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STAFFING IN
NURSING SERVICE
AND EDUCATION
MS.SREEKALA.R
SECOND YEAR MSC
DEFINITION
According to Koontz and O'Donnell
"staffing involves the proper and effective selection,
appraisal and development of personnel to fulfill the roles
designed into a Dale organizational structure"
"keeping the job filled with the right people is the staffing
phase of the management
According to Luther
Gallic
" Staffing is the whole
personnel function of
bringing in and training
the staff and maintaining
favorable conditions of
work"
PHILOSOPHY OF
STAFFING
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 favorable job attitudes
will follow as a matter of course.
PHILOSOPHY OF
STAFFING
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.
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.
PHILOSOPHY OF
STAFFING
The behavioral scientist believes that
The behavioral 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
it is possible to match employees knowledge and
skills to patient care needs in a manner that
optimizes job satisfaction and care quality.
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.
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.
Philosophy of staffing
in nursing
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.)
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.
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
Staff Related
The specific needs of various patient populations
should determine the appropriate clinical
competencies required of the nurse practicing in
that area.
Registered nurses must have nursing
management support and representation at both
the operational level and the executive level.
Clinical support from experienced RNs should be
readily available to those RNs with less
proficiency.
Institution/Organization Related
Organizational policy should reflect an
organizational climate that values registered
nurses and other employees as strategic assets
and exhibit a true commitment to filling budgeted
positions in a timely manner.
All institutions should have documented
competencies for nursing staff, including agency
or supplemental and travelling RNs, for those
activities that they have been authorized to
perform.
Organizational policies should recognize the
myriad needs of both patients and nursing staff.
FACTORS INFLUENCING
STAFFING
FACTORS INFLUENCING
STAFFING
layout of various nursing units and resources
available within the department such as adequate
equipment, supplies, and materials
budget including the amount allotted to salaries,
fringe benefits, supplies, materials and equipment
professional activities and priorities in nonpatient
activities like involvement I professional
organizations, formal educational development,
participation in research and staff development.
teaching program or the extent of staff
involvement in teaching activities.
expected hours of work per annum of each
employee. This is influenced by 40 hour week law.
NORMS RELATED TO
STAFFING
STAFF INSPECTION UNIT (S.I.U)
BAJAJ COMMITTEE, 1986
HIGH POWER COMMITTEE ON NURSING AND
NURSING PROFESSION (1987-1989)
STAFF INSPECTION
UNIT (S.I.U)
The Staff Inspection Unit was set up in 1964 with
the object of effecting economy in manpower
consistent with administrative efficiency and
evolving performance standards and work norms
in Government offices and Institutions wholly or
substantially dependent on Government Grants.
Its officers also serve as Core Member on the
Committees appointed to scrutinize manpower
requirements of Scientific and Technical
Organizations.
The Staff Inspection Unit (S.I.U.) is the unit which
has recommended the nursing norms in the year
1991-92.
NORMS OF STAFFING
(S I U- staff inspection
unit)
Recommendations of S.I.U:
The norms for providing staff nurses and nursing sisters
in Government hospital has been recommended taking
into account the workload projected in the wards and
the other areas of the hospital.
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.
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 staff nurses fixed by the government
in settlement with the Delhi nurse union in May 1990.
NORMS OF STAFFING
(S I U- staff inspection
unit)
The assistant nursing superintendents are
recommended in the ratio of 1 ANS to every 4
nursing sisters. The ANS will perform the duty
presently performed by nursing sisters and
perform duty in shift also.
The posts of Deputy Nursing Superintendent may
continue at the level of 1 DNS per every 7 ANS
There will be a post of Nursing Superintendent for
every hospital having 250 or more beds.
There will be a post of 1 Chief Nursing Officer for
every hospital having 500 or more beds.
The Nurse-patient
Ratio as per the S.I.U.
Norms
General ward : 1:6
Special wards (pediatrics, burns, neuro surgery,
cardio thoracic, neuro medicine, nursing home,
spinal injury, emergency wards attached to
casuality) : 1:4
Nursery : 1:2
ICU: 1:1
Labour room : 1:1 per table
OT : Major 1:2 per table, minor 1:1 per table
Casualty : I staff per shift
Gynaec casualty 1:35
Vaccination: 1
Family planning :2
Medical:2
Dental :2
Central sample collection center:3
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.
BAJAJ COMMITTEE,
1986
An "Expert Committee for Health Manpower
Planning, Production and Management" was
constituted in 1985 under Dr. J.S. Bajaj, the then
professor at AIIMS.
Manpower is one of the most vital resources for
the labour intensive health services industry.
Health for all (HFA) can be achieved only by
improving the utilization of these resources.
Policy.
Formulate on of National Health Manpower Policy.
Establishment of an Educational Commission for
Health Sciences (ECHS) on the lines of UGC.
