Assignment

on
Staffing in 800 Bedded Hospital

Submitted to- Ms. Rajlaxmi

Tutor
Rufaida College of Nursing
Submitted by- Ms. Sneha Sehrawat
M. Sc. Nursing (OBG)
Rufaida College of Nursing
Subject-Nursing Management & Administration

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Introduction

Staffing:

Staffing is defined as the management function of employing and

developing human resources for carrying out various managerial and non-
managerial activities of the organization.
Nursing Services:

WHO defines the nursing services as the part of the total health
organization, which aims to satisfy the nursing needs of the community.

Organization of nursing Services:

Chief Nursing Officer

↓
Nursing Supdt.
↓
Dy. Nursing Supdt.
↓
Asstt. Nursing Supdt
↓
Ward Sister – Clinical Supervisor
↓
Staff Nnurse - Student Nurse.

Objectives of staffing in Ward

- Maximum comfort and happiness by way of pleasant surroundings

- Qualitative and comprehensive care to the patient
- Adequate material resources at all the time
- Health education to the patient and attendants
- Management and administration of ward
Factors to be Considered in Planning Hospital Nursing Services
- Number and type of patients
- Number of beds and types of patients

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 - The service required
- Procedures/ techniques required for care
- Number and type of personnel needed to perform care effectively
- Physical facilities
- Provision of equipment and supplies
S.I.U Norms Recommended for Nursing Service
- One CNO for 500 or more beds
- One Nursing Supdt. For 250- 500 beds
- One DNS for 7.5 ANS
- One ANS for 4.5 Nursing sisters
- One Nursing Sister for 3.6 Staff Nurses
Placement of Nursing Staff in Each Shift
- Normal Wards : 1: 6 beds + 30% leave reserve
- Special Wards : 1:4 beds+ 30% leave reserve
- ICU : 1: 1 bed + 30 % leave reserve
- Nursery : 1: 2 beds + 30% leave reserve
- Labor room : 1 staff nurse per every bed or table + 30%
leave reserve
- OT (major) : 2 staff nurses / functional operating table+ 30%
leave reserve
- OT (minor) : 1 staff nurse / functional table + 30% leave reserve
- Casualty& emergency: 1:4 beds & 1 nursing sister + 30% leave
reserve
- OPD (100pts/day): 1 staff nurse / shift + 30% leave reserve

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 Staffing in 800 Bedded Hospital
Distribution of Beds

Department No of Beds
1. Normal Wards 300
 Medical Ward 150
 Medicine Ward A 50
 Medicine Ward B 50
 Medicine Ward C 50
 Surgical Ward 150
 Surgical Ward A 50
 Surgical Ward B 50
 Surgical Ward C 50
2. Special Wards 400
 Cardiology and Cardiosurgery 60
 Neurology and Neurosurgery 60
 Oncology and Oncosurgery 40
 Nephrology and Nephrosurgery 40
 Pediatric Ward 50
 Maternity Ward Gynae Ward 50
 Orthopedic Ward 20
 Eye Ward 30
 ENT Ward 30
 Dental Ward 20
3. Emergency and Causality 40
4. ICUs (Neuro, Cardio and Main ICU) 50
5. Nursery 10
6. Major OTs (Neuro, Cardio and Main OT) 25 Tables
7. Minor OT 5 Tables

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8. Labour Rooms 10 Tables
9. OPD Expected 1000 Patients/Day

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 Distribution of Staff in Various Departments
Emergency and Causality (40 beds)
Bed capacity of causality and emergency is 40; staff requirement
according to SIU Norms is 1:4/ shift i.e.30 staff/day. So, total Staff
Nurses required are 30 + 30% Leave reserve = 39.
Staff Nurses – 39
Nursing Sister – 11(1/ 3.6 staff nurses)
ANS – 2 (1/ 4.5 Nursing Sister)
Normal Wards (Medical + Surgical Ward) - 300 Beds
Staff requirement according to SIU norms is 1:6/ shift i.e. 150 Staff
Nurses/ day. So, total Staff Nurses required are 150 + 30% Leave reserve,
150+45 = 195
Staff Nurses – 195
Nursing Sister – 55
ANS – 12
DNS - 2
Special Wards (400 Beds)
Staff requirement according to SIU norms is 1:4/ shift i.e. 300 Staff
Nurses/ day. So, total Staff Nurses required are 300 + 30% Leave reserve,
300+90 = 390
Staff Nurses – 390
Nursing Sister – 109
ANS – 25
DNS – 4
ICUs (Neuro, Cardio, Main Surgical and Main Medical ICU) – 50
Beds
Staff requirement according to SIU norms is 1:1/ shift i.e.150 Staff
Nurses/ day. So, total Staff Nurses required are 150 + 30% Leave reserve,
150+45 = 195

