TASK #7

If you are the chief nurse of the Biliran Provincial Hospital, considering the overall factors affecting
staffing, which shift option (8-hour or 12-hour) do you think would be beneficial for the staff or the
hospital? Support your answer with facts and scientific basis.

TASK #8

Interview the supervising nurse of the Biliran Provincial Hospital regarding the adapted staffing
formula and computation for the distribution of shifts. Critique the technique or mechanism used based
on the standards provided by the Hospital Nursing Service Administration of the Philippines

TASK #9

Find the number of nursing personnel needed for 300 patients in a tertiary hospital. Be sure to
categorize the professional and non-professional personnel. Also distribute the nurses and non-nurse
personnel into the different shifts. (Follow the steps in the Staffing Formula).

TASK #10

Based on your clinical exposures/experiences in various affiliated health care facilities, which
hospital or station/unit of a hospital adapts the following models of care:

a. Functional Method

b. Case Method

c. Primary Nursing

d. Team Nursing

Support your answer based on facts and relate it to the principles of the care modalities.

TASK #11

In your opinion, which among the modalities of care should be adapted by a hospital to ensure
quality of care and to promote job satisfaction among staff nurses?

Support your answer with scientific basis. (reflection should not be less than 200 words).
OVERVIEW

Staffing is an especially important phase of the management process in health-care organizations

because such organizations are usually labor intensive (i.e., numerous employees are required for an
organization to accomplish its goals). It is the process of determining and assigning the right personnel
to the right job. Furthermore, it is also the process of balancing the quantity of staff available with the
quantity and mix of staff needed by the organization.

The goal of staffing is to provide the appropriate numbers and mix of nursing staff (nursing care hours)
to match the actual or projected patient care needs (patient care hours) that will lead to the delivery of
effective and efficient nursing care.

To determine staffing requirements (number of staff), nurse-managers must determine the following, to
wit:

· level of care

· average daily census

· hours of care provided for 24 hours a day, 7 days a week

FACTORS IN DETERMINING THE STAFFING NEEDS

1. Patients Acuity of Illness

§ Level of Care

§ Degree of Dependence

§ Communicability

§ Rehabilitation Needs
2. Special Treatment & Procedures

3. Type of Hospital

4. Ratio of Professional to Non-Professional Nursing Personnel

5. Turnover of Patients and Nursing Personnel

6. Hospital Policies

7. Budget

8. Available Equipment/Materials/Supplies

9. Population Served

10. Regulatory Standards for Accreditation and Licensure

PATIENT CARE CLASSIFICATION SYSTEM

The Patient Care Classification System is a means of categorizing patients on the basis of certain needs
that can be clinically observed by the nurse. It was introduced as a basis for staff planning when it was
recognized that patients’ differing needs for a care is a result of their varying dependency needs and not
their diagnosis.

To develop a workable patient care classification system, the nurse manager must determine the
following:

Staffing - the system must establish a unit of measure for nursing time. This unit of measure will be
used to determine both numbers and kind of staff needed.

Budgeting - the pre-described unit of time will be used to determine the actual
cost of nursing service. Profit s and losses of nursing can be determined.
Tracking changes in patient care needs – it gives nurse managers the ability to moderate and control
delivery of care services, adjusting intensity, and cost

Determining values for the productivity equation which is output divided by input. Reducing
input costs reduces cost of its output (time unit). Output becomes the criteria for measuring nursing
productivity regardless of quality.

Determining quality - Once the standard time element is established, staffing is adjusted to meet the
aggregate times. A nurse manager can elect to staff below the standard time to reduce cost. Thus, nurse
managers make a decision to reduce quality by reducing time and cost.

FACTORS AFFECTING THE AMOUNT OF NURSING CARE A PATIENT NEEDS (basis in determining the
Patient Care Classification System)

1.            Feeding self with little or no assistance  vs.  Requires total assistance. 

2.            Ambulatory  vs.  Bed-bound.

3.            Receiving oral medications  vs.  Intravenous medications

4.            Requiring special wound care or isolation

5.            Needs teaching of a specific self-care function.

6.            Confused and disoriented

7.            Needs vital signs measured every 15 minutes  vs.  Every 2 hours/4 hours.

Table 1. Nursing Care Hours/ Patient/Day According to Classification of Patient Care by Units

CASES NCH/PATIENT/DAY PROFESSIONAL TO NON

PROFESSIONSL RATIO

General Medicine 3.5 60:40

Medical 3.4 60:40

Surgical 3.4 60:40

Obstetric 3.0 60:40

Pediatrics 4.6 70:30

PICU/NICU 6.0 70:30

ER/SICU/PACU 6.0 70:30

MICU/CCU 6.0 80:20

Table 2. Categories or Levels of Care of Patients, Nursing Care Hours Needed per  Patient per Day and
Ratio of Professional to Non-Professional

LEVELS OF CARE NCH NEEDED/PATIENT/DAY RATIO OF PROF.

