Staffing –

nursing,staffing
norms, staff
estimation and
scheduling

Submitted by: Ligi Xavier

Second year Msc nursing
 Staffing
• Definition
• 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 patient’s demand.
• Purpose: to provide each nursing
unit with an appropriate and
acceptable number of workers in
each category to perform the
nursing tasks required
 Functions in staffing

1. Identifying the type and amount of service needed by

agency client.
2. Determining the personnel categories that have the
knowledge and skill to perform needed service measures.
3. Predicting the number of personnel in each job category
that will be needed to meet anticipated service demands.
4. Obtaining, budgeted positions for the number in each job
category needed to service for the expected types and
number of clients.
5. Recruiting personnel to fill available positions.
6. Selecting and appointing personnel from suitable
applicants.
7. Combining personnel into desired configurations by unit
and shift.
8. Orienting personnel to fulfill assigned responsibilities.
9. Assigning responsibilities for client services to available
personnel
 Steps of staffing

• 1. Determine the number and types of personnel

needed to fulfil the philosophy, meet fiscal planning
responsibilities, and carryout the chosen patient care
• 2. Recruit, interview, select, and assign personnel
based on established job description performance
standards.
• 3. Use organizational resources for induction and
orientation
• 4. Ascertain that each employee is adequately
oriented to organizational values and unit norms.
• 5. Use creative and flexible scheduling based on
patient care needs to increase productivity
• 6. Develop a program of staff education that will
assist employees meeting the goals of the
organization.
 Factors affecting staffing
• 1. The type, philosophy and objectives of 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
• 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
• 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 non-patient
activities like involvement in professional organizations,
formal educational development, participation in research
and staff development
• 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 ½ days of 12 hours per day and
3 ½ days off per week.
 Objectives of staffing in
nursing
• Provide an all professional nurse staff in critical care units, operating rooms,
labour and emergency room

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

• Staff the general medical, surgical, obstetrics and gynaecology, paediatric and
psychiatric units to achieve a 2:1 professional- practical nurse ratio.

• Provide sufficient nursing staff in general, medical, surgical, obstetrics and

gynaecology, paediatric and psychiatric units to permit a 1:5 nurse patient ratio
on a day and afternoon shifts and 1:10 nurse- patient ratio on night shift.

• Involve the heads of the nursing staffs and all nursing personnel in designing the
department’s overall staffing program.

• Design a staffing plan that specifies how many nursing personnel in each
classification will be assigned to each nursing unit for each shift and how
vacation and holiday time will be requested and scheduled.
 Nursing staffing in
government hospital
• Usually the staffing is based on the vacancies reported
from the institutions to PSC.( public service
commission ) kerala.psc makes bulletin and publish the
notification in the newspapers and the internet via
home page of PSC. The notifications usually contain
category number of the post, the no. of posts,
reservation, by transfer,. Based on the notificaction the
candidates has to apply for the required post via
online. After the verification of the application form,
PSC invites the eligible candidates for the written
exam. Based on the results PSC publishes the list, from
this rank list the candidates are invited to attend the
interview . After qualifying the interview the
Candidates are selected based on the vacancies
available. The selected candidates have to undergo the
medical checkups and brief orientation programme.
 KERALA SERVICE RULES
(KSR)
• The Kerala Service Rules were issued by the Governor
of Kerala and published on 10th November 1959 in the
Kerala Gazette.Later, on 17th September 1968, Kerala
Legislative Assembly passed ‘Public Service Act-19’, for
the conditions of service of Government employees
and since then the Kerala Service Rules have been
governed by that Act.
• KSRs are divided into three parts.
• Part I Rules 1 to 159 - General conditions of service
and rules on Pay, Leave, Joining Time, and Foreign
Service
• Part II Rules 1 to 116 - Travelling Allowance Rules,
and
• Part III Rules 1 to 151 - Pension Rules
 Nursing staffing in private
hospitals
• Recruitment
• Recruitment procedures include
the process and the methods by
which vacancies are notified,
post are advertised, applications
are handled and screened,
interviews are conducted and
appointments are made.
 Sources of recruitment:
The sources of recruitment are:
• I) Internal sources:
• Internal sources include present
employees, employee referrals,
former employee and former
applicants.
 External sources:

