTORS AFFECTING STAFFING- 6
: PATTERN

1. Nursing organization factors.

2. Patient factors.

3. Staff factors.

4. Health organization factors.

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20
 Factors affecting staffing pattern
Nursing organization factors

1.Patient care objectives

2.Determined level of patient care
3.Nursing division
4.Assignment system
5.Services to staf

 Patient factors
from the organization
Variety of patient conditions
Acuity
Length of stay
Patient number
Age groups ( pediatric , adults )
General health status and health goals
Staff factors
Job description- 1
Educational level of staff- 2
Experience level of staff- 3
work ethics of staff members- 4
Expectation of staff- 5
staff number available- 6
: Health organization factors
financial resources available- 1
Personal polices- 2
Support services within the- 3
organization
Numbers of beds per units- 4
Budget available- 5
Methods of determining the staffing pattern

1- The traditional system

1 - The number of beds per unit ( one

nurse per 4-6 beds), or

2 - The average census of patients per

unit ( one nurse per 4 patients).

The distribution of nurses is based on the nurse
manager' opinion of the proportion of care that is
needed on each shift and the adequate staff number
to provide that care.
Example: Days: 45% of the staff
Evenings 35% of the staff
Nights 20% of the staff

The traditional system ignored that the

group of patients might need more care
than another group of the same number.
2- The advanced system

A- PATIENT CLASSIFICATION.

B- TASK QUANTIFICATION.
Focuses on patient needs. Patients are
grouped according to the acuity of their
needs and the degree of their dependency
on nurses. The patients grouped
according to their nursing needs into 3 or
more groups:

Group 1: Self care

Group 2: Partial or intermediate care
Group 3: Intensive or total care
For example:-Determining nursing care hour by patient classification
system in medical-surgical unit by

No of pts Acuity level of care Associated hours of care Total No of hr

needed
I 2 6 3

II 6 60 10

III 7 77 11

IV 9 18 2

161 36
 Task quantification system
Focuses on nursing tasks. To be performed.
Common nursing tasks are either direct nursing
care ( in the presence of the patient as in giving
medication, measuring vital signs..) or indirect
nursing care ( away from the patients as in
preparing medication , documentation in
patients'
files, giving instructions or educative
sessions)
: STAFFING COMPONENT- 7
I. Staffing plan:

Indicates scheme mathematically derived to indicate how many

people of what classification must be hired in order to deliver
staffing pattern.

Staffing pattern determine positions which required to the unit

or the hospital, but staffing plan determine the number of
.workers to fill those position

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 Methods of staffing plan:
1- Using calendar days:

Divided the number of days in the year by the number of days actually
worked per nurse per year to drive the number of staff required to fill one
position for the year.
Example :
In some Hospitals in the ICU:
1. The nurse worked 17 days per month
2. So actual working days/year=1712=204 days
3. The number of nurses needed to fill one position of professional nurse =
364/204=1.8 worker.
4. The number of nurses to fill 6 positions of LPN/year = 6*1.8=11 nurses.
 :- using the care hours- 2
Calculate P.T hours/unit/shift.

Calculate the total number of nursing hours

required/year.

Calculate the number of staff required to deliver those

hours.

Calculate the number of positions required to deliver

that staff.
Example :
In the chemotherapy unit
The patient needs 2 hours of care.
The patient come to take this therapy daily=20.
So the number of patient care hours = 220=40h/day.
The number of hours in one shift= 8h.
Then the nurse required to give these hours= 40/8= 5 P.N
The number of workers to fill one position of nurse=1.65
So the number of nurses required to fill 5 positions of P.N =
5*1.65=8nurses
 Factors influencing staffing plan:
Job description.

Personnel policies.

Variability in patient care requirement.

Budged resources.

Equipment, supplies and technology.

Staff category.

