Staffing

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 patients’ demand for care.

The purpose of all staffing activities is to provide each nursing unit with an appropriate and
acceptable number of each category of workers to perform the nursing tasks required. Too few or an
improper mixture of nursing personnel will adversely affect the quality and quantity or work performed.
Consequently, absenteeism and turn-over rates are high leading to dissatisfaction and low morale.

Factors Affecting Staffing

a. Type, philosophy and objectives of the hospital and the nursing service.
b. Population served – Kind of patients served whether pay or charity.
c. Number of patients and acuity of their illness – Knowledge and ability of nursing personnel are
matched to the actual care needs of patients
d. Availability and characteristics of the nursing staff – Education, level of preparation, mixof
personnel, number and position.
e. Administrative policies – Such as rotation, week-end and holiday off-duties
f. Standards of care desired – Should be available and clearly spelled out. Institution may utilize
the ANSAP’s Standards of Nursing Practice; PRC-ANSAP’s – Standards of Safe Nursing Practice;
and/or the hospital themselves formulate/develop their own standards.
g. Lay-out of the various nursing unit and resources available within the department – adequate
equipment, supplies and materials should be provided.
h. Budget – Amount allotted for salaries, fringe benefits, supplies and materials and equipment.
i. Professional activities and priorities in nonpatient activities – Involvement in professional
organizations, formal educational development, participation in research and staff
development.
j. Teaching program – Extent of staff involvement to teaching activities.
k. Expected hours of work per annum of each employee. This is influenced by the 40-hour per
week law.
l. Patterns of work schedule – traditional 5 days per week, 8 hour per day; 4 day a week, ten hours
per day and three day off; or 3 ½ days of 12 hours per day and 3 ½ day off per week.

The Hospital Nursing service Administration Manual of the Department of Health has recommended
the following nursing care hours for patients in the various nursing units of the hospital.
The 1 of Nursing Care Hour Patient Per Day According to Classification of Patients by Units

Cases/Patients NCPH/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 60.40
5. Pediatrics 4.6 70.30
6. Pathologic nursery 2.8 55.45
7. ER/ICU/RR 6 70.30
8. CCU 6 80.20

Patient Care Classification System

The patient care classification system is a method of grouping patients according to

the amount and complexity of their nursing care requirements, of nursing time and skill they
require. This assessment can serve in determining the amount of nursing care required,
generally within 24 hours, as well as the category of nursing personnel who should provide that
care.
To develop a workable patient classification system, the nurse manager must
determine the following:

1.The number of categories into which the patients should be divided,

2.The characteristic of patients in each category,
3.The type of number and care procedures that will be needed by a typical patient in each
category,
4.The time needed to perform these procedure that will be needed by a typical patient in each
category.

The number of categories in a patient classification may range from three to four, which is
most popular ,to five or six. This classes relate to the acuity of illness and care
requirements ,such as minimal , moderate, or intensive care .Other factors affecting the
classification system would relate to the patient’s capability to meet his physical needs to
ambulate , bathe, feed himself, instructional needs including emotional support.

Patient care classifications have been developed primarily for medical, surgical, paediatrics,
and obstetrical patients in acute care facilities.
Classification Categories
The various unit may develop their own way of classifying patient care according to the acuity
of their patient’s illness. The following is an example of a patient care classification in the
medical-surgical unit.

Level 1 - Self Care or Minimal Care-Patient can bathe, feed and perform his activities of daily
living. In this category are patients about to be discharge ,or one who is non-emergency, is
newly admitted , does not exhibit unusual symptoms, and requires little treatment/observation
and/or instruction. Average amount of nursing care hours per patient per day is 1.5.. Ratio of
professionals to non-professional nurses is 55:45.

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

Levels of care NCH Needed Per Pt. Per Day Ratio of prof.to Non Prof.

Level I 1.5 55:45

Self Care or
Minimal Care
Level II 3 60:40
Moderate or
Intermediate
Level III 4.5 65:35
Total or Intensive
Care
Level IV 6 70:30
Highly Specialized 7 or higher 80:20
Or Critical Care

Level II – Moderate Care or Intermediate Care – Patient needs some assistance in bathing,
feeding, or ambulating up and about for short period of time, extreme symptoms have subsided
or not yet appeared, with slight emotional needs, vital signs ordered up to three times per shift,
with intravenous fluids or blood transfusion; problems; requires periodic treatments, and/or
observations and/or instructions. Average nursing hour per patient per day is 3 and ratio of
professional to non-professional in 60:40.

