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level of care to meet the patient’s demand. 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; 4. 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. Institutions may utilize the ANSAP’s Standard of Nursing Practice; PRC- ANSAP’s Standards of Safe Nursing Practice and/ or the hospitals themselves may formulate/ develop their own standards; 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 allotted to salaries, fringe, benefits, supplies, materials, and equipment; 9. Professional activities and priorities in nonpatient 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- hour week law; and 12. Patterns 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. Patient Care Classification
conscious and exhibiting some psychosocial or social problems. are fed.Self Care or Minimal Care. and requires little treatment/ observation and/ or instruction. Complete or Intensive Care. and the ratio of professionals to nonprofessionals also range from 70:30 to 80: 20. Factors Considered in Making Schedules . Ratio of professional to non. A desirable distribution of off.Patients under this level need some assistance in bathing. Falling under this category are patients about to be discharged. Extreme symptoms of their illness must have subsided or have not yet appeared. Average amount of nursing care hours per patient per day is 1:5.Patients under this level need maximum nursing care with a ratio of 80 professionals to 20 non.Highly Specialized Critical Care. periodic treatments.professional personnel is 60: 40. feed himself. with marked emotional needs. and with chest or abdominal tubes. Patients need continuous treatment and observation. Average nursing care hours per patient per day is 3 and the ratio of professional to non. with vital signs more than three times per shift. They will also know their schedule in advance. The objective in scheduling is to assign working days and days. intravenous fluids or blood transfusion. with many medications. Patients may have slight emotional needs. Scheduling A schedule is a timetable showing planned work days and shifts for nursing personnel.professional ratio of 65: 35. vital signs every 15. feeding. feed and perform his activities of daily living. or ambulating for short periods of time. The nursing care hours per patient per day is 6 with a professional to non.professional nursing personnel is 55: 45. may or may not be unconscious. do not exhibit unusual symptoms.9 or more. They are provide complete bath. with hypo or hypertension and/ or cardiac arrhythmia. Level III.emergency. hourly output. Following is an example of a patient care classification in the medical. They require close observation at least every 30 minutes for impending hemorrhage.30 minutes. Level I. and/ or observations and/ or instructions. those newly admitted.The various units may develop their own ways of classifying patient care according to the acuity of their patient’s illnesses.Total.off to the nursing personnel so that adequate patient care is assured. There are significant changes in doctor’s orders and care hours per patient per day may range from 6.surgical unit.duty days can be achieved and the individual members of the nursing team will feel that they are treated fairly. those in non. Level II. Level IV.Moderate Care or Intermediate Care.Patient can take a bath on his own. may be on continuous oxygen therapy. IV piggy backs. are semi.Patients under this category are completely dependent upon the nursing personnel. with vital signs ordered up to three times per shift.professionals.
or specialization or even working abroad. and floating.shift periods. Disruption in the unity of work groups may occur and this may cause job dissatisfaction and high turnover rates. are likewise staggered to ensure adequate coverage at all times. education. Emphasis. Afternoon and night shift requirements for staff are usually lower than in the morning shift. Quality to enhance the nursing personnel’s knowledge.end off a month. This is especially true if the nurse does not have the necessary skill and knowledge that the unit may require. long stretches of consecutive working days. new nurses are informed of the possibility that they may be asked to relieve in areas other than their regular assignments. Problems may also affect schedules. crosstraining and/ or orientation to complementary units are recommended. but the scheduling system must function smoothly in terms of: 1. would prefer to experience being assigned to various units before setting down to a particular unit of their choice. Assessing a Scheduling System Scheduling may vary from agency to agency.While permanent assignment to one unit enhances skills in caring for a particular kind of patient (whether obstetrical. Weekends are scheduled in such a way that everyone gets a fair share of at least one week.The factors to be considered in making schedules are the different levels of the nursing staff. there is lower staff requirement on Saturdays and Sundays since there are lesser medical rounds. and Pediatrics and Pediatric