(cont.

) Staff Development
RSUM personal data sheet and self-advertisement
Assists in completing an employment application quickly and accurately
Demonstrates your potential
Focuses on your strongest points
Gives you credit for all your achievements
Identifies you as organized, prepared, and serious about the job search
Serves as a reminder and adds to your self-confidence during the interview
Provides initial introduction to potential employers in seeking the interview
Serves as a guide for the interviewer
Functions as a tool to distribute to others who are willing to assist you in a job search

Essentials of a Resume

Identification
Job Objective clear and brief. To accomplish this, ask yourself: what do I want to do? For or with whom?
When? At what level of responsibility?
o What: RN
o For whom: Pediatric Patients
o Where: Large metropolitan hospital
o At what level: Staff
Education name and location of every educational institution attended, dates, degree, diploma or
certificate attended
Work Experience
Military Service
Affiliations
Honors and Awards
References
Cover Letter the introduction; acts as a transmittal letter
- Presents credentials to prospective employer
- Generates interest in interviewing you


CAREER MAPPING

is a strategic plan for one's career.
provides direction for formal education, experience, continuing education, professional
associations, and networking
One has to:
1. assess interests and skills
2. determine goals
3. develop a map
4. pursue strategies to maintain the map; set 1-, 5-, 10-year plans.
Time frame can be illustrated in a career map with a 10-year time frame across the top of the
paper.





PATIENT CLASSIFICATION SYSTEM

means of categorizing present patients on the basis of certain care needs that can be clinically observed
by the nurse.
can serve as a basis for planning the staffing needs of patients.
There are three methods of classifying patients:

In 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 checklist style divides descriptions of care routine into activity categories, such as eating and bathing.
Activity levels are described in each category.

Time standard or relative value unit (RVU) systems assign a value unit (usually a measure of time) to various
activities of patient care. Those activities are usually clustered according to categories, such as diet, bathing, and
mobility.

The patient classification system is described as follow.

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 day, even if only at
infrequent intervals. This care group also includes patients who require diagnostic studies, minimal therapy, less
frequent observations, and daily care for monitor conditions, and who are awaiting elective surgery or have
difficulty arranging transportation between home and hospital, or whose home environment temporarily makes
discharge undesirable or impractical.

Time requirement: 1-2 hours per day

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.

Time requirement: 3-4 hours per day

Category III: Maximum Care

Moderate 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 and
complex medications or treatments.

Time requirement: 7-8 hours per day

Category IV: Intensive Care

Intensive care is given to acutely ill patients who have a high level of nurse dependency, including those,
requiring intensive therapy and/or intensive nursing care and whose unstable condition requires frequent
evaluation with adjustment therapy.

Time requirement: 10-14 hours per day

Staffing Formulas

When determining the number of staff to hire, one must consider hours needing coverage, vacations,
holidays, absenteeism, and staff development time. If nurses work 5 days a week and coverage is needed for
7 days, it takes 1.4 nurses to have one nurse on duty 7 days and 2.8 to have two nurses on duty for 7 days. This
is calculated by multiplying the number needed on duty days by days of the week needing coverage and dividing
the number of days each employee works per week to determine the number of personnel needed for coverage.
For example:

Number
Needed
Days of
Week
Number of
Days Each
Workweek
Number of
People
Required


1 x 7 5 = 1.4
2 x 7 5 = 2.8
3 x 7 5 = 4.2
4 x 7 5 = 5.6
5 x 7 5 = 7.0

Vacation Coverage


Number of vacation
days per year at that
skill level


x

Number of full-time
people

=

Total vacation days by skill level



Total vacation days Total days worked Number of
By skill level per person per year = full-time people needed for
vacation relief coverage


Holiday Coverage

Number of personnel x Number of holidays = Number of holidays needing coverage

Number of Number of
holiday relief days days worked per year = Number of personnel required for holiday
per person coverage per year

Absentee Relief Coverage

Weeks/year x Days worked/week x % of absenteeism = Absentee days/person/year

Personnel Absenteeism Absentee coverage
requirements (7day/week) x days/person/year = for staffing