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Staff Nurses – 195
Nursing Sister – 54
ANS – 12
DNS – 1
Nursery (10 Beds)
Staff requirement according to SIU norms is 1:2/ shift i.e. 15 Staff
Nurses/ day. So, total Staff Nurses required are 15 + 30% Leave reserve,
15+4 = 19
Staff Nurses – 19
Nursing Sister – 5
ANS – 1
Labour Rooms (10 Tables)
Staff requirement according to SIU norms is 1 per Table/shift i.e.
30 Staff Nurses/day. So, total Staff Nurses required are 30 + 30% Leave
reserve, 30+9 = 39
Staff Nurses – 39
Nursing Sister – 11
ANS – 3
Major OT’s (Neuro, Cardio Main OT) – 25 Tables
Staff requirement according to SIU norms is 2 per Table/shift i.e.
150 staff nurses/ day. So, total staff nurses required are150 + 30% Leave
reserve, 150+45 = 195
Staff Nurses – 195
Nursing Sister – 54
ANS – 12
DNS – 2
Minor OT (5 Tables)

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 Staff requirement according to SIU norms is 1 per Table/ shift i.e.
15 Staff Nurses/day. So, total staff nurses required are 15 + 30% Leave
reserve, 15+4 = 19
Staff Nurses – 19
Nursing Sister – 5
ANS – 1
OPD (Expected 1000 Patients/Day)
Injection room - 1
Blood bank – 1
Paediatric -2
Immunization work – 2
Eye – 1
ENT -1
Pre-anesthetic -1
Bronchoscopic lab -1
Cardiac lab – 1
Vaccination antirabies – 1
Dental -1
Medical -1
Central sample collection center -1
Orthopaedic – 2
Gynae – 2
X-ray – 3
Skin – 2
V. D. center – 2
Chemotherapy -2
Neurology – 1
Microbiology infection control – 2
Psychiatry – 1

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Burns -2
Total staff requirement according to SIU norms – 34/day.
So, total staff nurses required is 34 + 30% Leave reserve, 34+10 = 44
Staff Nurses – 34
Nursing Sister – 10
ANS – 2

Total Staff Requirement

Total Staff Nurses Required = 39+195+390+195+19+39+195+19+34
= 1125
Total Nursing Sister Required – 11+55+109+54+5+11+54+5+10 = 314
Total ANS Required – 2+12+25+12+1+3+12+1+2 = 70
Total DNS Required – 2+4+1+2 = 9
Nursing Superintendent - 2
Chief Nursing Officer - 1
Total Nursing Staff Required = 1125+314+70+9+2+1
= 1521
Total 1521 Nursing Staff Required for a 800 Bedded Hospital.

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Functions in staffing

1. Identifying the type and amount of service needed by agency

client.
2. Determining the personnel categories that have the knowledge and
skill to perform needed service measures.
3. Predicting the number of personnel in each job category that will
be needed to meet anticipated service demands.
4. Obtaining, budgeted positions for the number in each job category
needed to service for the expected types and number of clients.
5. Recruiting personnel to fill available positions.
6. Selecting and appointing personnel from suitable applicants.
7. Combining personnel into desired configurations by unit and shift.
8. Orienting personnel to fulfill assigned responsibilities.
9. Assigning responsibilities for client services to available personnel.

Man power planning may be defined as a strategy for the

acquisition, utilization, improvement and preservation of the human
resources of an organization. This involves ensuring that organization has
enough of the right kind of people at the right time and also adjusting the
requirements to the available supply.