• Sources external to an
organization are
advertisements,
college/university/institute
placement services, walk-ins
and writer-ins, consultants
• Advertisements: these
constitute a popular method of
seeking recruits as many
recruiters; prefer
advertisements because of their
wide reach. For highly
specialized recruits,
advertisements may be placed in
professional journals. Newspaper
is the most common medium.
 Advertisement must contain
the following information:

• The job content ( primary tasks

and responsibilities)
• A realistic description of working
conditions
• the location of the job
• the compensation, including the
fringe benefits
• job specifications

• To whom one applies.

 SELECTION

• Selection is the process of choosing

from among applicants the best-
qualified individual or individuals for
a particular job or position. This
process involves verifying the
applicant’s qualifications, checking
his or her work history, and deciding
if a good match exists between the
applicant’s qualifications and the
organization’s expectations.
• Educational and Credential
Requirements
• Reference Checks
• Preemployment Testing
• Physical Examination as a
Selection Tool
• Making the Selection
• Finalizing the Selection
 Finalizing the Selection
• Once a final selection has been made, the manager is responsible for closure
of the pre employment process as follows:
• Follow up with applicants as soon as possible, thanking them for applying
and informing them when they will be notified about a decision.
• Candidates not offered a position should be notified of this as soon as
possible. Reasons should be provided when appropriate (e.g., insufficient
education or work experience), and candidates should be told whether their
application will be considered for future employment or if they should
reapply.
• Applicants offered a position should be informed in writing of the benefits,
salary, and placement. This avoids misunderstandings later regarding what
employees think they were promised by the nurse-recruiter or the
interviewer.
• Applicants who accept job offers should be informed as to pre employment
procedures such as physical examinations and supplied with the date to
report to work.
• Applicants who are offered positions should be requested to confirm in
writing their intention to accept the position.
 NORMS OF STAFFING

• Norms are standards that guide, control,

and regulate individuals and
communities. For planning nursing
manpower we have to follow some
norms. The nursing norms are
recommended by various committees,
such as; the Nursing Man Power
Committee, the High-power Committee,
Dr. Bajaj Committee, and the staff
inspection committee, TNAI and INC.
INDIAN NURSING COUNCIL

