1. STAFFING

2. Staffing Third managerial function.
Hiring and keeping the right people is one of the manager’s most critical responsibility. (Dee Ann Gillies)
It involves the following:
a. selection of personnel and assignment systems and
b. the determination of staffing schedules.

3. Types of healthcare personnel:RN
LPN NA
UAP
Relatives (SOs) – local setting

4. Assignment Systems for Staffing
Case method
Functional nursing
Team nursing/ Modular nursing
Primary nursing
Managed care

5. Various Assignment Systems:
Case method – each patient is assigned to a nurse for total patient care while that nurse is on duty.
Functional nursing – implements classic scientific management which emphasizes efficiency, division of labor, and rigid controls.

6. Various Assignment Systems:
Team nursing – achievement of nursing goals through group action.
Primary nursing – the RN remains responsible for the care of a client/ patient 24 hours a day throughout the patient’s hospitalization.
Modular nursing – modification of team and primary nursing. Used when there is not enough RNs.

7. Various Assignment Systems:
Managed care – is a unit-based care system that can be used with any nursing care delivery system in any clinical setting. It uses standard critical paths with nursing care plans, analyzes the positive and negative variations from the critical paths, and uses them in change of shift reports.

8. Various Assignment Systems:
Case management – focuses on an entire episode of illness. It emphasizes achievement of outcomes in designated time frames with limited resources. It incorporates managed care. Care is coordinated by a case manager. It is sometimes called second-generation primary nursing.

9. Staffing Schedules Self-scheduling Rotating work shifts
Permanent shifts
Block or cyclical scheduling
Variable staffing

10. Types of Patient Classification Systems:
Descriptive – classifies the patient in the category that most closely describes the care received. The tool used is a narrative on a concise acuity table.
Checklist style – divides descriptions of care routines into activity categories, such as eating and bathing.

11. Patient Classification Systems
Time standard or relative value unit (RVU) – assign a value unit (usually a measure of time) to various activities of patient care.
To develop patient classification systems, acuity definitions must be established and validated through work sampling.

12. Examples of Patient Classifications:
Warstler (1972)
1. Category I: Self-care
(Requires 1 to 2 hours of care)
2. Category II: Minimal care
(Requires 3 to 4 hours of care)
3. Category III: Intermediate Care
(Requires 5 to 6 hours of care)
4. Category IV: Modified Intensive Care
(Requires 7 to 8 hours of care)
5. Category V: Intensive Care
(Requires 10 to 14 hours of care)

13. Examples of Patient Classifications:
DOH (1994)
Level I – Self-Care or Minimal Care
Level II – Intermediate, Partial or Moderate Care
Level III – Total Intensive Care
Level IV – Critical Care

14. Examples of Patient Classifications:
Regnery (1977) Public Health Nursing
Level I – Clients who require a high degree of nursing skill.
Level II – Includes families that need regular public health nursing service.
Level III – For people requiring occasional service.
Level IV – For clients and families requiring limited public health nursing service.

15. Examples of Patient Classifications:
Four-level patient classification
Category 1 - Minimal nursing care
Category 2 – Moderate nursing care
Category 3 – Considerable direct nursing care
Category 4 – Intensive nursing care

16. Examples of Patient Classifications:
Four-category system:
1. Self-care
2. Partial care
3. Complete care
4. Intensive care
Three-level categories:
1. Minimal care
2. Moderate care
3. Maximal care

17. Patient Acuity
Acuity – level of care, degree of dependence, communicability, and rehabilitation needs.
DOH Patient Classification (1994)
Level I – Self-Care or Minimal Care
Level II – Intermediate, Partial or Moderate Care
Level III – Total Intensive Care
Level IV – Critical Care

18. Patient Acuity Nursing Care Hour (NCH) required: Example:
1. Level I – 1.5 hours
2. Level II – 3.0 hours
3. Level III – 4.5 hours
4. Level IV – 6.0 hours

19. Staffing Pattern Components
Personnel Mix – ratio between Professional and Non-professional personnel
Level I – 55/45
Level II – 60/40
Level III – 65/35
Level IV – 70/30 or 80/20
Hours of work – 8 to 12 hours shift
Distribution of workload
AM – 45%
PM – 37%
Night – 18%

20. Staffing Formulas Predict patient days by category.
Determine NCH required for this patient mix.
Distribute hours required over all shifts.
Develop staffing pattern considering personnel mix available.
Convert hours of care to actual cost.

21. Determine the number of personnel needed for a 100 bed capacity secondary hospital.
1. Categorize patients according to levels of care:
100 pts. X .65 = 65 needing minimal care
100 pts. X .30 = 30 needing moderate care
100 pts. X .05 = 5 needing intensive care
2. Find the required NCH per day at each category:
65 X 1.5 = 97.5 NCH needed by patients needing minimal care
30 X 3.0 = 90.0 NCH needed by patients needing moderate care
05 X 4.5 = 22.5 NCH needed by patients needing intensive care
Total NCH needed by 100 patients = 210 NCH

22. 3. Find the total NCH for 1 year
210 X 365 = 76,650 NCH needed/ year
4. Find the number of nursing personnel needed
76,650 NCH/ year
= 44 nursing personnel
1728 working hrs/year (constant)
5. Determine the personnel mix
44 X .60 (RNs) = 26 RNs
44 X .40 (NAs) = 17.6 or 18 NAs
6. Distribute by Shifts
26 X .45 = 12 RNs (am shift) X .45 = 8 NAs (am shift)
26 X .37 = 10 RNs (pm shift) X .37 = 7 NAs (pm shift)
26 X .18 = 4 RNs (night shift) 18 X .18 = 3 NAs (night shift)

23. Thank you for listening!