 Introduction to staffing norms and pattern

 Nursing care delivery models

 staff allocation /staff mix
 work assignments
 staff scheduling
 duty roster and roster planning.

by Pushpa Gupta
SNO
PHD SCHOLAR IN HCM
& HOSP.Admin.
 STAFFING

It is determining the number of nursing personnel to meet the patient’s demand for care.
The staffing process involves the selection of competent personnel, a system of
assignment and staffing schedules.
It involves deciding what type of and how much personnel are needed to provide
adequate and quality patient or client care.

“Staffing means filling and keeping filled a

position in the organization structure”
Harold Koontz
 Staffing Process

Orientation and Training and

Workforce Recruitment &
planning development
planning Selection

Promotion and Performance

Remuneration(
transfer evaluation
 Staffing begins with planning labor needs through job analysis and forecasting.
HR then invites applications based on identified workforce requirements to fulfill
organizational goals.

Recruitment aims to attract eligible candidates, utilizing internal and external

sources. Job design, description, and advertisement are tailored to draw in suitable
applicants efficiently.

Selection is the screening step of staffing in which the solicited applications are
screened out and the best suitable candidates are appointed as per the
requirements.

After screening, new hires undergo orientation to understand their

roles and environment. Placement ensures the right person is in the
right job.
New workers receive training tailored to their roles and organizational goals.
Development includes tasks to gauge performance and keep individuals updated in
a competitive environment, often facilitated through in-house or external programs.

Performance Evaluation is the act of keeping a track record of the

behavior, attitudes as well as opinions of the workers towards their jobs.

Remuneration is a kind of compensation provided in monetary

terms to the employees for their work performances.

Promotion and Transfer is the last step involved in

process of staffing. Promotion means updating the
profile or position of an employee.
 STAFFING NORMS & PATTERNS

Staffing norms are the guidelines and expectations regarding work hours,
dress code, and communication within a workplace.
These norms play a crucial role in promoting consistency, professionalism,
and a positive work culture in organizations.
 Statutory/Accrediting Summary of nurse-to-patient ratio recommendations
Bodies
Indian Nursing Council,
(1985) It recommended CNO- 1:500 beds, NS- 1:400 beds, DNS- 1:300 beds & 1
additional for every 200 beds, ANS- 1:100-150 beds or 3-4 wards, Nursing
sisters- 1:25-30 beds or one ward+30% LR, Staff Nurses- 1:3 beds in
teaching and 1:5 beds in non-teaching hospital+30% LR, Staff Nurses for
ICU- 1:1 (or 1:3 for each shift)+30% LR, For OPD & Emergency etc.- 1:
NORMS 100 patients+30% LR, For specialized departments such as OT, Labour
Room- 1:25+30% LR, one Infection Control Nurse (ICN) for 250 bedded
hospital, Extra nursing staff for departmental research work.

Staff Inspection Unit

(SIU) Norms, (1991-1992) It recommended CNO- 1:500 or more beds; NS- 1:250 beds; one DNS: 7.5 ANS; one
ANS: 4.5 nursing sister; one nursing sister: 3.6 staff nurses;
Staff Nurses-to-bed ratio: General wards- 1:6; Special wards-1:4; ICUs-1:1; Nursery
Unit-1:2; Major OT- 2 staff nurses per table; Minor OT- 01 staff nurse per table.
Casualty:- Main (up to 100 patients/day)- 03 staff nurses/nursing sisters for 24 h; 1:1
per shift+1:35 (for every additional 35 patients); Burns (up to 15 patients/day)- 3 staff
nurses for 24 h; 1:1 per shift+1:10 (for every additional 10 patients); Orthopaedics
(up to 45 patients/day)- 03 staff nurses/nursing sisters for 24 h; 1:1 per shift+1:15 (for
every additional 15 patients); Gynae/Obstetric (up to 40 patients/day)- 03 staff
nurses/nursing sisters for 24 h, 1:1 per shift+1:15 (for every additional 15 patients).
Outpatient Department (OPDs): 1-3 staff nurses, Injection Room- 1: 100 patients, 2:
120-220 patients, 3: 221-320 patients, 4: 321-420 patients per day.
It also recommended 45% additional staff for the leaver reserve.
NABH, (2005) ICU- 1:1 (Ventilator beds), 1:2 (Non- Ventilator
beds) each shift, HDU- 1:3 each shift, Inpatient
beds- 1:6 each shift, OT- two nurses per table
each shift, Emergency- 1:1 (Ventilator beds), 1:4
(other beds) each shift, OPD/Various procedures-
as per workload, Labour table- 01 nurse per table
each shift, ICN - 01 for 100 beds, Supervisor
staff- as applicable.
Impact of Staffing Norms on Patient
Outcomes and Staff Satisfaction

 Effective staffing norms

significantly impact patient
outcomes and staff
satisfaction.
 Adequate staffing levels
contribute to improved patient
care, safety, and overall
experience. This leads to
higher staff morale and job
satisfaction.
Challenges in Implementing Effective Staffing
Norms and Nursing Care Delivery Models

 Implementing effective staffing norms and caregiver delivery models

can be challenging due to the need for adaptability and individualized
care requirements.