• ownership of the hospital,

• resources of the hospital,
• type of the hospital and level of care it
provides,
• size of the hospital and community it
serves,
• hours and pattern of work,
• type of building and premises plan, and
• other variables like level of technology,
automation and research
Staffing Norms For Nursing Staff And
Nursing Supervisors
• Nursing Superintendent :1:1per hospital
• Dy. Nursing Supdt. :1 upto 400 beds
• Asst. Nursing Supdt. :1 for every 200 beds
• Ward Sisters :1 for 100-150 beds
• Staff Nurse :1 nurse for 3 beds
• Teaching hospital :1 nurse for 5 beds
• Non-teaching hospital :1 nurse for 3 beds
• For ICU/CCU :1 nurse for 1 beds
 The Nurse-patient Ratio as
per INC
• The Nurse-patient Ratio as per INC The norms are based on Hospital Beds.
• Chief Nursing Officer :1 per 500 beds
• Nursing Superintendent :1 per 400 beds or above
• D.NS. :1 per 300 beds and 1 additional for every 200 beds
• A.N.S. :1 for 100-150 beds or 3-4 wards
• Ward Sister :1 for 25-30 beds or one ward
• Staff Nurse :1 for 3 beds in Teaching Hospital in general ward& 1 for
5 beds in Non-teaching Hospital +30% Leave reserve Extra Nursing staff
to be provided for departmental research function.
• For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) + 30%
leave reserve
• For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leave
reserve.
• It is suggested that for 250 beded hospital there should be One Infection
Control Nurse (ICN).
 ( S I U- staff inspection
unit) Norms
• The Staff Inspection Unit (S.I.U.) is the unit which has
recommended the nursing norms in the year 1991-92.
As per this S.I.U norm the present nurse-patient ratio is
based and practiced in all central government hospitals.
• Recommendations of S.I.U:
• The norm has been recommended taking into account
the workload projected in the wards and the other areas
of the hospital.
• 2. The posts of nursing sisters and staff nurses have
been clubbed together for calculating the staff
entitlement for performing nursing care work which
the staff nurse will continue to perform even after she
is promoted to the existing scale of nursing sister.
• 3. Out of the entitlement worked out on the basis of the norms,
30%posts may be sanctioned as nursing sister. This would further improve
the existing ratio of 1 nursing sister to 3.6.
• 4. The assistant nursing superintendent are recommended in the ratio of
1 ANS to every 4.5 nursing sisters. The ANS will perform the duty
presently performed by nursing sisters and perform duty in shift also.
• 5. The posts of Deputy Nursing Superintendent may continue at the
level of 1 DNS per every 7.5 ANS
• 6. There will be a post of Nursing Superintendent for every hospital
having 250 or beds.
• 7. There will be a post of 1 Chief Nursing Officer for every hospital
having 500 or more beds.
• 8. It is recommended that 45% posts added for the area of 365 days
working including 10% leave reserve (maternity leave, earned leave, and
days off as nurses are entitled for 8 days off per month and 3 National
Holidays per year when doing 3 shift duties).
 High power committee on
nursing in India
• Recommendations of high power
committee on nursing and nursing
profession
1. Employment:Uniformity in employment procedures
to be made.
2. Job description
3. Working hours: The weekly working hours should
be reduced to 4o hrs per week.
4. Work load/ working facilities
5. Pay and allowances
6. Promotional opportunities
7. Career development
8. Accommodation
9. Transport
10. Special incentives
11. Occupational hazards
12. Other welfare services
 Norms recommended for
nursing service and education
•
hospital setting.
1. Nursing Supdt -1: 200 beds (hospitals with 200 or
more beds).
2. Dy. Nsg. Supdt. - 1: 300 beds ( wherever beds are
over 200)
3. Asst. Nsg . Supdt - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave
reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift )
30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients
( 1 bed : 5 out patients) 30% leave reserve