The main objectives of man power planning

1. Ensuring maximum utilization of the personnel

2. Assessing future requirements of the organization
3. Determining the recruitment sources.
4. Anticipating from past records, i.e. resignations, simple discharge,
dismissal and retirements.

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 5. Determining training requirements for management’s development
and organizational development.

Major activities of manpower planning

1. Forecasting future manpower requirements

2. Inventorying, present manpower resources and analysing the
degree to which these resources are employed optimally.
3. Anticipating manpower problem by projecting present resources
into the future and comparing them with forecast of requirement of
requirement to determine their adequacy, both quantitatively, and
qualitatively
4. Planning the necessary program, recruitment, selection, training,
development, motivation and compensation, so that future
manpower requirements will be met.

Steps of manpower planning:

1. Scrutiny of present personnel strength.

2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions

Steps of staffing

1. Determine the number and types of personnel needed to fulfil the

philosophy, meet fiscal planning responsibilities, and carryout the
chosen patient care management organization
2. Recruit, interview, select, and assign personnel based on
established job description performance standards.
3. Use organizational resources for induction and orientation

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 4. Ascertain that each employee is adequately socialized to
organizational values and unit norms.
5. Use creative and flexible scheduling based on patient care needs to
increase productivity and retention
6. Develop a program of staff education that will assist employees
meeting the goals of the organization.

Philosophy of staffing

Philosophy is a statement encompassing ontologic claims about the

phenomena of central interest to a discipline, epistemic claims about how
the phenomena came to be known, and what members of the discipline
value.

There are three general philosophies of personnel management. The first

is based on organizational theory, the second on industrial engineering,
and the third on behavioural science.

1. The organizational theorist believes that

 Human needs are either so irrational or so varied and adjustable to

specific situations that the major function of personnel
management is to be pragmatic as the occasion demands.
 If the jobs are organized in a proper manner, he reasons, the result
will be most efficient job structure, and the most favourable job
attitudes will follow as a matter of course.

2. The industrial engineer believes that

 The man is mechanistically oriented and economically motivated

and his needs are best met by attuning the individual to the most
efficient work process.

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  The goal of personnel management therefore should be to concoct
the most appropriate incentive system and to design the specific
working conditions in a way that facilitates the most efficient use
of the human machine.
 By structuring jobs in a manner that leads to the most efficient
operation, the engineer believes that he can obtain the optimal
organization of work and the proper work attitudes.

3. The behavioural scientist believes that

 The behavioural scientist focuses on group sentiments, attitudes of

individual employees, and the organizations’ social and
psychological climate.
 Personnel management generally emphasizes some form of human
relations education, in the hope of instilling healthy employee
attitudes and an organizational attitudes and an organizational
climate which he considers to be felicitous to human values. He
believes that proper attitudes will lead to efficient job and
organizational structure.

Philosophy of staffing in nursing

 Nurse administrators of a hospital nursing department should adopt

the following staffing philosophy.
 Nurse administrators believe that it is possible to match employees’
knowledge and skills to patient care needs in a manner that
optimises job satisfaction and care quality.

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  Nurse administrators believe that the technical and humanistic care
needs of critically ill patients are so complex that all aspects of that
care should be provided by professional nurses.

 Nurse administrators believe that the health teaching and

rehabilitation needs of chronically ill patients are so complex that
direct care for chronically ill patients should be provided by
professional and technical nurse.

 Nurse administrators believe that patient assessment, work

quantification and job analysis should be used to determine the
number of personnel in each category to be assigned to care for
patients of each type( such as coronary care, renal failure, chronic
arthritis, paraplegia, cancer etc)

 Nurse administrators believe that a master staffing plan and

policies to implement the plan in all units should be developed
centrally by the nursing heads and staff of the hospital.

 Nurse administrators believe the staffing plan details such as shift-

start time, number of staffs assigned on holidays, and number of
employees assigned to each shift can be modified to accommodate
the units’ workload and workflow.

