3RD MANAGEMENT FUNCTION

STAFFING
€

Process of determining and providing acceptable number of personnel to produce desired level of care

y PROFESSIONAL y NON-PROFESSIONAL

STAFFING
€

INVOLVES:
y A. SELECTION OF PERSONNEL y B. ASSIGNMENT SYSTEMS y C. DETERMINATION OF STAFFING

SCHEDULES

SELECTION OF PERSONNEL

SELECTION OF PERSONNEL
ƒ

HRD : HUMAN RESOURCE DEPARTMENT 
INTERVIEW, HIRE, PERPERMANCE EVALUATION

ƒ

RECRUITMENT
PROCESS OF ENLISTING PERSONNEL FOR EMPLOYMENT PROCESS OF HIRING 
ACTIVE RECRUITMENT

ATTRACTION OF QUALIFIED

APPLICANTS

RECOMMENDATIONS ADVERTISEMENT POSTERS JOB FAIR INTERNET

SELECTION OF PERSONNEL
€

SCREENING
y 3 UNDERLYING PHILOSIPIES OF

SCREENING PROCESS
1. SCREEN OUT APPLICANTS WHO DO NOT FIT THE COMPANY 2.MANAGER SHOULD TRY TO FIT THE JOB TO PROMISING APPLICANT 3. FIT APPLICANT TO THE JOB

SELECTION OF PERSONNEL
€

RESUMES
y DEMOGRAPHIC INFORMATIONS y EDUCATIONAL BACKGROUND y WORK EXPERIENCES

DETERMINES APPLICANT¶S MINIMAL HIRING REQUIRMENT

SELECTION OF PERSONNEL
€

INTERVIEW
FACE TO FACE CONTACT BETWEEN APPLICANTS AND PERSON IN AUTHORITY TO FILL IN THE POSITION
y PRE-EMPLOYMENT INTERVIEW PURPOSES: TO 1. OBTAIN INFORMATION 2. GIVE INFORMATION 3. DETERMINE IF APPLICANT MEETTHE REQUIRMENT FOR THE POSITION

SELECTION OF PERSONNEL
ƒ

TYPES OF INTERVIEW 
DIRECTIVE INTERVIEW USE CLOSE ENDED QUESTIONS  NON-DIRECTIVE 

GROUP INTERVIEW SEVERAL APPLICANTS ARE INTERVIEWED TOGETHER  BOARD INTERVIEW SELECTED MEMBER OF PERSONNEL INTERVIEW APPLICANT  STRUCTURE

INTERVIEW
APPLICANTS NARRATES HIMSELF

INTERVIEW
USES PRE-PREPARED GUIDELINES FOR INTERVIEW

SELECTION OF PERSONNEL
€

TEST/EXAMINATIONS
y MEASURES:

CLERICAL & MECHANICAL APTITUDES
y KNOWLEDGE y SKILLS

GENERAL INTELLIGENCE MENTAL, PERCEPTUAL & PSYCHOMOTOR ABILITIES

TYPES OF TEST
ƒ

APTITUDE TEST 
MEASURES CAPACITY ON POTENTIAL

ABILITY TO LEARN
ƒ

PSYCHOMOTOR 
MEASURES STRENGTH AND

COORDINATION
ƒ

PROFICIENCY 
MEASURES HOW WELL AN APPILCANT

CAN DO SIMPLE WORK
ƒ

PSYCHOLOGICAL 
MEASURES PERSONALITY

CHARACTERISTICS

ASSIGNMENT SYSTEM FOR STAFFING

CASE METHOD
€

PATIENT ASSIGNED TO A NURSE FOR TOTAL PATIENT CARE

€

1:1 NURSE/PATIENT RATIO

TOTAL CARE/ CASE NURSING
HEAD NURSE
STAFF NURSE PATIENT

CASE METHOD
€

ADVANTAGES
y CONSISTENCY OF

€

DISADVANTAGES
y NURSE MAY NOT

CARE FOR 1 WHOLE SHIFT y MORE OPPORTUNITY TO OBSERVE AND MONITOR PATIENT¶S CONDITION

HAVE SAME PATIENT THE NEXT DAY OF DUTY

FUNCTIONAL NURSING
HEAD NURSE/SENIOR NURSE

MEDICATION

TREATMENT

NURSING ASSISTANT

HOUSE KEEPING

PATIENT

FUNCTIONAL NURSING
€

HIERARCHIAL STRUCTURE PREDOMINATES IMPLEMENTS SCIENTIFIC MANAGEMENT DIVIDES WORK TO BE DONE
y MEDICATION NURSE y TREATMENT NURSE y BEDSIDE NURSE

€

€

FUNCTIONAL NURSING
€

WORK DONE FASTER WORKERS WORKS FASTER

ƒ

€

HOLISTIC CARE NOT ACHIEVED FRAGMENTATION OF NURSING CARE NURSE-PATIENT RELATIONSHIP IS NOT FULLY DEVELOPED

ƒ €

DEVELOPED SKILL IN CERTAIN PARTICULAR TASK

ADVANTAGES

EVALUATION OF NURSING CARE IS POOR DISADVANTAGES
ƒ

TEAM NURSING
INTRODUCED IN 1950s DUE TO SCARCITY OF RN¶S AFTER WW II € BASED ON PHILOSOPHY OF GROUP ACTION TO ACHIEVE GOAL € FEATURES:
€
y NURSING CARE CONFERENCE

PURPOSE: DEVELOPMENT & REVISION OF NCP
y NURSING CARE PLAN

TEAM NURSING
CHARGE NURSE

TEAM LEADER NURSING STAFF PATINTS/CLIENTS

TEAM NURSING
€

WORK SHARED WITH OTHERS

UNPERSONALIZED, FRAGMENTED PATIENT CARE € COMPLEX COMMUNICATION € ACCOUNTABILITY AND RESPONSIBILTY SHARED WITH OTHERS CAUSE CONFUSION
€