Level III – Total, Complete or Intensive Care – Patients under this category are completely
dependent upon the nursing personnel. They are provided complete bath, fed; may or may not
be unconscious, with marked emotional needs, vital signs are more than three times per shift ,
may be on continuous oxygen therapy, with chest or abdominal tubes, needs close observation
at least every 30 minutes for impending hemorrhage, with hypo or hypertension and/or cardiac
arrhythmia. The nursing care hours per patient per day is 6 with a professional to non-
professional ratio of 65:35.

Level IV – Highly Specialized Critical Care – Patients need maximum nursing care with a ratio of
80:20 professionals to non-professional. Patients under this category need continuous
treatment, observation; many medications, IV piggy backs; vital sign every 15-30 minutes;
hourly output; significant changes in doctor’s orders more than care hours per patient per day is
6 with a professionals to non-professionals also range from 70:30 to 80:20.

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. For primary hospitals about 70% of their patients need minimal
care needing intensive care are given emergency treatment and when their condition becomes
stable and when immediate treatment is necessary and the hospital has no facilities for this, the
patient is transferred to a secondary or tertiary hospital.
In a secondary hospital 65% of its patients need minimal care, 30% need moderate care
and only 5% need intensive care. In tertiary hospitals about 30% of their patients need minimal
care; 45% need moderate care, 15% need intensive, while 10% will need highly specialized
intensive care. In special tertiary hospitals about 10% will need minimal care; 25% need
moderate care; 45% need intensive care; while about 20% will need highly specialized intensive
care. See Table 3.

Table 3. Percentage of Patients at Various Levels of Care Per Type Per Type of Hospital

Percentage of Patients in Various

Levels of Care
Types 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

Computing for the Number of Nursing Personnel Needed.

When computing for the number of nursing personnel in the various nursing units of the
hospitals, one should ensure that there should be sufficient staff to cover all shifts, off duties,
holidays, leaves, absences, and time for staff developments programs.
The Forty hour week law, Republic Act 5901, provides that employees working in
hospitals with 100 bed capacity and up will work only 40 hours per week. This also applies to
employees working on agencies with atleast one million population. These employees working
in agencies with less than one hundred bed capacity or in agencies located in communities with
less than one million in population, will work forty eight hours a week and therefore will get only
one off duty week.
There are also personnel policies that have to be enjoyed by each personnel regardless
of working hours per week. The latest of which is the granting of 3 day special privileges to
government employees by the civil service commission as per memorandum circular no. 6 series
of 1996 which maybe spent for birthdays, weddings, anniversaries, funeral (mourning), paternity
leave, relocation and enrolment or graduation leave, hospitalization and accident leaves.

Table 4 Total no. Of Working and non- Working Days and Hours of Nursing Personnel Per Year

Rights and Privileges Given Each Working Hours per Week

Personnel per Year
40 Hours 48 Hours
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Continuing Educating 3 3
Program for Professionals
7. Off-Duties as per R.A. 5091 104 52

Total Non-Working Days Per Year 152 100

Total Working Days Per Year 213 265
Total Working Hours Per Year 1704 2120

Relievers Needed

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

A. Average number of leaves
Taken each year -------------------------------------------15
1. Vacation Leave---------------------------------10
2. Sick leave---------------------------------------- 5
B. Holidays ------------------------------------------------------12
C. Continuing Educations------------------------------------ 3
D. Special Privileges as per CSC MC#6 s.1996----------- 3
Total Average Leave 33 days
 It will be noted therefore that although an employee is entitled 15 days sick leave and 15 days
vacation leave, 12 holidays, 3 days for continuing education, plus 3 days of special privileges or 48 days
total, he gets only an average of 33 days leave per year.

To determine the relievers needed divide 33 (the average number of days an employee is absent
per year) by the number of working days per year each employee serves (whether 213 or 265). This will
be 0.15 per person who works 40 hours per week and 0.12 per person for those working 48 hours per
week.

Multiply the computed reliever per person by the computed number of nursing personnel. This
will give the total number of relievers needed.

Distribution by Shifts

Studies have shown that the morning or day shifts need the most number of nursing personnel
45%-51%, for the afternoon shifts 34%-37% and for the night shifts 15%-18%. In the Philippines the
distribution usually followed is 45% for the morning shift 37% for the afternoon shift and 18% for the
night shifts.