Objectives of staffing in nursing

 Provide an all professional nurse staff in critical care units,

operating rooms, labour and emergency room
 Provide sufficient staff to permit a 1:1 nurse- patient ratio for each
shift in every critical care unit

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 Staff the general medical, surgical, obstetrics and gynaecology,
paediatric and psychiatric units to achieve a 2:1 professional-
practical nurse ratio.

 Provide sufficient nursing staff in general, medical, surgical,

obstetrics and gynaecology, paediatric and psychiatric units to
permit a 1:5 nurse patient ratio on a day and afternoon shifts and
1:10 nurse- patient ratio on night shift.

 Involve the heads of the nursing staffs and all nursing personnel in
designing the department’s overall staffing program.

 Design a staffing plan that specifies how many nursing personnel

in each classification will be assigned to each nursing unit for each
shift and how vacation and holiday time will be requested and
scheduled.

 Hold each head nurse responsible for translating the department’s

master staffing plan to sequential eight weeks time schedules for
personnel assigned to her/ his unit.

 Post time schedules for all personnel at least eight weeks in

advance.

 Empower the head nurse to adjust work schedules for unit nursing
personnel to remedy any staff excess or deficiency caused by
census fluctuation or employee absence.

 Inform each nursing employee that requests for specific vacation or

holiday time will be honoured within the limits imposed by patient
care and labour contract requirements.

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  Reward employees for long term service by granting individuals
special time requests on the basis of seniority.

ANA Priciples of Nursing Staffing (Reference: ANA Website on Safe

Staffing)

The nine principles are:

I. Patient Care Unit Related

a. Appropriate staffing levels for a patient care unit reflect
analysis of individual and aggregate patient needs.
b. There is a critical need to either retire or seriously question
the usefulness of the concept of nursing hours per patient
day (HPPD).
c. Unit functions necessary to support delivery of quality
patient care must also be considered in determining staffing
levels.
II. Staff Related
a. The specific needs of various patient populations should
determine the appropriate clinical competencies required of
the nurse practicing in that area.
b. Registered nurses must have nursing management support
and representation at both the operational level and the
executive level.
c. Clinical support from experienced RNs should be readily
available to those RNs with less proficiency.
III. Institution/Organization Related
a. Organizational policy should reflect an organizational
climate that values registered nurses and other employees as

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 strategic assets and exhibit a true commitment to filling
budgeted positions in a timely manner.
b. All institutions should have documented competencies for
nursing staff, including agency or supplemental and
traveling RNs, for those activities that they have been
authorized to perform.
c. Organizational policies should recognize the myriad needs of
both patients and nursing staff.

NORMS OF STAFFING ( S I U- staff inspection unit)

Norms are standards that guide, control, and regulate individuals

and communities. For planning nursing manpower we have to follow
some norms. The nursing norms are recommended by various
committees, such as; the Nursing Man Power Committee, the High-power
Committee, Dr. Bajaj Committee, and the staff inspection committee,
TNAI and INC. The norms has been recommended taking into account
the workload projected in the wards and the other areas of the hospital.

All the above committees and the staff inspection unit

recommended the norms for optimum nurse-patient ratio. Such as 1:3 for
Non Teaching Hospital and 1:5 for the Teaching Hospital. The Staff
Inspection Unit (S.I.U.) is the unit which has recommended the nursing
norms in the year 1991-92. As per this S.I.U. norm the present nurse-
patient ratio is based and practiced in all central government hospitals.

Recommendations of S.I.U:

1. The norms for providing staff nurses and nursing sisters in

Government hospital is given in annexure to this report. The norm

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 has been recommended taking into account the workload projected
in the wards and the other areas of the hospital.
2. The posts of nursing sisters and staff nurses have been clubbed
together for calculating the staff entitlement for performing nursing
care work which the staff nurse will continue to perform even after
she is promoted to the existing scale of nursing sister.

3. Out of the entitlement worked out on the basis of the norms,

30%posts may be sanctioned as nursing sister. This would further
improve the existing ratio of 1 nursing sister to 3.6. Staff Nurses
fixed by the government in settlement with the Delhi nurse union
in may 1990.

4. The Assistant Nursing Superintendent are recommended in the

ratio of 1 ANS to every 4.5 nursing sisters. The ANS will perform
the duty presently performed by nursing sisters and perform duty in
shift also.