Absentee coverage Total days Full-time personnel required for
required worked/person/year = absentee coverage per year
Staff Development Relief

Number of hours required
or recommended for staff
development per year per
person


x


Number of
staff


=
Number of hours
per year for staff development
needing relief coverage


Number of staff
development
hours needing
coverage



Hours worked/
day


Total days
worked/person

=
Full-time personnel
required for staff
development
coverage

Staffing to Meet Fluctuating Needs

Full-time Staff may be hired to meet the average staffing needs of an institution.
- oriented to many areas and like the challenge of different types of patients and settings
Part-time Staff flexible working hours can be an incentive for inactive nurses to start part-time employment and
can thus reduce staffing shortages
- most nurses are women who have to combine their nursing role with many others
- broaden the womans horizons beyond her home, increase her income, give her ego
satisfaction, and help her maintain her continuing their education.
- Disadvantages: 1) educational and administrative expenses are higher. For example, it is likely
to cost as much to orient part-time as a full-time nurse.
2) maintaining continuity of care is complicated, because two or more part-time
people may fill budgeted full-time positions
3) For the employee, may not receive benefits such as paid sick or vacation
days and it not likely to be considered for promotion.

Rightsizing/downsizing
Productivity - product or work produced through a specific amount of resources, measured as outputs divided
by inputs.

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 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 the 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. Find the actual number of working hours rendered by each nursing personnel each year.
a. hours on duty per day x actual working days per 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 reliever 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.

100 patients x .65 = 65 patients needing minimal care
100 patients x .30 = 30 patients needing moderate/intermediate care
100 patients x .05 = 5 patients needing intensive care

2. Find the number of nursing care hours (NCH) needed per day at Level I, Level II, and at Level III.
Given: Level I: Minimal Care: 1.5 NCH needed per patient per day
Level II: Intermediate Care: 3.0
Level III: Intensive Care: 4.5

Level I = 65 x 1.5 = 97.5 NCH needed by 65 patients
Level II = 30 x 3 = 90 NCH needed by 30 patients
Level III = 5 x 4.5 = 22.5 NCH needed by 5 patients or a total of 210 NCH per year

3. Find the actual number of NCH needed by 100 patients per year.
210 x 365 = 76, 650 total NCH needed per year


4. Find the actual number of working hours rendered by each nursing personnel each year.
a. hours on duty per day x actual working days per year

5. Find the number of nursing personnel needed.

a. 76, 650 NCH per year = 44 nursing personnel
1, 728 (working hours per year for 216 working days at 40 hours per week)
b. 44 x .095 = 4.18 or 4 nursing personnel as relievers
(Note: Total average of absences of an employee is 35 days per year. This includes vacation, sick levels,
and holidays.)
35 divided 365 = .095 relief needed
c. 44 + 4 = 48 total nursing personnel needed

6. Categorize into professional and non-professional
44 x .60 = 26 nurses
44 x .40 = 17.6 nursing attendants

7. Distribute by shifts

26 x .45 = 24 nurses on 7-3 shift 17 x .45 = 8 nursing attendants
26 x .37 = 10 nurses on 3-11 shift 17 x .37 = 6 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.

Level I - Minimal Care 55-45
Level II - Intermediate or Moderate Care 60-40
Level III - Intensive Care 65-35
Level IV - Highly Specialized Intensive Care 70-30 or 80-20

