CONTENT 12.

)Patterns of work schedule – traditional 5 days per week, 8 hours per day; 4
days a week, 10 hours per day and three days off; or 3 ½ days of 12 hours per
I. Definition of Staffing day and 3 ½ days off per week.

Staffing 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.
II. Purpose of Staffing
Its purpose is to provide a nursing unit with an appropriate and acceptable
number of workers in each category to perform the various nursing tasks required. If
proper staffing is not done, it will adversely affect the quality and quantity of work
done.
IV. Staffing Needs
Nurse staffing varies on every factor that affects it. The environment changes
as new patients are admitted each day in the hospital. The effectiveness of a
staffing pattern is only as good as the planning that goes into its preparation.
Several key concepts were identified according to Anne Bernat. These key
concepts are the Full-Time Equivalent (FTE) and Nursing Hours per Patient Day
(NHPPD).
Full-Time Equivalent (FTE)

III. Factors Affecting Staffing Full-time equivalent (FTE) is a measure of the work commitment of a full-time
employee. FTE hours are the total paid time and includes the productive and
Various factors affect staffing and these are: nonproductive time. An FTE of 1.0 means that the person is a full-time employee
1.) The type, philosophy and objectives of the hospital and nursing service; while an FTE of 0.5 means that the person is only a part-time employee. A full time
2.) The population served or the kind of patients served whether pay or charity; employee works for 8 hours a day for 5 days a week which is equal to 40 hours of
3.) The number of patients and severity of their illness – knowledge and ability work per week for 52 weeks a year. This amounts to 2,080 hours of work time per
of nursing personnel are matched with the actual care needs of patients; year.
4.) Availability and characteristics of the nursing staff, including education,
level of preparation, mix of personnel, number and position; 5 days per week X 8 hours per day = 40 hours per week
5.) Administrative policies such as rotation, weekends and holiday off-duties; 40 hours per week X 52 weeks per year = 2,080 hours per year
6.) Standards of care desired which should be available and clearly spelled out.
Institutions may utilize the Association of Nursing Service Administrators of To get the FTE from the hours per week, the table below can be used to get the FTE.
the Philippines’s (ANSAP) Standard of Nursing Practice; PRC-ANSAP’s
Standards of Safe Nursing Practice and/or the hospitals themselves may 1.0 FTE = 40 hours or five 8-hour shifts per week
formulate/develop their own standards; 0.8 FTE = 32 hours or four 8-hour shifts per week
7.) Layout of the various nursing units and resources available within the 0.6 FTE = 24 hours or three 8-hour shifts per week
department such as adequate equipment, supplies and materials; 0.4 FTE = 16 hours or two 8-hour shifts per week
8.) Budget including the amount allotted to salaries, fringe benefits (insurance), 0.2 FTE = 8 hours or one 8-hour shift per week
supplies and materials;
9.) Professional activities and priorities in non-patient activities like involvement On June 21, 1969, there has been an implementation of Republic Act 5901 which is
in professional organizations, formal educational development, participation known as an act prescribing forty hours a week of labor for government and private
in research and staff development; hospitals or clinic personnel who are working in hospitals with over 100 bed
10.)Teaching program or the extent of staff involvement in teaching activities; capacity. Employees working in agencies with less than 100 bed capacity or those in
11.)Expected hours of work per year of each employee. This is influenced by the communities with less than one million population will work 48 hours a week.
40-hour week law; and
> 100 Bed Capacity = 40 hours a week with 2 days off
< 100 Bed Capacity = 48 hours a week with 1 day off
 organization. In order to attain the NHPPD, first solve for the number of staff