Intensive Care Units. Vacations. During orientation to the Nursing Service. training and experience. Unscheduled absences may require a staff to be pulled out from her regular area of assignment to cover for another unit. and experiences. schedules for holidays are staggered at least once a month. Afternoon and night shifts are more difficult than the day shifts. Examples are trainings for the Medical and Medical Intensive Care Units. weekends. staggered vacations and holidays. In order to minimize similar problems as a result of emergency assignments. many nurses who have future plans of going into teaching. medical. seven days a week. surgical or pediatrics). Ability to cover the needs of the unit. is given to the fact that cross. Long stretches of consecutive working days should be avoided as much as possible because it might affect the health of the nursing personnel. Since not everybody can enjoy the holiday off on exactly the same day that it occurs.a minimum required number of staff must meet the nursing needs of the patients in the units at all shifts. Nursery and Neonatal Intensive Care Units. adequate coverage for 24 hours. training. however.training enhances their skills and capabilities aside from meeting the needs of the service. 2. Also. fewer medical orders and lower patient census. . An adequate mix of nurses and nursing attendants should be observed so they only assume duties that they are legally responsible for according to their positions. Busy units may require additional help. evening and night shifts. Surgical and Surgical Intensive Care Units. whether forced or requested. The nursing personnel should get their fair share of these shifts including the “relief” duty for the three. The nurse may feel insecure in the area where she is asked to help or relieve.
e. while 10% will need highly specialized intensive care. holiday offs. and only 5% need intensive care. Job categories. 15% need intensive care. and 5. training and experience. Patients needing intensive care are given emergency treatment and when their condition becomes stable or when immediate treatment is necessary and the hospital has no facilities for this. For Primary Hospitals. the staff’s preference. their education.flexibility means the ability to handle changes brought about by emergency leaves. Special Days (birthdays. training programs. assigns the nursing personnel to the various units of the hospital. In tertiary hospitals. Stability. 30% needs moderate care. about 70% of their patients need minimum care.The cyclical schedule covers a designated number of weeks called the cycle length and is repeated thereon. The following scheduling variables should be considered: a. b. Decentralized Schedule. or meetings. h.3. 45% need moderate care.the nursing personnel would like to know in advance their schedule of assignment so that their personal schedules (whether at home. Flexibility. Holiday offs. Types of Scheduling 1. etc. c. d. usually the Chief Nurse or her designate. wedding anniversary. and Continuing professional education (CPE) programs Percentage of Nursing Care Hours The percentage of nursing care hours at each level of care also depends on the setting in which the care is being given.duty.The shift and off.duties are arranged by the Supervising Nurse or Head or Senior Nurse of the particular unit.ends off. scheduled or unscheduled leaves of absence. about 30% of patients need minimal care. Length of scheduling period whether 2 or 4 weeks.One person. This includes the shifts on duty and off. Fairness to the staff. Week. 3. Cyclical Schedule. f. rotation patterns for the whole year including assignment to “difficult” or “light” or “undesirable” units or shifts. g. Shift Rotation. 4. Centralized Schedule. In a secondary hospital. and civic responsibilities) are in harmony with each other. the patient is transferred to a secondary or tertiary hospital. Vacation leaves. In special tertiary hospitals about 10% will need minimal care. 25% needs moderate care.All nursing personnel should get a fair share of weekends. social. 25% need . 2. It assigns the required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements. i. 65% of the patients need minimal care.) Scheduled events in the hospital.
Continuing Education Program for Professionals Total Average Leaves 33 Distribution by Shifts Studies have shown that the morning or day shift needs the most number of nursing personnel at 45 to 51 percent. and for the night shift 15 to 18 percent. Considerations in computing for relievers needed: To compute for relievers needed. 37 percent for the afternoon shift and 18 percent for the night shifts. Holidays 12 3. 45% need intensive car.moderate care. while about 20% will need highly specialized intensive care. In the Philippines the distribution usually followed is 45 percent for the morning shift. for the afternoon shift 34 to 37 percent. Sick Leave 5 2. . the following should be considered: 1. Average number of leaves taken each year 15 a.1996 3 4. Vacation Leave 10 b. Special Privileges as per CSC MC#6 s.
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