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
• For specialised depts such as operation theatre, labour
room etc- 1: 25 30% leave reserve.
Community nursing services
1 ANM :for 2500 population ( 2 per sub centre)
1 ANM :for 1500 population for hilly areas
1 health supervisor :for 7500 population( for supervision
of 3 ANM's)
1 public health nurse :for 1 PHC ( 30000 population to
supervise 4 Health Supervisors )
1 Public Health Nursing Officer for 100000 population (
community health centre)
2 district public health nursing for each district.
Teaching staff for schools/colleges of Nsg as per INC
1 Nurse Teacher to 10 students for post graduate
programmes.
 Bajaj committee (
1985):
• Bajaj committee ( 1985)
Formulation of National Medical
& Health Education Policy.
Formulation of National Health
Manpower Policy. Establishment
of an Educational Commission
for Health Sciences (ECHS) on
the lines of UGC.
ESTIMATING OF
NURSING STAFF
REQUIREMENT
 Staff estimation
Guide to staffing nursing services
1. Projecting Staffing Needs
Some steps to be taken in projecting staffing needs include:
1. Identify the components of nursing care and nursing service.
2. Define the standards of patient care to be maintained.
3. Estimate the average number of nursing hours needed for the required
hours.
4. Determine the proportion of nursing hours to be provided by registered
nurses and other nursing service personnel
5. Determine polices regarding these positions and for rotation of personnel.
2. Computing number of nurses required on a Yearly
Basis
1. Find the total number of general nursing hours needed
in one year.
Average patient census X average nursing hours per
patient for 24 hours X days in week X weeks in year.
2. Find the number of general nursing hours needed in one
year which should be given by registered nurses and
the number which should be given by ancillary nursing
personnel.
a. Number of general nursing hours per year X percent to
be given by registered nurses.
b. Number of general nursing hours per year X percent to
be given be ancillary nursing personnel.
 Nursing Care hours per patient/day
according to classification of patients
per units
Cases/Patients NCH/Pt/Day Prof to Non Prof
Ratio
1. General Medicine 3.5 60:40
2. Medical 3.4 60:40
3. Surgical 3.4 60:40
4. Obstetrics 3.0 60:40
5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
7. ER/ICU/RR 6.0 70:30
8. CCU 6.0 80:20
 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 -Can take a bath on his own; feed himself; perform his
Care or own ADL.
Minimal Care -For discharge pt; non-emergency, newly admitted
-NCH don’t exhibit unusual s/s;
1.5/pt/day - requires little treatment and observation
- Ratio 55:45
Level II – -Need some assistance in bathing, feeding, ambulating
Moderate for short period.
Care or -Extreme s/s of illness must have subsided or have not
Intermediate yet appeared
Care -May have slight emotional needs
-NCH 3/pt -v/s taking ordered 3x/shift; with IVF/BT; are semi-
- Ratio 60:40 conscious and exhibiting some psychosocial or social
problems;
- periodic treatments and/or observations and
/instructions
 Classification Categories
Level III – -Patient are completely dependent upon
Total,
Complete or the nursing personnel.
Intensive
Care
-They are provided complete bath, are
fed, may or may not be unconscious,
-NCM with marked emotional needs; with v/s
6hrs/pt/day monitoring more than 3x/shift
-Ratio 65:35
-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 IV- -Need maximum level of nursing care
Highly
Specialized with a ratio of 80 professionals to 20
Critical Care non-professionals.
-NCH 6-9 or
-Needs continuous treatment and
more /pt/day observation
- Ratio 70:30 -With many medications, IV piggy
or 80:20
backs; v/s monitoring every 15-30
minutes; hourly output.
-There are significant changes in
doctor’s orders
Percentage of patients at various levels
of care per type of hospital
Type of Hospital Minimal Moderate Intensive Highly
Care Care Care Spl. Care