Establishment of Health Science Universities in
various states and union territories.
Establishment of health manpower cells at centre
and in the states.
Vocationalisation of education at 10+2 levels as
regards
health
incentives,
so
related
that
fields
good
with
quality
appropriate
paramedical
supervisors/sisters
5. Staff nurse for wards
1:3 (or 1:9 for each shift)
8:200 + 30%
Community Nursing
Service
Projected population - 991,479,200
assumption) by 2000 AD
1 Community Health Centre population
1 Primary Health Services population in plain area
1 Primary Health Services population in difficult areas
1 Sub-centre population in plain area
1 Sub-centre population for difficult area
(medium
1,000,00
30,000
20,000
5000
3000
Sub-centre ANM/FHW
323882
Health supervisors /LHV
107960
Primary Health Centres PHN
26439
Community health centre Nurse-midwives
26439
Public health nursing supervisor
7436
Nurse-midwives
52,052
District public health nursing officer
900
NURSING EDUCATION
There should be 2 levels of nursing personnel professional nurse (degree level) and auxiliary
nurse (vocational nurse). Admission to
professional nursing should be with 12 yrs of
schooling with science. The duration of course
should be 4 yrs at the university level. admission
to vocational /auxiliary nursing should be with 10
yrs of schooling .The duration of course should be
2 yrs in health related vocational stream.
All school of nursing attached to medical college
hospitals is upgraded to degree level in a phased
manner.
All ANM schools and school of nursing attached to
district hospitals be affiliated with senior
secondary boards.
NURSING SERVICES:
HOSPITALS/INSTITUTIONS
(URBAN AREAS)
1. Staffing of the hospitals should be as per
norms recommended.
2. District hospitals /non teaching hospitals may
appoint professional teaching nurses in the ratio
of 1; 3 as soon as nurses start qualifying from
these institutions.
3. Students not to be counted for staffing in the
hospitals
4. Adequate supplies and equipments, drugs etc
be made available for practice of nursing.
Community Nursing
Services
INDIAN NURSING
COUNCIL (INC)
The Indian Nursing Council is an Autonomous
Body under the Government of India and was
constituted by the Central Government under the
Indian Nursing Council Act, 1947 of parliament.
It was established in 1949 for the purpose of
providing uniform standards in nursing education
and reciprocity in nursing registration throughout
the country.
Nurses registered in one state were not registered
in another state before this time.
The condition of mutual recognition by the state
nurses registration councils, called reciprocity was
possibly only if uniform standards of nursing
education were maintained.
Staff
Sister( Departmental
nurse
each
assistant
1:3
shift)
1:25
superintendent
1 for 3-4 weeks
1:25
Orthopedic
1:3
1:25
ward
Pediatric
1:3
1:25
ward
Gynecology
1:3
1:25
ward
Maternity
1:3
1:25
Medical ward
ward
including
newborns
sister/
nursing
ICU
1:1(24
CCU
hours)
1:1(24
Nephrology
hours)
1:1(24
hours)
department
sister/assistant
nursing
& 1:1(24
and
hours)
neurosurgery
Special wards- 1:1(24
eye, ENT etc.
Operation
hours)
3
for
theatre
hours
Casuality
clubbed together
table
and 2-3
24 1
per
staff 1
department
sister/asst
Collegiate programme-A
Qualifications and experience of teachers of college of nursing1. Professor-cum-Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years of teaching
experience
2. Professor-cum- Vice Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years in teaching
3. Reader/Associate Professor
-Masters Degree in Nursing
Total 7 years of experience with minimum of 3 years in teaching
4. Lecturer
Masters Degree in Nursing with 3 years of experience.
5. Tutor/Clinical Instructor
M.Sc.(N) or B.Sc. (N) with 1 year experience or Basic B.Sc. (N) with
post basic diploma in clinical specialty
principal
Professor cum 1
vice principal
Reader/Associ
Lecturer
Tutor/clinical
19
24
ate professor
instructor
Total
Total 42
School of nursing-B
Qualification of teaching staff 1. Professor cum principal M.Sc. (N) with 3
years of teaching experience or B.Sc.(N) basic or
post basic with 5 years of teaching experience.
2. Professor cum vice principal M.Sc. (N) or B.Sc.
(N) (Basic)/Post basic with 3 years of teaching
experience.
3. Tutor/clinical instructor
M.Sc. (N) or B.Sc. (N)
(Basic) / Post basic or diploma in nursing
education and Administration with two years of
professional experience.
Total 7
Teacher student ratio should be 1:10 for student
sanctioned strength.
ESTIMATION OF
NURSING STAFF
REQUIREMENTS
TYPES
The critical indicator PCS
uses broad indicators such as bathing, diet,
intravenous fluids and medications, and
positioning to categorize patient care activities.