ADVANTAGES

DISADVANTAGES

PRIMARY NURSING
ƒ

RN GIVES TOTAL CARE TO 4- 6 PATIENTS WHILE ON DUTY PRIMARY NURSE 
RESPONSIBLE FOR THE CARE OF THE

ƒ

PATIENT x 24 HOURS THROUGH OUT HOSPITALIZATION
ƒ

ASSOCIATE NURSE 
CARE FOR THE PATIENTS USING THE CARE

PLAN DEVELOPED BY THE PN IS OFF DUTY

WHEN PN

PRIMARY NURSING
PHYSICIAN HEAD NURSE HOSP. & COMM. RESOURCES

PRIMARY NURSE PATIENT

SRCONDARY NURSE PM

SECONDARY ASST. NURSE NIGHT

SECONDARY ASST. NURSE RELIEVER

PRIMARY NURSING
ƒ

DEVELOPED TRUSTING RELATIONSHIP BETWEEN RN & PATIENT AND FAMILY DEFINED ACCOUNTABILITY & RESPONSIBILITY

€

HIGH COST RN SKILL

HIGHER

€

PROXIMITY OF PATIENT ASSIGMENT OVERLAPPING OF STAFF FUNCTION

ƒ

€

HOLISTIC/CONTINUITY OF CARE ADVANTAGES
ƒ

DISADVANTAGES

MODULAR OR DISTRICT NURSING
ƒ

MODIFICATION OF TEAM & PRIMARY NURSING 
DIVIDES AREA INTO MODULE/GROUP OF

PATIENT  EACH MODULE CARED BY A TEAM NURSE
ƒ ƒ

A KIND OF TEAM NURSING RN 
PLAN THE CARE  DELIVER CARE  DIRECTS PARAPROFESSIONALS ON

TECHNICAL ASPECTS OF CARE

MODULAR NURSING
€

ADVANTAGES
y INCREASED CONTINUITY AND QUALITY

OF CARE
y MORE TIME SPENT IN DELIVERY OF

CARE

MANAGED CARE
ƒ

UNIT-BASED CARE SYSTEM 
USES STANDARD CRITICAL PATH WITH

NCP
ƒ

CRITICAL PATH METHOD ± CPM 
CALCULATE A SINGLE TIME ESTIMATE

FOR EACH ACTIVITY, THE LONGEST POSSIBLE TIME  COST ESTIMATE FIGURED FOR BOTH NORMAL & CRASH OPERATING PROCEDURE
NORMAL THE LEST COST METHOD CRASH CONDITION IN LESS THAN NORMAL TIME

CASE MANAGEMENT
€

2ND GENERATION PRIMARY NURSING

€

FOCUSES ON ENTIRE EPISODE OF ILLNESS

€

CARE IS COORDINATED BY A CASE MANAGER

CASE MANAGEMENT
ƒ

INVOLVES: 
CRITICAL PATH S VISUALIZE OUTCOMES WITHIN A TIME FRAME  VARIATION ANALYSIS NOTES POSITIVE OR NEGATIVE CHANGES FROM CRITICAL PATH CAUSE & CORRECTIVE ACTION TAKEN  INTERSHIFT REPORTS

CASE MANAGEMENT
y CASE CONSULTATION INDICATED WHEN CLIENT¶S CONDITION DIFFERS FROM CRITICAL PATH AS NOTED IN THE INTERSHIFT REPORT y HEALTH CARE TEAM MEETING PROVIDE INTERDISCIPLINARY APPROACH TO PROBLEM SOLVING

COLLABORATIVE PRACTICE
€

INCLUDE
y INTERDISCIPLINARY TEAMS y NURSE-PHYSICIAN INTERACTION IN

JOINT PRACTICE
y NURSE-PHYSICIAN COLLABORATION IN

CARE GIVING

STAFFING SCHEDULES

SCHEDULE
€

TIMETABLE SHOWING PLANNED WORK DAYS AND SHIFT SCHEDULING
y ASSIGNING WORK AND OFF DAYS TO

€

NURSING PERSONNEL TO ASSURE ADEQUATE PATIENT CARE

STAFFING SCHEDULES
€

CENTRALIZED SCHEDULING DECENTEALIZED STAFFING

€

SELF SCHEDULING
y COORDINATED BY

€

NURSES AND OTHER STAFFCLLECTIVELY DEVELOP AND IMPLEMENT WORK SCHEDULE, TAKING POLICIES AND VARIABLES AFFECTING STAFFING INTO CONSIDERATION

STAFFING SCHEDULES
ƒ

ROTATING WORKSHIFT 
DAY OR AM SHIFT  EVENING SHIFT  NIGHT SHIFT

ƒ

VARIABLE STAFFING 
USES PATIENT

ƒ ƒ

PERMANENT SHIFT BLOCK OR CYCLICAL 
USES SAME

NEEDS TO DETERMINE THE NUMBER AND MIX OF STAFF  TIME MEASURES DONE FOR DIRECT AND INDIRECT PATIENT CARE
ƒ

SCHEDULE REPEATEDLY  REPEATED EVERY 6 WEEKS

EIGHT HOUR SHIFT, 5 DAY WORK WEEK

STAFFING SCHEDULES
ƒ

TEN HOUR DAY, FOUR DAY WORK WEEK TEN HOUR SHIFT, SEVEN-DAY WORKWEEK 
7-70 PLAN  10 HOUR SHIFT 7 DAYS

ƒ

TWELVE HOUR SHIFT, SEVEN DAY WORKWEEK ƒ BAYLOR PLAN
ƒ 
INTRODUCED IN

BAYLOR UNIVERSITY MEDICAL CENTER IN DALLAS, TEXAS
USES 2 DAYS ALTERNATIVE PLAN NURSES OPTION FOR WORK
TWO 12 HOUR DAYS ON THE WEEKENDS TO BE PAID  FOR 36 HOURS FOR DAY SHIFT  40 HOURS FOR NIGHT SHIFT FIVE 8 HOUR SHIFT