 Staffing decisions must consider fluctuating patient needs, skill mix,

and budget constraints, making it complex to balance resources and
quality of care.

 Additionally, resistance to change and staff turnover pose obstacles in

establishing sustainable and efficient care delivery models within
healthcare organizations.
Different types of nursing care delivery model
The four classic nursing care delivery models used during the past five decades are •
Total patient care
The oldest method of organizing
patient care is total patient care,
sometimes referred to as case
nursing.
nurses are responsible for
planning, organizing, and
performing all care, including
personal hygiene, medications,
treatments, emotional support,
and education required for their
assigned group of patients
during the assigned shift.
FUNCTIONAL NURSING
staff members are assigned to complete
certain tasks for a group of patients
rather than care for specific patients
the RN performs all assessments and
administers all intravenous medications;
the LVN/LPN gives all oral medications;
and the assistant performs hygiene tasks
and takes vital signs. A charge nurse
makes the assignments and coordinates
the care
 Modular nursing
a modification of team nursing In
modular nursing, staff are
geographically assigned to
patients for whom they co-
ordinate and provide
comprehensive care.
It focuses on geographic location
of patient rooms and assignment
of staff members.
Team nursing
• RN functions as a team leader
and coordinates a small group
(no more than four or five) of
ancillary personnel to provide
care to a small group of patients.
• responsible for encouraging a
cooperative environment and
maintaining clear communication
between all team members. • The
team leader's duties include
planning care, assigning duties,
directing and assisting team
members, giving direct patient
care, teaching, and coordinating
patient activities.
Advantages and Disadvantages of Each Delivery Model

Advantages Disadvantages

• Increased patient-centered care • Potential for inconsistent care quality

• Flexibility in scheduling • Complex coordination and communication
• Enhanced continuity of care • Challenges in workload distribution
 The term "staffing patterns" describes the
STAFFING PATTERN allocation of personnel, in terms of both quantity
and classifications, to specific hospital wards.
Staffing patterns that accommodate imbalanced
patient to nurse ratios can affect nursing staff
negatively.

s
STAFFING LEVEL

Patient
STAFFING SKILL MIX experience of
care

STAFFING FLEXIBILITY
 TYPES OF STAFFING
PATTERNS

Traditional Advance

No. of beds
Avg census Patient Task
per unit 1:4
of pts/ unit classification quantification
or 6
 STAFF ALLOCATION

Appropriate selection of
staff in the departments
according to their
capabilities would help
nurses to provide
efficient nursing care to
the patient
 ROTATION PLAN & DUTY ROSTER

A rotation plan schedules individuals or teams to switch

tasks, roles, or locations regularly, fostering skill development,
workload balance, and resource optimization.

Duty roster is a list or plan showing turns of duty or leave

for individuals or groups in an organization

Master rotation
plan
o A systematic rotation
scheme has been
developed for students
enrolled in various courses
and different academic
levels. The master rotation
plan for the 1st, 2nd, 3rd,
and 4th year should be
prepared either separately
or in a unified chart, as per
the institution's policy.
o This plan must be prepared
in advance.
For preparing the master
rotation plan, read
guidelines and syllabus issue
by Indian nursing council
TYPES OF ROTATION PLAN
Individual rotation
plan
o This plan is made to
individual.
o It must be kept in mind that
each student is posted in
their perspective areas.
o Individual rotation plan in
college of nursing should
be prepared by subject
teacher so that every
student can get a chance in
a particular field or subject
of study like mental health
nurse/cssd, dietary
departments etc.
Clinical rotation
plan
o Clinical rotation plan is also
necessary for practical point
of view.
o According to syllabus, clinical
learning experience should be
planned.
o Students should be grouped,
and each group must be
posted according to learning
experience
Factors affecting duty roster and work
assignments
1 Staffing Levels
The number of healthcare professionals available for a particular shift.

2 Skill Mix
The combination of different skills and expertise among the staff.

3 Patient Acuity
The level of medical care and attention required by the patients.
Best practices for creating duty rosters

 Consider staff preferences

 Equitable distribution
Ensure fair distribution of shifts
Take into account
among all staff members,
Individual preferences
considering workload and shift
and availabilities when
types.
creating the rosters.
 Flexible scheduling  Effective communication
Implement flexible Establish clear channels for
scheduling practices to staff to communicate availability
accommodate personal needs and preferences for scheduling.
and work-life balance.
Strategies for fair and equitable work assignments

Clear Expectations
1
Establish specific criteria for assignments.

Transparent Process
2
Openly communicate how assignments are made.

Feedback Loop
3
Regularly gather input on workload fairness.

Flexibility Options
4 Allow for flexible work arrangements when
possible.
Future Trends and Innovations in Nursing
Staffing and Delivery Models

Technology Integration
1 Implementing AI and automation in patient care.

Telemedicine Expansion
2
Utilizing virtual platforms for remote healthcare.

Interdisciplinary Collaboration
Enhancing teamwork across healthcare specialties.
3