Calculating for Productive Time and Nonproductive Time available over 24 hours and multiply the sum by 8 hours, then divide the result by the
number of patients in a unit.
At work, a person has two different types of working time, the productive and
nonproductive time. The productive time is the amount of time the employee works # of Staff X 3 Shifts = # of Staff available for 24 hours
such as patient care and charting. Nonproductive hours are benefit hours which are # of Staff/24hours X 8 hours = # of Nursing Hours available in 24 hours
given to employees. These benefit hours are vacation leave, sick leave, holidays, # of Nursing Hours ÷ # of Patients = NHPPD
special privileges, off duties and training programs. The 3 day special privilege is
given to all government employees by the Civil Service Commission as per A standard was developed by the Department of Health about the amount of nursing
Memorandum Circular No. 6, series of 1996 which can be spent for birthdays, care hours should be given to patients in various units of a hospital. This standard can
weddings, anniversaries, funerals, relocation, enrollment or graduation leave, be found in the Hospital Nursing Service Administration Manual.
hospitalization and accident leaves. The productive time can be taken by subtracting
total working hours to the nonproductive time. Cases/Patients NCH/Pt/Day Prof. to Non
(NHPPD) Prof. Ratio
Productive Time = Total Working - Nonproductive Time 1. General Medicine 3.5 60:40
Hours 2. Medical 3.4 60:40
3. Surgical 3.4 60:40
To get the nonproductive hours of an employee, there would be a need to get the sum 4. Obstetrics 3.0 60:40
of all benefits given to him. 5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
Rights and Privileges Given Each Working Hours Per Week 7. ER/ICU/RR 6.0 70:30
Personnel per Year 40 hours 48 hours Unit 8. CCU 6.0 80:20
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10 D V. Patient Care Classification System (PCCS)
4. Special Holidays 2 2 A
5. Special Privileges 3 3 Y Patient care classification system (PCCS) is a method of grouping patients according
6. Off- Duties (R.A. 5901) 104 52 S to the amount and complexity of their nursing care requirements and the nursing time
7. Training 3 3 and skill they require. (Venzon, 2003). Bernat defines the PCCS as a measurement
---------- ----------- tool used to articulate the nursing workload for a specific patient or group of patients
Total Non-Working Days Per Year 152 100 Days over a specific period of time. As defined by the two authors, PCCS is a tool used to
Total Working Days Per Year 213 265 Days classify patients according to the amount of care they need. The amount of care is
Total Working Hours Per Year 1704 2496 Hours generated for each patient through patient acuity. Patient acuity is the determination
of level of care needed by a certain patient and is mainly used for staffing purposes.
Note: One working day is equal to 8 hours as stated in the R.A. 5901.
Purposes of the PCCS:
Nursing Hours per Patient Day (NHPPD)
In order to fully understand the PCCS, there would be a need to know its purpose to
make the PCCS effective. Its purposes are the following:
Nursing hours per patient day (NHPPD) is a standard measure that quantifies the
1.) Staffing
nursing time available to each patient by available nursing staff. This measure is
2.) Program costing and formulation of the nursing budget
useful in quantifying nursing care to both nurses and financial staff in an
3.) Tracking changes in patient care needs.
 4.) Determining values for the productivity equation.
5.) Determining quality.
Characteristics of an effective PCCS:
The following characteristics are desirable of PCCS, which should:
1.) Differentiate intensity of care among definitive classes.
2.) Measure and quantify care to develop a management engineering
standard.
3.) Match nursing resources to patient care requirements.
4.) Relate to time and effort spent on the associated activity.
5.) Be economical and convenient to report and use.
6.) Be mutually exclusive, counting no item under more than one work unit.
7.) Be open to audit.
8.) Be understood by those who plan, schedule, and control the work.