A WEEK, FOLLOWED BY 7 CONSECUTIVE DAYS OFF  TWO TEAKS ALTERNATE WEEKS  NO ROTATION OF SHIFT

PATIENT CLASSIFICATION SYSTEM
€

QUANTIFY THE QUALITY OF NURSING CARE BY MATCHING PATIENTS¶ NEEDS TO NUMBER AND KIND OF NURSING PERSONNEL USING TIME AS THE UNIT OF MEASURE

************************

FOR STAFFING € PROGRAM COSTING AND FORMULATING BUDGET € TRACK CHANGES IN PATIENT CARE METHODS € DETERMINE VALUES FOR PRODUCTIVITY EQUATION € DETERMINE QUALITY PURPOSES
€

PATIENT CLASSIFICATION SYSTEM
ƒ

NURSE MANAGER MUST DETERMINE THE FOLLOWING 
NUMBER OF CATEGORIES IN WHICH

PATIENT SHOULD BE DIVIDED 

CHARACTERISTIC OF PATIENTS/CATEGORY  TYPE AND NUMBER OF CARE

PROCEDURES NEEDED BY PATIEN /CATEGORY 

TIME NEEDED TO PERFORM THE

PROCEDURES

PATIENT CARE CLASSIFICATION SYSTEM
LEVELS OF CARE NCH NEEDED /DAY RATIO OF PROF. TO NONPROFESSIONALS 55:45 60:40 65:35 70:30 80:20

LEVEL I - SELF CARE OR MINIMAL CARE LEVEL II ± MODERATE OR INTERMEDIATE LEVEL III ± TOTAL OR INTENSIVE CARE KLEVEL IV ± HIGHLY SPECIALIZED OR CRITICAL CARE

1.5 3.0 4.5 6.0 7 or higher

PATIENT CARE CLASSIFICATION SYSTEM
€

LEVEL I: Minimal Care or Self care
y Can take a bath on his own y Perform ADL on his own y Patient about to be discharge y Non-emergency cases y Do not exhibit unusual symptoms y Requires little treatment

PATIENT CARE CLASSIFICATION SYSTEM
ƒ

LEVEL II: Intermediate or Moderate Care 
Needs assistance in bathing, feeding or      

ambulating for short periods of time Extreme symptoms have subsided or yet to appear Have slight emotional needs With IVF or BT Semi-conscious Have some psychosocial or social problem Periodic treatment, observation

PATIENT CARE CLASSIFICATION SYSTEM
ƒ

LEVEL III: Intensive, Total, Complete Care 
  

Completely dependent on nursing personnel On continuous O2 therapy With chest or abdominal tubes Requires close observations Needs continuous treatment & observations VS q 15 minutes Hourly I & O Significant changes in Doctor¶s order

ƒ

LEVEL IV: Highly Specialized Critical Care 
  

PERCENTAGE OF PATIENT AT VARIOUS LEVEL OF CARE/TYPE OF HOSPITAL
TYPE OF HOSPITAL PRIMARY SECONDAR Y TERTIARY SPECIAL TERTIARY MINIMAL CARE 70 65 30 10 MODERATE CARE 25 30 45 25 INTENSIVE CARE 5 5 15 45 HIGHLY SPECIALIZE D CARE 10 20

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED
€

Ensure that there is sufficient staff to:
y Cover all shifts y Off duties y Holidays y Leaves y Absences y Time for staff development

COMPUTING FOR NUMBER OF NURSING PERSONNEL NEEDED
ƒ

RA 5901: Forty-Hour Week Law 
EMPLOYEES WILL WORK 40 HOURS/WEEK

FOR:
Hospitals with 100 bed capacity or more Community population with at least 1 million population

ƒ

However; 
ANURSE WILL RENDER 48 HOURS/WEEK

WITH ONLY I DAY OOF DUTY A WEEK IF
Hospitals with less than 1oo bed capacity Communities with less than 1 million population