TO NON-PROF.

Level 1    

   Self Care or Minimal Care 1.50 55:45

     

     

Level 2    

  Moderate or Intermediate                    3.0 60:40

Care 

 Level 3    

    Total or Intensive Care 6.0 65:35

     

Level 4     

   Highly Specialized or                        7 or higher 70:30 to 80:20

Critical Care

LEVEL 1 – SELF CARE OR MINIMAL CARE

            Under this category, the patient is capable of carrying out daily activities as long as the nurse
provides the necessary materials and supplies.

            Patient for diagnostic work-up like various lab. Tests,  x-ray, and other non-invasive tests.

LEVE 2 – MODERATE CARE OR INTERMEDIATE CARE

            Under this category, the patient can feed, bathe, toilet and dress himself without help but requires
some assistance from the nursing staff for special treatment or certain aspects of personal care.

                        Patients for wound debridement or dressing, catheterization, colostomy irrigation. IVF

therapy, IM/SQ injection, or chest physiotherapy.

LEVEL 3 – TOTAL, COMPLETE OR INTENSIVE CARE

            Under this category, the patient is bedridden and lacks the strength or mobility, needs assistance
with his/her daily activities.

LEVEL 4 – HIGHLY SPECIALIZED CRITICAL CARE

            An acute or critically ill patient who is in constant danger of death or serious injury would require
critical care. Patient needs continuous treatment and observation, vital signs every 15-30 minutes and
hourly output.

Table 3. Percentage of Patient at Various Levels of Care per Type of Hospital

LEVELS OF CARE
TYPES OF HIGHLY
HOSPITAL MODERATE INTENSIVE
MINIMAL CARE SPECIALIZED
CARE CARE
CARE

Level 1 70 25 5 ---

Level 2 65 30 5 ---

Level 3 30 45 15 10

Level 4 10 25 45 20

STAFFING FORMULA

STAFFING FORMULA – refers to the formula for computing the number of staff needed in the in-patient
areas of the hospital.

  Guidelines:

 1. Categorize the number of patients according to the levels of care needed. Multiply the total number
of patients by the percentage of patients at each level of care (whether minimal, moderate, intensive, or
highly specialized).

 2. Find the total number of nursing care hours needed by the patients at each category level.

      a. Find the number of patients at each level by the average number of nursing care hours needed per
day.

      b. Get the sum of the nursing care hours needed at the various level

 3. Find the actual number of nursing care hours needed by the given number of patients. Multiply the
total nursing care hours needed per day by the total number of days in a year.

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

 5. Find the total number of nursing care personnel needed.

      a. Divide the total number of nursing care needed per year by the actual number of working hours
rendered by an employee per year.

     b. Find the number of relievers. Multiply the number of nursing personnel needed by .15 (for those
working 40 hours per week)  or by .12 (for those working 48 hours per week).

     c. Add the number of relievers to the number of nursing personnel needed.

 6. Categorize the nursing personnel into professionals and non-professionals. Multiply the number of
nursing personnel according to the ratio of professionals to non-professionals.

 7. Distribute by shifts.  

            Studies have shown that the morning or day shift needs the most number of nursing personnel at
45 – 51 percent, for the afternoon shift, about 34-37 percent, and for the night shift only about 15-18
percent.

Number of Relievers Needed

            To compute for relievers needed, the following should be considered:

            Average number of leaves taken each year

                        Vacation Leave                                                          - 15 days

                        Sick Leave                                                                    - 15 days

                        Legal & Special Holidays                                          - 12 days

                        Special Privileges Leave per CSC MC 6, s. 1996   - 3 days

                        Continuing Education Program for Prof.               - 3 days

                                                            Total Average Leaves            48 DAYS

          Based on studies, 33 days is the average number of days an employee can be absent per year. To
determine the relievers needed, divide 33 (average number of days for absence) by the number of
working days per year that each employee serves (213 for those working in 40-hour/week basis or 265
for those working in a 48-hour/week basis). There will be .15 additional staff needed per personnel for
those who work 40 hours/week and .12 for those working 48 hours/week. Multiply the computed
reliever per person by the computed number of nursing personnel. This will give the total number of
relievers needed. 