Assignment Systems for Staffing
PROS AND CONS OF VARIOUS ASSIGNMENT SYSTEMS
Assignment System Pros Cons
Case Method Total Patient Care Different nurse, different
shifts, different days
Functional Nursing Efficiency Nurses do managerial work
Nurses aides do patient care
Team Care Team effort
Frees patient care coordinator to
manage the unit
Nursing care conferences help
problem solve and develop staff
Nursing Care Plan
Time to coordinate delegated
work
Modular Nursing Useful where there are few RNs
RNs plan care
Paraprofessionals do
technical aspects of care
Primary nursing RNs give total patient care
Primary nurse has 24 hour a day
responsibility
Associate nurse works with patient
while the primary nurse is of
duty
Accountability in place
Continuity of care is facilitated
Reduces number of errors from
relay of orders
Fewer patient complaints
Shorter hospitalization
Confines nurses talents to a
limited number of patients
Associate nurse may change
care plan without discussion
with primary nurse
Managed care Unit-based
Can be used with any nursing care
delivery system
Standard critical paths
Questionable continuity of
care
Case management Focuses on entire episode of
illness
Emphasizes achievement of
outcomes
Incorporates managed care
Care is coordinated by a case
manager
Second-generation primary nursing
Critical Paths
Variation analysis
Intershift reports
Health care team meetings
Quality assurance
Interdisciplinary approach
Effort to coordinate


CASE METHOD
Each patient is assigned to a nurse for total patient care while other nurse is on duty. The patient has a different
nurse shift and no guarantee of having the same nurses next day. The patient care coordinate, with no obligations
to assign nurses to the same patient, supervises and evaluates all of the care given on the unit.

FUCTIONAL NURSING
hierarchical structure predominates
medication nurse, treatment nurse, and bedside nurse are all products of this system
Implements classic scientific management which emphasizes efficiency, division of labor and rigid
controls.
RNs keep busy with managerial and nonnursing duties, and nurses aides deliver the majority of patient
care.
Does not encourage patient and staff satisfaction

TEAM NURSING
Professional, technical, and ancillary nursing personnel are grouped together as a team to give total care
to a selected group of patients.
Senior professional nurse as team leader
The team leader is responsible for making assignments, conducting rounds throughout the shift,
conducting team conferences and updating nursing care plans.
o Team Conference main feature of team nursing; primary purpose is the development and
revision of nursing care plans by providing an opportunity to identify and solve problems.
- also provides the opportunity to identify and work through staff educational needs.

MODULAR OR DISTRICT NURSING

Is a modification of team and primary nursing.
Used when there are not enough RNs to practice primary nursing.
Each RNs, assisted by paraprofessionals, delivers as much care as possible to group of patients. The
registered nurse plans the care, delivers as much of it as possible, and directs the paraprofessionals or
the more technical aspects of care.
RNs role is closer to that of a coordinator and information processor than that of a charge nurse.
Decreases the sense of isolation and unrealistic expectations often associated with primary nursing.
PRIMARY NURSING
Was instituted in some hospitals by professional nurses who were unhappy with fragmented care and
lack of direct patient care.
Based on the philosophy that patients, instead of tasks, should the focus of professional nurses, primary
nursing features a registered nurse who gives total patient care to four or six patients.
The associate nurse cares for the patient by using the care plan developed by the primary nurse while
the primary nurse is off duty.
Advantages include mobile use of auxiliary workers and increased satisfaction by both nurse and patient.
Nurses can identify patient outcomes as a result of their work.
Confines a nurses talents to a limited number of patients.
STAFFING SCHEDULES
Major concepts and definitions
Staffing schedules work schedules for personnel
Centralized scheduling scheduling done in one location
Decentralized scheduling scheduling done in local areas
Self-scheduling staff coordinating their own work schedules
Rotating work shifts alternating work hours among days, evenings, and night shifts
Permanent shifts personnel working the same hours repeatedly
Block scheduling using the same schedule repeatedly
Variable staffing determining the number and mix of staff based on patients needs
Patient classification systems calculating staffing needs based on patient acuity
Staffing formulas calculations used to determine staffing needs

CENTRALIZED SCHEDULING

- based on a maser staffing pattern that is carried out by one person who plans and coordinates the
schedule of the nurses. The coordinator knows how many staff nurses there are and their availability.
The coordinator is able to make necessary changes in the rotation in case of illness or emergencies
that may unexpectedly arise
- Two major advantages: fairness to employees through consistent, objective, and impartial application of
policies and opportunities for cost-containment through better use of resources
- Relieves head nurses from time-consuming duties, freeing them from other activities
- Lack of individualized treatment of employees is a chief complaint, and has brought to the surface
previously unrecognized organizational and managerial problems
- Organizational problems can be reduced when
1. the philosophy and goals of the agency are identified
2. goals, objectives, and organizational structure are defined
3. scheduling policies are stated
4. standards of nursing practices are set
5. acuity of care is determined as it relates to staffing needs
6. patient needs, personnel policies such as vacation and personnel leave, and staff development are
taken into account in personnel schedules
7. quality of care is measured