Primary Hospital 70 25 5 -

Secondary Hospital 65 30 5 -

Tertiary Hospital 30 45 15 10

Special Tertiary 10 25 45 20
Hospital
 Categories of Level of Care of Patients:
Nursing Care Hours/Pt/Day & Ratio of Prof-
Non Prof
Levels of Care NCH Needed Per Ratio of Prof to
Pt./Day Non-Prof
Level I – Self-Care 1.50 55:45
or Minimal Care
Level II Moderate 3.0 60:40
or Intermediate
Care
Level II Total or 4.5 65:35
Intensive Care
Level IV Highly 6.0 70:30
Specialized or 7 or higher 80:20
Critical Care
 Computing number of
nurses assigned on weekly
basis
• 1. Find the total number of general nursing hours
needed in one week. Average patient censes X
average nursing hours per patient in 24 hours X
days in week.
• 2. Find the number of general nursing hours needed
in the week which should be given by registered
nurses and the number which could be given by
ancillary nursing personnel.
• a. Number of general nursing hours per week X
percent to be given by registered nurses.
• b. Number of general nursing hours per week X
percent to be given by ancillary nurses
One method for determining the nursing staff
of a hospital
• 1. To determine the number of nursing staff for staffing
a hospital involves establishing the number of work
days available for service per nurse per year.
•
• Example: Analysis of how the days are used; Days in
the year 365 Days off 1 day/week 52 Casual leave 12
Privilege leave 30 1 Saturday /month 12 Public
Holidays 18
• Public Holidays 18 Sick Leave 8 Total non-working
days 132
• Total working days /nurse/year 233 So 1 nurse = 233
working days /year Example, 20 nurse means 20X233=
4660 hours 4660/365= 12.8 (13
 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 pts needing moderate
care
250 pts x 0.15 = 37.5 pts needed intensive
care
250 pts x 0.01 = 25 pts need highly specialized
250 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) = 150 NCH/day
Total 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
Staff scheduling
• 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
•
 Cyclic scheduling
• Cyclic scheduling is one way of staffing to meet the
requirements of equitable distribution of hours of work
and time off. A basic pattern for a certain number of
weeks is established and then repeated in cycles. There
are several advantages in cyclic scheduling
• Once developed , it is permenant schedule, requires only
temporary adjustments.
• Nurses no longer have to leave in anticipation of their
time off duty, because it is scheduled 6 months advance.
• Personal plans can be made in advance
• It can be modified to fit known or anticipated periods of
heavy workloads and can be temporarily adjusted to meet
emergencies or unexpected shortage of personnel.
• Because cyclic scheduling is relatively inflexible , it works
only with astaff that rotates by policy and personnal
choice.
 A one-week cyclical
schedule
Personnel S M T W T F S
7/3 Headnurse/Senior Nurse x x
Staff Nurse x x
Nsg. Att. x x
3/11 Staff Nurse x x
Nsg. Att. x x
11/7 Staff Nurse x x
Nsg. Att. x x
Gen. Rel. 3/11; 11/7 S. nurse 3/11 3/11 11/7 x x 3/11 11/7
N. Att. 3/11 11/7 x 7/3 3/11 11/7 x
 Self scheduling
• Self scheduling is an cativity that
may make a staff happier , more
cohesive, and more committed.
It should be planned on a unit
basis with a written policy as a
guideline. Planning may use
either a self directed work team
or quality circle technique
approach. personnel are
scheduled to work
 Flex time
• Nurses often want flexible scheduling to
better to accommodate their personal
lives. Such scheduling options have,
infact become an essential component of
the job satisfaction.it resulted in
improved attitudes and increased
productivity as employees have gained
more more control over their work
environment.
 Modified work week:
• This using 10 and 12 hour shifts and other methods
are common place. A nurse administrator should be
sure work schedules are fulfilling the staffing
philosophy and policies, particularly with regard to
efficiency. Also, such schedules should not be
imposed on the nursing staff but should show a
mutual benefits to employer, employees and the
client served.
• One modification of the worksheet is four 10 hour
shifts per week in organized time increments. One
problem with this model is time overlaps of 6 hours
per 24 –hour day. The overlap can be used for
patient –centered conference, nursing care
assessment and planning and staff development. It
can be done by hour or by a block of 3-4 hours
 The weekend
alternatives:
• another variation of flexible
scheduling is the weekend
alternative. Nurses work two 12
hour shifts and are paid for 40
hours plus benefits. They can
use the weekdays for continued
education or other personal
needs. The weekend scheduled
has several variations. Nurses
working Monday through Friday
 Other modified
approaches
• Premium day weekend: nursing
staffing is a scheduling pattern that gives
the nurse an extra day off duty, called a
premium day, when he/she volunteers to
work one additional weekend worked
beyond those required by nurse staffing
policy. This technique does not add
directly to hospital costs.
 Reference
Basavanthappa BT. Nursing administration. Ist edn. New Delhi: Jaypee
brothers medical publishers (p) ltd; 2000.
• 2. Wise PS. Leading and managing in nursing. Ist edn. Philadelphia:
Mosby publications; 1995.
• 4. Koontz H, Weihrich H. Management a global perspective. 1st edn.
New Delhi: Tata Mc. Graw Hill publishers;2001.
• 5. Anthony MK, Theresa S, Glick J, Duffy M, Paschall F. Leadership and
nurse retention, the pivotal role of nurse managers. JONA. Vol 35, Mar
2005.
• 6. Beyers Marjorie. Nurse executives’ perspectives on succession
planning. JONA. Vol 36. June 2006.
• 7. Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide
staffing. JONA.vol 37, no.3 mar 2007.
• 8. Blegen MA, Goode C J& Reed L. Nurse staffing and patient outcomes.
Nurs res. 1998; 47(1):43-50.
• 9.currentnursing.com/nursing_management/staffing_nursing
• 10. KSR volume
• 11.Nursing world.org
• 12.,www.national nurses united. Org
• 13.www.mn nurses.org
 Discussion
• Discuss the staffing scheduling
patterns in the government
hospitals and private hospitals
• Merits and demerits.