Staffing Formula

To compute for the staff needed in the in-Patient units of the hospital the following steps are
considered:

1. Categorized the number of patients according to the levels of care needed.

a. Multiply the total number of patients by the percent of patients at each level of care
(whether minimal, intermediate, intensive or highly specialized)
2. Find the total number of nursing care hours needed by the patients at each categorized level
a. 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 levels.
3. Find the actual number of nursing care hours needed by these given number of patients.
a. Multiply the Total number 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.
a. Multiply number of hours on duty per day by the actual working days per year.
5. Find the total number of nursing 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 0.15
(for those working 40 hours per week) or by 0.12 (for those working 48 hours per week)
c. Add the number of relievers to the number of nursing personnel needed.
6. Categorized into professionals and non-professionals.
a. Multiply the number of nursing personnel according to the number of professionals to
non professionals.
7. Distribute by shifts

To illustrate:

Find the number of nursing personnel needed for a 250 patients in a tertiary hospital

1. Categorized the patients according to levels of care needed.

250 (pts) x .65= 160 pts needing minimal care
250 (pts) x .30= 75 pts need moderate/intermediate care
250 (pts) x .05= 12 pts need intensive care
250 (pts) x .01= 3 pts need highly specialized nursing care
250
2. Find the number of nursing care hours needed (NCH) by the Patients at each level of care
160 (pts) x 1.5 (NCH needed at level I) = 240 NCH needed per day
75 (pts) x 3 (NCH needed at level II) = 225 NCH needed per day
12 (pts) x 4.5 (NCH needed at level III) = 54 NCH needed per day
3 (pts) x 6 (NCH needed at level IV) = 18 NCH needed per day
Total NCH needed by 250 pts per day 537
3. Find the total number of NCH needed by 250 patients per year
537 x 365 = 196,005 NCH/year
4. Find the actual working hours rendered by each nursing personnel per year
40(hrs./week) x 216 (working days/year)
1,704 working hours per year
5. Find the total number of nursing personnel needed
a. 196,005 (NCH/year) = 115 nursing personnel
1,704 (working hrs./year)
b. 115 x 0.15 = 17 or 16 relief
c. 115 + 17 = 132 Total nursing personnel needed
6. Categorized to professional and non professional personnel. Since this is a tertiary hospital , the
ratio of professionals to non-professionals is 65:35.
132x.65 =86 nurses
132x.35 = 46 nursing attendants
Total 132 nursing personnel needed
7. Distribute by shifts.
86 nurses x .45 = 39 nurses on morning shift
86 nurses x. 37 = 32 nurses on PM shift
86 nurses x. 18 = 15 nurses on Nite shift
Total 86 professional nurses
46 nursing attendants x. 45 = 21 NA on morning shift
46 nursing attendants x. 37 = 17 NA on PM shift
46 nursing attendants x. 18 = 8 NA on Nite shift
 Total 46 nursing attendants

It should be noted that the above personnel are only for the in-patients. Therefore,
additional personnel shall be hired for those in supervisory and administrative positions and for
those in special units such as Operating Rooms, the Delivery Rooms, the Emergency Rooms and
Out-Patient Departments. Although roomed-in babies in the mother’s unit are not included in
the patient census, they are given service such as bathing changing of diapers and the like.
Additional staff should be provided for these babies.
Hospitals now are also centers for wellness. Therefore, additional personnel shall be
needed for health education classes both at the in-patient and out-patient units.

3. Scheduling

Definition:

A schedule is a timetable showing planned work days and shifts for nursing personnel.

The objective in scheduling is assign working days and days-off to the nursing personnel
so that adequate patient care is assured, a desirable distribution of off duties is achieved,
the individual members of the nursing are treated fairly and that they know in advance what
their schedules are.

Factors Considered in Making Schedule

Factors considered in making schedules are: the different levels of the nursing staff;
adequate coverage for 24 hours, seven days a week; staggered vacations and holidays;
weekends; long stretches of consecutive working days; evening and night shifts and floating.

An adequate mix of nurses and nursing attendants should be observed so that they only
assume duties they are legally responsible for, according to their positions, education,
training and experiences.

Afternoon and night shift requirements for staff are usually lower than in the morning
shift. Also, Saturdays and Sundays tend to have lower requirements since there are lesser
medical rounds, fewer medical orders and lower patient census.

Since not everybody can enjoy the holiday off on exactly the same day that these occur;
schedules for holidays are staggered at least once a month. Vacations ( whether forced or
requested are likewise staggered to ensure adequate coverage at all times. Weekends are
scheduled in such a way that everyone gets a fair share of at least one week –end off a
month.