Staff functions of the scheduler include
o scheduling employees according to staffing policies,
o implementing procedures for position control and reallocation of staff,
o maintaining records for line managers,
o gathering information and preparing reports to help line authority prepare personnel
budgets and maintaining communications with other appropriate departments, such as
personnel and payroll.

DECENTRALIZED STAFFING
- When managers are given authority and assume responsibility, they can staff their own units through
centralized staffing.
- Staffing is easier and less complicated when done for a small area instead of the whole agency.
- Unfortunately, some staff members may receive individualized treatment at the expense of others
and work schedules can be used as a punishment reward system
- May utilize resources less efficiently and consequently make cost containment more difficult
SELF-SCHEDULING
- is a system that is coordinated by staff nurses.
- process by which nurses and other staff collectively develop and implement work schedules, taking
policies and variables affecting staffing into consideration.
- can help create a climate where professional nursing can be practiced.
- saves the manager considerable scheduling time and changes the role of the manager from
supervisor to coach
- increases the amount of time staff spends on scheduling, increases their ability to negotiate with
each other, and helps develop a more accountable and professional staff.

ALTERNATING OR ROTATING WORK SHIFTS

- Frequency of alternating between days and evenings, or days and nights, or rotating through all
three shifts varies among institutions
- Affect the health of nurses and the quality of their work.
- Rapid shift of work schedules causes stress

PERMANENT SHIFTS

- Relieve nurses rom stress and health-related problems
- Provide social, educational, and psychological advantages.
- One disadvantage: nurses may not develop an appreciation for the workload or problems of other
shifts

BLOCK OR CYCLICAL SCHEDULING

- Uses the same schedule repeatedly
- With a 6-day forward rotation, personnel are scheduled to work 6 successive days followed by at
least 2 days off. The schedule repeats itself every 6 weeks.
- Helps establish stable work groups and decreases floating, thus promoting team spirit and continuity
of care.
- A decrease in flexibility of staffing, however may be perceived as a disadvantage.

Variable Staffing
- A method that uses patient needs to determine the number and mix of staff.
- Time measures are done for direct and indirect patient care.
Eight-Hour Shift, Five-day Workweek
Ten-Hour day, Four-day Workweek
Ten-Hour Day Plus Five- or Six-Hour Shift
Ten-Hour Shift, Seven-Day Workweek
Twelve-Hour Shift, Seven-Day Workweek

VARIABLES AFFECTING STAFFING

Workload budgets indicate the amount of work produced by a units in terms of units of service, which are
used to calculate expense budgets.
Activity reports measure statistics about current activity centering on the number of units of service given
compare with the capacity.
Average daily census is the average number of patients care for per day for a period of time.
Average length of stay is the average number of days that patients stay in the agency.
Adjusted units of service allows budgeting based on expected workload units of service adjusted for the
expected mix of patients.
Care hours calculation determines the average required care hours per patient per 24 hours for each
classification level and the sum of the total hours of care needed for all patients.
Personnel expense budget is the budget for all personnel assigned to a unit.
Fixed staffs are employees who do not vary with the patient volume.
Variable staffs are responsive to the projected number of care hours needed.
Establishing positions should involve the managers discretion for use of full-time and part-time personnel to
total the number of full-time equivalents needed to meet the care needs.
Labor costs are calculated by calculating the dollar basis of the straight-time salary, differentials, overtime,
raises, and fringe benefits for each employee used by the unit.
Expense budget (other than personnel) is a combination of the direct unit expenses plus the indirect
overhead expenses.
Revenue budget is the units income



Prepared by: Leslie Masaya &
Keith Edzel Lazo