Shift Options

1. EIGHT – HOUR SHIFTS

          Full-time employees on the 8-hour shift work five days a week for a total of 40 hours/week. Staff
may work permanent days, evenings, or nights, or they may rotate to different shifts.

a.              DAY                     7am – 3pm/6am – 2pm shift

b.              EVENING  3pm – 11pm/2pm – 10pm shift

c.              NIGHT            11pm – 7am/10pm – 6am shift

  ADVANTAGES:

          a.  The traditional work day is 8 hours, the staff no longer need to adjust to an                             
extended workday

          b.  Staff may have the option of selecting from 3 shifts.

  DISADVANTAGES:

          a.  More nurses are needed in the unit to cover the 3 shifts.

 2. TWELVE – HOUR SHIFTS

          Includes arranging for staffing for only 2-shift days.

  ADVANTAGES:
      a.  Provides for several consecutive days off.
      b.  Employees can have more weekends.
      c.  More time for leisure and recreation.
      d.  Allows safe travelling hours.
      e.  Fewer days on duty thus decreasing traveling time to and from work.
      f.  Provides more time for patient care, patient teaching, or staff education.
      g.  Fewer staff positions are needed.
      h.  Seems to be a drawing card for recruitment.
  DISADVANTAGES:
      a.  If the units are very busy, this may lead to easy fatigability and eventually less efficiency.
      b.  Increased chances of medication errors related to fatigue and inefficiency.
NURSING CARE ASSIGNMENTS/MODALITIES OF CARE

           As nurses move to accept more professional status and the responsibility of delegating and
working through others, they opted to adapt various practice models in which there is less supervision,
more opportunities for independent thought, creativity, and more accountabilities. Nursing care
assignments maybe called in various terms, modalities of care, systems of nursing care, or patterns of
nursing care.

   CARE MODALITIES.pdf

TYPES OF CARE DELIVERY MODELS - FUNCTIONAL METHOD

1. FUNCTIONAL NURSING

         This is the oldest nursing practice modality. It can be best described as a task-oriented method in
which a particular nursing function is assigned to each staff member. One RN is responsible for
administering medications, one for treatment, one for managing IV administration, and nursing 
attendants make linens.. This method divides the work to be done with each person being responsible to
the senior nurse.

  ADVANTAGES:

1.    t is efficient and the best system that can be used when confronted with large number of patient load
and a shortage of nurses.
2.  Implements scientific management, which emphasizes efficiency, division of labor and rigid control.
3.  It is less costly and requires few registered nurses.
DISADVANTAGES:
1.  Care tends can be fragmented and depersonalized.
2.  RNs are occupied with managerial and non-nursing duties while nursing attendants deliver the
majority of nursing care.
3.  Does not encourage patient staff satisfaction
4.  Routinized patient care for patients with similar needs.
  Figure 1. Functional Nursing Model

  TYPES OF CARE DELIVERY MODELS - CASE METHOD

TOTAL CARE OR CASE NURSING

           In the case method of nursing care, one nurse is assigned to one patient for the delivery of total
care the nurse plans, coordinates, implements, evaluates, and documents the nursing care she has given
during her shift. His or her entry point is anytime of the patient’s illness. The one-on-one pattern os a
common assignment for private duty nurses, for nurses in special care units such as the critical care
units or those in isolation, and for nursing students.

 ADVANTAGES:

  1. The nurse is accountable for his or her own actions and can provide holistic nursing care to her
patient.
2. Improves communication and collaboration among health care team members
3. Focuses on the entire episode of illness
4. Emphasizes achievement of outcome
5. Care is coordinated by a case manager

 DISADVANTAGES:

 1. Needs extra efforts in coordinating with the other members of the health care team

Figure 2. Total Care Nursing Model

TYPES OF CARE DELIVERY MODEL - PRIMARY NURSING

PRIMARY NURSING

            Primary Nursing as a form of assigning responsibilities for patient care, is an extension of the
principle of decentralization of authority. Each registered nurse is responsible for the total care of a small
group of patients from admission to discharge. The primary nurse is assigned to take care of patients’
total needs for the duration of hospital stay.

                      Responsibility calls for a 24-hour period with other nurses providing care when the primary
nurse is not there. The care given is planned and prescribed totally by a primary nurse.

  ADVANTAGES:

1.  Enhances autonomy among nurses thus increasing motivation, responsibility, and accountability.

2.  Assurance of the continuity of care as one primary nurse directs care throughout patient’s
hospitalization

3.  Enhances understanding on the patients’ needs

4.  Facilitates trust between the nurse and patient thus enhances therapeutic relationship

5.  Improves communication of information to the physician and other members of the health care team

  DISADVANTAGES:

  1.  Confines nurses’ competencies to a limited number of patients.

Figure 3. Primary Nursing Model