9.) Be individually standardized as to the procedures needed for
accomplishment.
10.)Separate requirements for registered nurses from those of other staff.
Factors Affecting the PCCS:
There are certain factors that mainly affect the PCCS, and these are:
1.) The number of categories into which the patients should be divided;
2.) The characteristics of patients in each category;
3.) The type and number of care procedures that will be needed by a typical
patient in each category; and
4.) The time needed to perform these procedures that will be required by a
typical patient in each category.
Types of PCCS:
There are various types of PCCS, the main difference of these types is on how each
patient is categorized. The different types are:
1.) Descriptive
In the descriptive style, the nurse classifies the patient in the category
that most closely describes the care received. The tool used is a narrative on a
concise acuity table. The nurse chooses the category that best describes the
patient. The main problem with this style is interrater reliability, caused by
the subjectivity of the interpretation of the patient’s degree of care. The
descriptive style is a quick-check guide, but the poor interrater reliability
leads to a wide range of requested nurse-patient ratios.
2.) Checklist
The checklist-style acuity table divides descriptions of care routines
into activity categories such as eating and bathing. Activity levels are
described in each category. Levels in the eating category might be self-care,
help setting up, feed, frequent feedings. Each activity is assigned to an
activity level point score. After the nurse totals the points for each patient,
the level of care can then be determined according to a range of points per
category.
3.) Time or Relative Value Unit Standard
In time or relative value unit standard system, it assigns a value unit
to various activities of patient care. Those activities are usually clustered
according to categories, such as diet, bathing and mobility.
4.) Medicus
The medicus is one of the first PCCS developed. It clusters patients
into five categories with 5 being the greatest intensity of care. Indicators and
the average hours of nursing care required determine the level.
Classification Categories:
Certain units in the hospital may develop their own classification system.
Venzon gives a good example of a classification system that has only four
classifications.
Level I – Self Care or Minimal Care. Patient can take a bath on his own, feed
himself, feed and perform his activities of daily living. Falling under this category are
patients about to be discharged, those in non-emergency, the newly admitted, does
not exhibit unusual symptoms, and requires little treatment, observation and/or
instruction. Average amount of nursing hours is 1.5. Ratio of professional to non-
professional nursing personnel is 55:45.
Level 2 – Moderate Care or Intermediate Care. Patients under this level need some
assistance in bathing, feeding, or ambulating for short periods of time. Extreme
symptoms of their illness must have subsided or have not yet appeared. patients may
have slight emotional needs, with vital signs ordered up to three times per shift,
intravenous fluids or blood transfusion; are semiconscious and exhibiting some
psychosocial or social problems; periodic treatments, and/or observations and/or
instructions. Average nursing hours is 3 and the ration of professional to non-
professional personnel is 60:40.
Level 3 – Total, Complete or Intensive Care. Patients under this category are
completely dependent upon the nursing personnel. They provided complete bath, are
fed, may or may not be unconscious, with marked emotional needs, with vital signs
more than three times per shift, may be on continuous oxygen therapy, and 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. The
nursing hours is 6 with a ratio of 65:35.
VI. Computing for the Number of Nursing Personnel Needed
In computing for the number of personnel needed, one should ensure that there is
sufficient staff to cover all shifts, off-duties, holidays, leaves, absences, and time for
staff development programs (Nonproductive Hours).
Relievers Needed