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22
Criteria for Effective
Staffing Procedure
An effective allocation procedure meets the
:following criteria
Coverage: the number of nurses assigned to be on
duty should be in relation to the minimum number
of nurses required
Quality: the total number of patient care should be
planned in such a way that trained nurses are
available for patient care of 24 hours a day. It should
.also cover off days on rotation
 Criteria for Effective
Staffing Procedure
Stability: allocation procedure must be consistent
with leave and rotation policy. Each nurse must
.know her off, privileged leave etc
Flexibility: the allocation policy must provide for
flexibility e.g., if a request for days off or leave
.comes as emergency, that should be taken care of
Objectives: there should be fairness in allocation
and scheduling shift duties
Written staffing policies should be readily available
in at least the following areas :-
Vacations- 1
Holidays- 2
Sick leave- 3
Weekend off- 4
Over time- 5
Part time- 6
Absenteeism- 7
Emergency day off- 8
 : II. Staffing pattern
:Staffing pattern prediction

To predict the personnel allocation and scheduling system the manager

has to the amount and type of nursing care needed in each nursing
.unit(nursing workload)

: Work load component

Indirect care : which is consist in each unit .1

Direct care: activities which is varies according to the number and .2

.type of patient (patient classification)
Patient
classification
system
according to the following
:criteria
The activity of living-1

feeding-2

Grooming-3

Toileting-4

Comfort measures-5

Mobility-6
Criteria for Evaluating the Usefulness
: of Patient Classification Systems

HOW WELL DOES THE PATIENT - 1

CLASSIFICATION SYSTEM ACCOUNT FOR
VARIATIONS IN PATIENT NEEDS FOR
? HOSPITAL SERVICES
IDENTIFYING PATIENT NEEDS.
EASY AND QUACK ADAPTATION WITH CHANGED
PATIENT NEEDS.
RESOURCES .
FLEXIBLE.
 Criteria for Evaluating the
Usefulness of Patient
: Classification Systems

How strong Is the Patient Classification- 2

? System
refers to the ability of the system to maintain
its properties despite changes in the data used to
create or operate the system , persons using
system.
Criteria for Evaluating the Usefulness
: of Patient Classification Systems

How Reliable Are Patient Assignments to- 3

? Category
Reliability should be assessed at several levels :
primary data which as (sex, age, vital signs and lab
test results , diagnosis,)
category assignment (require subjective
(Judgment
Criteria for Evaluating the
Usefulness of Patient
: Classification Systems

How Does the Patient Classification- 4

? System Affect Economic Incentives
admission status (emergency vs. non
emergency), Because emergency
admissions have significantly higher
.costs and lengths of stay
 Criteria for Evaluating the
Usefulness of Patient Classification
: Systems

To What Extent Is the Patient Classification- 5

? System Meaningful to Care providers
care providers must understand the system
knowing PCS importance
resources.
Criteria for Evaluating the Usefulness
: of Patient Classification Systems
How Feasible and valuable Is the System To- 6
? Use
classification systems that use more detailed
.data, revision, easy to use, understand
should be capable by computer to minimize
cost , save time and enhance feasibility
Measurement of
:pcs

NCH /PPD = NURSING HOURS WORKED IN 24

HOURS
PATIENT CENSUS
Using the care hours for developing staffing pattern
Hospitals used the patient care hours for developing staffing pattern, can
calculate the staffing plan using the care hours methods.

For example:----------------------------------------------------------X

Estimating a core staff per shift

Bed number in surgical unit= 25 bed

The average daily census for 6 month = 19 patients

The average daily care hour to be provided= 5 hour per pt/24 hour.

Total hours of care will be needed= 19x5= 95 hours.

If the work day is 8 hours , then 95 divided on 8

= 11.9 or 12 FTE staff needed to unit for 24 hour.

Total of 12 EFT x 7 days / week = 84 shift /
work--------------------------------x
If the employee work 5 hours shift / week, then 84
.the number of EFT needed 16.8 = 5

The needed on each shift and the adequate staff number

.to provide that care
Example: days: 45% of staff
45x16.8/100=7.56=8
Evenings 35% of the staff
35x16.8/100=5.88=6
Nights 20% of the staff
20x16.8/100=3.34=3
Total Nigh Eve Day Cate
t ning gory
9 2 3 4 RNs

5 1 2 2 LPN

3 - 1 2 Other
17 3 6 8 Total
 T I O N
? ? ? ? Q UES
THANK YOU