The summative task type
requires the nurse to note for frequency of
occurrence of specific activities, treatments, and
procedures for each patient
Classification Categories
Level I Self Care or Minimal Care
Patient can take a bath on his own, feed himself,
feed and perform his activities of daily living.
Falling under this category are patients about to
be discharged, those in non-emergency, those
newly admitted, do 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 professional and non-professional nursing
personnel is 55:45.
Level II
Moderate Care or Intermediate Care
Patients under this level need some assistance
in bathing, feeding, or ambulating for short
periods of time. Extreme symptoms of their illness
must have subsided of have not yet appeared.
Patients may have slight emotional needs, with
vital signs ordered up to three times per shift,
intravenous fluids or blood transfusion; are semiconscious and exhibiting some psychosocial or
social problems; periodic and treatments, and/or
observations and/or instructions.
Average nursing care hours per patient per day is
3 and the ratio of professional to non-professional
personnel is 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, are fed, may or
may not be unconscious, with marked emotional
needs, with vital signs more than three times per
shift, may be on continuous oxygen therapy, and
with chest or abdominal tubes.
They require 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
Level IV
Highly Specialized Critical Care
Patients under this level need maximum nursing
care with a ratio of 80 professionals to 20 nonprofessionals.
Patients need continuous treatment and
observation; with many medications, IV piggy
backs; vital signs every 15-30 minutes; hourly
output.
There are significant changes in doctors orders
and care hours per patient per day may range
from 6-9 more, and the ratio of professionals to
non-professionals also ranges from 70:30 to
80:20.
7 or higher
NCH/Pt/day
General 3.5
Ratio
60:40
Medicine
2. Medical
3.4
60:40
3. Surgical
3.4
60:40
4. Obstetrics
3.0
60:40
5. Pediatrics
4.6
70:30
Pathologic 2.8
55:45
1.
6.
Nursery
7. ER/ICU/RR
6.0
70:30
8. CCU
6.0
80:20
Type of Hospital
Minimal Care
Moderate Care
Intensive Care
Primary Hospital
70
25
Secondary Hospital
65
30
Tertiary Hospital
30
45
15
10
Tertiary 10
25
45
20
Spl.
Hospital
Rights
and
Privileges
Each Personnel
Per Year
40 Hours
48 Hours
a) 1. Vacation Leave
15
15
2. Sick Leave
15
15
3. Legal Holidays
10
10
4. Special Holidays
5. Special Privileges
104
52
7.
Continuing
Education 3
Program
Total
Non-Working
______
Days
3
______
Per 152
100
Year
Total Working Days Per Year
213
265
1,704
2,120
Relievers Needed
Distribution by Shifts
Studies have shown that the morning or day shift
needs the most number of nursing personnel at
45 to 51 percent;
for the afternoon shift 34 to 37 percent; and for
the night shift 15 to 18 percent.
In the Philippines the distribution usually followed
is 45 percent for the morning shift, 37 percent for
the afternoon shift, and 18 shift for the night shifts
Staffing Formula
1. Categorize the number of patients according to
the levels of care needed. Multiply the total
number of patients by the percentage of patients
at each level of care
2. Find the total number of nursing care hours
needed by the patients at each category level.
a. Find the 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.
Staffing Formula
3. Find the actual number of nursing care hours
needed by the given number of patients. Multiply
the total nursing 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.
Multiply the 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
500
Total
1537.5 NCH/day
7. Distribute by shifts.
246 nurses x .45 = 111 nurses on AM shift
246 nurses x .37 =
91 nurses on PM shift
246 nurses x .18 = _ 44 _nurses on night shift
Total
246 nurses
132 Nursing attendants x .45 =
59 Nursing
attendants on AM shift
Total
132 Nursing
Attendants
TYPES OF STAFFING
CENTRALISE
D
TOP LEVEL
MANAGERS
DECENTRALI
SED
WARD
SISTERS
CENTRALISED
Advantages:
The managers role is limited to making minor
adjustments and providing input.
The manager continues to have ultimate
responsibility for seeing that adequate personnel are
available to meet the needs of the organization.
It is fairer to all employees because policies tend to
be employed more consistently and impartially.
It allows for the most efficient (cost effective) use of
resources since the more units that can be considered
together, the easier it is to deal with variations in
patient census and staffing needs.
Disadvantages:
It does not provide as much flexibility for the
worker, nor can it account as well for a workers
desires or special needs.
Managers may be less responsive to personnel
budget control if they have limited responsibility
in scheduling and staffing matters.
DECENTRALISED
Advantages:
The unit manager understands the needs of the
unit and staff intimately, which leads to increased
likelihood that sound staffing decisions will be
made.
The staff feels more in control of their work
environment because they are able to take
personal scheduling requests directly to their
immediate supervisor.