5. The posts of Deputy Nursing Superintendent may continue at the

level of 1 DNS per every 7.5 ANS

6. There will be a post of Nursing Superintendent for every hospital

having 250 or beds.

7. There will be a post of 1 Chief Nursing Officer for every hospital

having 500 or more beds.

8. It is recommended that 45% posts added for the area of 365 days
working including 10% leave reserve (maternity leave, earned
leave, and days off as nurses are entitled for 8 days off per month
and 3 National Holidays per year when doing 3 shift duties).

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 Most of the hospital today is following the S.I.U.norms. In this the
post of the Nursing Sisters and the Staff Nurses has been clubbed together
and the work of the ward sister is remained same as staff nurse even after
promotion. The Assistant Nursing Superintendent and the Deputy
Nursing Superintendent have to do the duty of one category below of
their rank.

The Nurse-patient Ratio as per the S.I.U. Norms

1. General Ward 1:6

2. Special Ward - ( pediatrics, 1:4

burns, neuro surgery, cardio
thoracic, neuro medicine,
nursing home, spinal injury,
emergency wards attached to
casuality)

3. Nursery 1:2
 1:1(Nothing mentioned about
4. I.C.U. the shifts)
 1:l per table
5. Labour Room
 Major - 1 :2 per table
6. O.T.
 Minor - 1:l per table

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 7. Casualty-

a. Casualty main attendance up to 3 staff nurses for 24 hours, 1:1per

100 patients per day thereafter shift.

b. for every additional attendance 1:35

of 35 patients

c. Gynae/ obstetric attendance

d. thereafter every additional
attendance of 15 patients.
8. Injection room OPD
·3 staff nurses for 24 hours, 1:1/ shift
1:15
Attendance upto 100 patients per day
1 staff nurse

120-220 patients: 2 staff nurses

221-320 patients: 3 staff nurses

321-420 patients: 4 staff nurses

9. OPD

NAME OF THE DEPARTMENT

· Blood bank 1

· Paediatric 2

· Immunization 2

· Eye 1

· ENT 1

· Pre anaesthetic 1

· Cardio lab 1

· Bronchoscopy lab 1

· Vaccination anti rabis 1

· Family planning 2

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 · Medical 1

· Dental 1

· Central sample collection 1

centre
1
· Orthopaedic
2
· Gyne
2
· Xray
3
· Skin
2
· V D centre
2
· Chemotherapy
2
· Neurology
1
· Microbiology
2
· Psychiatry
1
· Burns

In addition to the 10% reserve as per the extent rules, 45% posts
may be added where services are provided for 365 days in a year/ 24 hours.

The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing
Council, 1985)

The norms are based on Hospital Beds.

1. Chief Nursing Officer : 1 per 500 beds

2. Nursing Superintendent : 1 per 400 beds or above
3. D.NS. : 1 per 300 beds and 1 additional for evcry 200 beds

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 4. A.N.S. : 1 for 100-150 beds or 3-4 wards
5. Ward Sister : 1 for 25-30 beds or one ward. 30% leave reserve
6. Staff Nurse : 1 for 3 beds in Teaching Hospital in general ward& 1 for 5
beds in Non-teaching Hospital +30% Leave reserve
7. Extra Nursing staff to be provided for departmental research function.
8. For OPD and Emergency : 1 staff nurse for 100 patients (1 : 100 ) + 30%
leave reserve
9. For Intensive Care unit: (I.C.U.) - 1: l or (1:3 for each shift) +30% leave
reserve.
10. It is suggested that for 250 beded hospital there should be One Infection
Control Nurse (ICN).

For specialised depertments, such as Operation Theatre, Labour Room, etc. 1:25
+30% leave reserve. Norms are not based on Nursing Hours or Patient's Needs here.

Conclusion

The key to success of any hospital primarily depends upon its human resource
than any other single factor.The core determinants of staffing in the hospital
organization are quality, quantity and utilization of its personnel keeping in view the
structure and process. The staffing norms should aim at matching the individual
aspiration to the aims and objectives of the organization.

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