Long stretches of consecutive working days are to be avoided as much as possible

because it might affect the health of the nursing personnel. Afternoon and night shifts are
more difficult than the day shifts. The nursing personnel should get their fair share of these
shifts including the “relief” duty for the three shift periods.

There are some problems that occur in the schedules. Busy units may require additional
help. Unscheduled absences may occur and suddenly a staff may be pulled out from her
regular area of assignment to cover for another unit. The nurse may feel insecure in the area
where she is asked to help or relieve. Disruption in the unity of work groups may occur and
this may cause job dissatisfaction and high turnover rates. This is specially true if the nurse
does not have the necessary skill and knowledge that the unit may require.

In order to minimize problems as a result of emergency assignments, cross-training and/

or orientation to complementary units is advised. Examples are Medical and Medical
Intensive Care Units, Surgical and Surgical Intensive Care Units, Nursing and Neonatal
Intensive Care Units and Pediatrics and Pediatric Intensive Care Units. During orientation to
the nursing Service, new nurses are told the possibility that they may be asked to relieve in
areas of the hospital other than their regular assignments. Emphasis however is given to the
fact that cross-training enhances their skills and capabilities aside from meeting the needs of
the service.

Scheduling and Continuing Professional Education Programs

In making the schedules for nursing personnel, compliance to Executive Order No. 266
issued on July 25, 1995 of the President of the Philippines decreeing the institutionalization
of the Continuing Professional Education (CPE) Programs of the various Professional
Regulatory Boards (PRB’s) under the supervision of the Professional Regulation Commission
shall be observed.

PRC Res. No. 381 series of 1995 standardized the guidelines and procedures for the
implementation of continuing professional educational (CPE) Programs for all professions.
The total CPE units for a registered professional with a baccalaureate degree shall be sixty
(60) credit units for three years, while those without baccalaureate degrees shall need thirty
(30) credit unites for three years to renew their licenses. One credit hour of CPE Program,
activity or source shall be equivalent to one (1) credit unit.

Opportunities shall be given to these professionals to fulfil the requirements of

renewing their license to practice their respective professions. Registered nurses will need
therefore three extra days while midwives will need two extra days off within the year for
this purpose. These considered on official time.
 Assessing a Scheduling System

While scheduling may vary from agency to agency, the scheduling system must function
smoothly in terms of:

1. Ability to cover the needs of the unit. A minimum required number of staff must meet the
nursing needs of the patients on the units at all shifts.
2. Quality to enhance the nursing personnel’s knowledge, training and experience. While being
permanently assigned to one unit enhances skills in caring for a particular kind of patient
(whether obstetrical, medical, surgical or pediatrics) many nurses who have future plans of
going into teaching, or specialization or even working abroad, would prefer to experience
being assigned to various units first before settling down to a particular unit of their choice.
3. Fairness to the staff. All nursing personnel should get a fair share of weekends, holiday offs,
rotation patterns for the whole year including assignment to “difficult” or “light” or
undesirable” units or shifts.
4. Stability. The nursing personnel would like to know in advance their schedule of assignment
so that their personal scdules (whether at home, social, and civic responsibilities) are in
harmony with each other.
5. Flexibility. Flexibility means the ability to handle changes brought about by emergency
leaves, scheduled or unscheduled leaves of absence.

Types of Scheduling

There are several types of scheduling which are:

1. Centralized Schedules – One person, usually the Chief Nurse or her designate, assigns the
nursing personnel to the various units of the hospital. This includes the shifts of duty and
off-duties.
2. Decentralized Schedule – One person, usually the Chief Nurse or her designate, assigns the
nursing personnel to the various nursing units. The shift and off-duties are arranged by the
Supervising Nurse or Head or Senior Nurse of the particular units.
3. Cyclical Schedules – The cyclical schedule cover designated number of weeks called the cycle
length and is repeated thereon. It assigns the required number of nursing personnel to each
nursing unit consistent with the unit’s patients care requirements, the staff’s preference,
their education, training and experience.

The following scheduling variables should be considered:

a. Length of scheduling period whether 2 or 4 weeks
b. Shift rotation
c. Week-ends off
d. Holidays offs
e. Vacation Leaves
f. Special days (birthdays, wedding anniversary, etc)
g. Scheduled events in the hospital training programs, meetings, etc.
h. Job categories
i. Continuing Professional Education (CPE) programs

STAFFINGandSCHEDULING
 Submitted to:
Dr. Emelyn M.
Gadingan,RN,MAN,PhD

Submitted by:
Kharen A. Salva