It leads to increased autonomy and flexibility,
thus, decreasing nurse attrition.
Disadvantages:
It carries the risk that employees will be treated
unequally or inconsistently.
The manager may be viewed as granting rewards
or punishments through the staffing schedule.
It is time consuming for the manager and often
promotes more special pleading than
centralized staffing.
The major difficulty is ensuring high-quality
staffing decisions throughout the organization.
Staff self-scheduling
It was developed in 1960s where it allowed nurses
in a unit to work together to construct their own
schedules rather than have schedules created by
management.
Employees are typically given four to six week
schedule worksheets to fill out several weeks in
advance of when the schedule is to begin.
These employees typically have one to two weeks
to fill in the blanks on the schedule, following
whatever guidelines or requirements are set by
the management (i.e., number of weekend shifts
that must be worked, maximum number of
consecutive shifts) (Hung, 2002).
The nurse-manager then reviews the worksheet to
make sure all the guidelines or requirements have
STAFFING POLICIES
. Personnel policy is one of the policies in the
organization which lays down decision making
criteria in line with overall purposes in the area of
man power planning.
FORMULATION OF
PERSONNEL POLICIES:
APPRAISING
APPRAISING
THE
THE POLICY
POLICY::
COMMUNIC
COMMUNIC
ATING
ATING OF
OF
THE
THE POLICY
POLICY
FACT
FACT
FINDING:
FINDING:
ADOPTING
ADOPTING AND
AND
LAUNCHING
LAUNCHING THE
THE
POLICY
POLICY
DISCUSS
DISCUSS THE
THE
PROPOSED
PROPOSED
POLICY
POLICY
REPORTING
REPORTING
OF
OF THE
THE
PROPOSED
PROPOSED
POLICY
POLICY
WRITING
WRITING
THE
THE
PROPOSED
PROPOSED
POLICY
POLICY
FACTORS INFLUENCING
PERSONNEL POLICIES:
CONTENTS OF
PERSONNEL POLICY
EMPLOYMENT
Minimum requirement of qualifications for the job
Source of recruitment
Selection of devices such as tests and interviews.
DEVELOPMENT
Induction, transfer, promotions.
Bases and types of training.
Executives and workers development programmes.
COMPENSATION
Equitable and adequate remuneration.
Non-monetary rewards.
Profit sharing and incentive plans.
Bonus.
INTEGRATION
Efficient system of communication
Handling of grievances.
Recognition of labor unions.
Workers participation in management.
WORKING CONDITION AND MOTIVATION
Welfare measures for health, safety and high
morale.
Safety programmes.
Welfare services like canteen, rest room,
recreational activities, insurance etc.
Financial and non -financial rewards for
motivation.
CHARACERISTICS OF
PERSONNEL POLICIES
They should present the principle that will
guide the organizations actions and reflect a faith
in the ethical value of employees.
They should be stated in the broadest possible
terms so as to serve as a guide in practice now
and in future.
They should be formulated after taking the
long range plans and needs of the organization.
They should be flexible to cover a normal
range of activities
CHARACERISTICS OF
PERSONNEL POLICIES
They should be stable to preclude excessive
alterations.
They must be developed with the active
participation of management and employees.
They should be definite so that it is easy to
understand.
They should be communicated in writing so as
to remove any confusion
ADVANTAGES OF
PERSONNEL POLICY
Helps managers at various levels of decision
centers to act with confidence without the need for
consulting superiors every time.
Ensures prompt action for taking decision within
the overall framework of the objectives of the
organization whenever any situation arises.
Provide a rational and continuous system of
achieving results through better control.
Clearly lay down and liberates the management
from their personnel biases and self- interest.
Ensures long term welfare of employees and make
good relation between management and workers.
Makes the employees aware of where they stand
in the organization and creates confidence in them.
PRE EMPLOYMENT
ROLES
Plans for future needs proactively.
Predicts the future by being knowledgeable regarding
current and historical staffing events.
Identifies and recruits gifted individuals to the
organization.
Serves as a role model for recruitment.
Is self-aware regarding personal biases during pre
-employment process.
Uses interview process as a means to promote the
organizational image.
Assigns new personnel to positions that facilitate
success.
FUNCTIONS:
Ensures that there is adequate skilled work force
to meet the goals of the organization.
Shares responsibilities for the recruitment of staff.
Plans and structures appropriate interview
activities.
Uses techniques that increase the validity and
reliability of selection process.
INDOCTRINATION
ROLES:
He or she is expected to :
Periodically review induction and orientation program to
ascertain that they are meeting the unit needs.
Generates enthusiasm in employees in meeting
organizational goals.
Serves as role model.
Encourages mentorship
Supervision and correction.
Supports employees having problems with
resocialization.
Assist employees in developing personal strategies to
cope with role transition.