STAFFING
ƒ

ƒ

CIVIL SERVICE COMMISSION MEMORANDUM CIRCULAR NO. 6 SERIES OF 1966 GOVERNMENT EMPLOYEES ARE GRANTED 3 DAYS WHICH MAY BE SPENT FOR: 
      

BIRTHDAY WEDDINGS ANNIVERSARIES FUNERAL RELOCATION ENROLLMENT/GRADUATION LEAVE HOSPITALIZATION ACCIDENT LEAVE

RIGHTS AND PRIVELEGES OF PERSONNEL/YEAR 1. 2. 3. 4. 5. 6. 7. Vacation Leave Sick leave Legal holidays Special holidays Special privileges Off duties/ RA 5910 Continuing Education Program

48 WORKING HOURS /WEEK 15 15 10 2 3 104 3 152

40 WORKING HOUR/ WEEK 15 15 10 2 3 52 3 100

Total Non-working days/year Total Working days/year Total Working hours/year

213 1,704

265 2,12o

STAFFING FORMULA
1. Categorize the number of patients according to the levels of care needed. 


Multiply total # of patient by % of patient at each Level of Care Ex. Find the # of Nursing Personnel needed for 250 bed capacity in a tertiary hospital
250 patients x .30 = 75 patients needing minimal care ± L1 250 patients x .45 = 112.5 patient needing moderate care ± L2 250 patients x .15 = 37.5 patients need intensive care ± L3 250 patients x .01 = 25 patients needed highly specialized nursing care ± L4

Staffing formula
2. Find the # of NCH needed by patients at each level of care /day
A. find the number of patients at each level by the average number of NCH needed/day B. get the sum of NCH needed at various level 
  

75 patients x 1.5 NCH needed at Level I = 112.5 112.5 patients x 3 NCH needed at Level II = 337.5 37.5 patients x 4.5 NCH needed at level III= 168.75 25 patients x 6 NCH needed at Level IV = 150 _______ total 768.75

STAFFING FORMULA
3. Find the total NCH needed by given no. of patient or bed capacity/ year 
total NCH needed/day x total number of

days in a year 
768.75 x 365 days/year = 280,593.75 NCH/year

4. Find the actual working hours rendered by each nursing personnel per year 
8 hours x 213 working day/year = 1,704

working hours/year

STAFFING FORMULA
5. Find the total # of nursing personnel needed 
Total NCH /year = 280,593.75 = 165 TNP

working hrs/year 

1,704

Find the number of reliever
Total Nsg. Personnel x 0.15 (For those working 40 hours a week) = 165 x 0.15 = 25 total Nsg. Personnel x 0.12 (For those working 48 hours a week) 

Add no. of relievers to no. of nursing personnel

needed
165 + 25 = 190 nursing care personnel needed

STAFFING FORMULA
6. 

Categorize as to professional and non-professional personnel
Ratio of professional to non-professional in tertiary hospital is 65:35
190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants

7. 
 

Distribute by shift
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

STAFFING FORMULA
7.
y y y

Distribute nursing attendants/ shift
66 nursing attendant x .45 = 30 nsg. Attendant AM shift 66 nursing attendant x .37 = 24 nsg. Attendant PM shift 66 nursing attendant x .18 = 12 nsg. attendant

NCH/ patient / day : according to classification/unit
€

The Hospital Nursing Service Administration Manual of DOH has recommended the following NCH for patients in various nursing units of hospitals

-----------------------------------------CASES 1. GENERAL MEDICINE 2. MEDICAL 3. SURGICAL 4. OBSTETRICS 5. PEDIATRICS 6. PATHOLIGIC NURSERY 7. ER/ICU/RR 8. CCU NCH/PT/DAY 3.5 3.4 3.4 3.0 4.6 2.8 6.0 6.0 PROF TO NONPROF RATIO 60:40 60:40 60:40 60:40 70:30 55:45 70:30 80:20

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