Level 4 –Highly Specialized Critical Care. Patients under this level need maximum
nursing care with a ratio of 80:20 in terms of personnel. Patients need continuous
treatment and observation; with many medications, IV piggy backs; vital signs every
15-30 minutes; hourly output. There are significant changes in doctor’s orders and
the nursing hours rangers from 6-9 or more.
Relievers are the personnel who replace the absentees or people on leave. To get the
number of personnel needed, divide the average number of days an employee is
absent per year by the number of workings days per year that each employee serves.
This will be 0.15 per person who works 40 hours per week and 0.12 per person on a
48 hour week job.

Levels of Care NHPPD Ratio 40 Hours Per Week

Level 1 33 ÷ 213 = 0.1549295774647887323943661971831 or 0.15
Self Care 1.50 55:45 48 Hours Per Week
Minimal Care 33 ÷ 265 = 0.12452830188679245283018867924528 or 0.12
Level 2
Moderate 3.0 60:40 It will be noted that although an employee is entitled to 15 days sick leave and 15
Immediate Care days vacation leave, 12 holidays, 3 days of continuing education, plus 3 days of
Level 3 special privileges which totals to 48 days, an employee gets only an average of 33
Total 4.5 65:35 days leave per year.
Intensive Care
Level 4 Distribution by Shift
Highly Specialized 6.0 or higher 80:20
Critical Care Studies have shown that morning or day shift needs the most number of nursing
personnel at 45 to 51 percent; for the afternoon shift, 34 to 37 percent; and for the
Percentage of Nursing Care Hours night shift 15 to 18 percent. In the Philippines, the distribution of 45, 37 and 18
percent is usually followed.
The percentage of nursing care hours at each level of care depends on the setting in
which the care is being given. In some hospitals, such as that of the primary 45% for the morning shift
hospitals, they can only cater basic illnesses and cannot cater more severe cases that 37% for the afternoon shift
secondary and tertiary hospitals can provide. 18% for the night shift

Type of Minimal Moderate Care Intensive Critical Care

Hospital Care Care
Primary 70 25 5 -
Secondary 65 30 5 -
Tertiary 30 45 15 10
Special Tertiary 10 25 45 20
The Staffing Formula
To compute for the staff needed in all units of a certain level of hospital, there are
certain steps to be followed:
1.) Categorize the number of patients according to level of care needed.
7.) Distribute by shifts.
# of Patients x constant for minimal care = # of Patients needing minimal
care
# of Patients x constant for moderate care = # of Patients needing moderate
care
# of Patients x constant for intensive care = # of patients needing intensive
care
# of Patients x constants for special care = # of Patients needing special care
Total Number of Personnel Needed x ratio of professionals = # of
Professionals
Total Number of Personnel Needed x ratio of nonprofessional = # of Non-
Professional
# of Professional x AM Shift = # of Professionals on AM Shift
# of Professional x PM Shift = # of Professionals on PM Shift
# of Professional x Night Shift = # of Professionals on Night Shift
Total Number of Professionals Needed = AM + PM + Night shift
professional personnel

2.) Find the total number of nursing hours(NH) needed by the number of patients per # of Non-prof x AM Shift = # of Non-prof on AM Shift
day. # of Non-prof x PM Shift = # of Non-prof on PM Shift
# of Non-prof x Night Shift = # of Non-prof on Night Shift
# of Patients needing minimal care x NH at level 1 = NHPPD1
# of Patients needing moderate care x NH at level 2 = NHPPD2 Total Number of Non-Professionals Needed = AM + PM + Night shift non-
# of Patients needing intensive care x NH at level 3 = NHPPD3 professional
# of Patients needing special care x NH at level 4 = NHPPD4
Bibligraphy
Total Number of NHPPD = NHPPD1 + NHPPD2 + NHPPD3 + NHPPD4
Kelly-Heidenthal, Patricia. Nursing Leadership and Mangement. Thomson Delmar.
3.) Find the total NHPPD needed by the patients per year. Australia.
2003. Pg. 239-241.
Total Number of NHPPD x 365 (days/year) = # NH/year Tomey, Ann Marriner. Guide to Nursing Management. 7th Edition. Mosby. St. Louis.
2004. Pg.
4.) Find the actual workings hours rendered by each nursing personnel per year. 395-396.
Swansburg, Russell and Richard Swansburg. Introductory Management and
# of working hours/day x Total Working Days/year = # of working Leadership for
hours/year Nurses. 2nd Edition. Jones and Barlett Publishers. Massachusetts. 1997. Pg.
128- 134.
nd
5.) Find the total number of nursing personnel needed. Venzon, Lydia. Nursing Management Towards Quality Care. 2 Edition. C&E
Publishing Inc.
a.) Total NH/year ÷ # of working hours/year = Total Nursing Personnel Philippines. 2003. Pg. 56-66.
b.) Relief x Total Nursing Personnel = Relievers
c.) Total Nursing Personnel Needed = Total Nursing Personnel + Relievers By:
Don Chen
BSN-4O
6.) Categorize to professional and non-professional personnel. Ratio of professionals July 22, 2008
to non-professionals by the level of hospital. http://dchen.wordpress.com/