Staffing

Rajesh edit Master subtitle style Click to Kumar Sharma

Introduction of Staffing
Nursing profession is considered a caring profession to begin with, it was an art and a vocation. Now its considered a scientific profession nursing care is defined as the care of the patient with specific regard to nursing needs, with the ever increasing dimension of medical sciences quantitatively and qualitatively nursing care is becoming more and more complex with its management service. 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

Definition of Nursing Services

WHO expert committee on nursing defines the nursing services as the part of the total health organisation which aims to satisfy the nursing needs of the community. The major objective of the nursing services is to provide.

ORGANISATION OF NURSING SERVICES | CHIEF NURSING OFFICER | NURSING SUPDT. | DY. NURSING SUPDT. | ASSTT. NURSING SUPDT. | WARD SISTER - CLINICAL SUPERVISOR | STAFF NURSE -------->STUDENT NURSE

Purpose of staffing

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

Factors Affecting Staffing

The type, philosophy, objectives of the hospital and the nursing service. The population served or kind of patients served whether pay or charity. The number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the actual care needs of patients Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and position. Administrative policies such as rotation, weekends, and holiday off-duties. Standards of care desired which should be available and clearly spelled out.

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 in 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. Patterns of work schedule-traditional 5 days per week, 8 hours per day; 4 days a week, ten hours per day and three days off; or 3 days of 12 hours per day and 3 days off per week.

For an effective staffing management, a nurse manager must apply the managerial skills:CONCEPTUAL SKILL

MANAGER

HUMAN SKILL

TECHNICAL SKILL

OBJECTIVES OF STAFFING IN WARD

Maximum comfort and happiness by way of pleasant surroundings. Qualitative/Comprehensive care to the patient. Care based on patients needs. Accurate assessment of illness. Adequate material resources at all times. Health education to the patient and attendants. Managerial skills as and when required. Privacy at all levels.

FACTORS TO BE CONSIDERED IN PLANNING HOSPITAL NURSING SERVICES

Number and type of patients. Number of beds and type of ward. The service required. Procedures / techniques necessary for care. Number and type of personnel needed to perform care effectively. Physical facilities. Provision of equipment and supplies.

PLAN OF ACTION

Assignment of personnel a) Number b) Category c) Qualification Method a) Functional b) Team c) Patient assignment (ICU)

Analysis of total Nursing needs a) Prepare a daily & weekly time-table. b) Ensure adequate hours, meal time, etc. Monitoring and Control a) Supervision & Coordination. b) Teaching & guidance to improve the quality of work. c) Maintain good Human relations. d) Details of all activities to be performed such as: i) Nursing Care. ii) Management of Ward-personnel.

NURSING HOURS
Area No. of hours Medical & Surgical Wards 3.2 Maternity ward 2.3 Neonatal ward 5.5 Pediatric ward 4.3 Communicable diseases ward 4.7

Master Staffing Pattern, INC, 1985

Area Gen. Wards ICU, CCU L.R. O.T. OPD Casualty Nursing sister 11 : 1 1in each shift 1in each shift 1in each shift Staff Nurses 11 : 11 : 1in each shift 1per table, each shift

One overall, 1 in GOPD 1in each deptt. 1in each shift 11depending upon admn.

NORMS Recommended for Nursing Service and Education Indian Nursing year Book 2000-2001
Hospital Setting: i. Nursing Supdt. - 1:200 beds (Hospitals with 200 or more beds) ii. Dy. Nursing Supdt. - 1:300 beds (wherever beds are over 200) iii. Asstt. Nursing Supdt. - 1:150 beds (wherever beds are over 150) (7:1000 beds) iv. Ward Sister /Ward Supervisor- 1:25 beds + 30% leave reserve. v. Staff Nurses for ward - 1:3 or 1:9 for each shift + 30% Leave reserve. vi. for OPD Emergency etc.- 1:100 patients (1 bed :5 outpatients)+30% leave reserve. vii. for Intensive care units - 1:1 (or 1:3 for each shift) +30% leave reserve viii. for specialized deptt., such as operation theatre, labour room, etc 1.25+30% leave reserves

Placement of nursing staff

Normal Wards - 1:6 beds 1 nursing sister in every shift Special Wards - 1:4 beds 1 nursing sister in every shift Nursery - 1:2 beds 1 nursing sister in every shift ICU / ICCU - 1 staff nurse/nursing sister for every bed. Labour Room - 1 staff nurse / nursing sister in every bed/table OT (Major) - 2 staff nurses / nursing sister for every functional operating table including recovery room. OT (Minor) - 1 staff nurse / nursing sister for every functional operation table Casualty (Main) Attendance upto 100 patients per day - 3 staff nurses / nursing sister for 24 hours i.e. per shift. Thereafter for every additional - 1 staff nurse / nursing sister. Attendance of 35 patients.

PROBLEMS AND CHALLENGES FACED BY THE NURSING ADMINISTRATOR

Lack of Adequate Training. Problem of Personnel Management. Inadequate number of Nursing Staff. Shortage of Trained manpower. Lack of Motivation. No Involvement in Planning.

cont.

No Career Mobility. Poor Role Model. Non-Nursing Activities. No Research Scope. No Proper Authority. Professional Risk / Hazards. No Autonomy in Nursing Activities.

PATIENT CLASSIFICATION SYSTEM

1. 2. 3. 4.

Self care or Minimal Care Patients Intermediate or Moderate Care Total Care Patients Intensive Care Patients

1. Self care or Minimal Care Self care or Minimal Care Patients capable of carrying activities of daily living (ADL) Convalescing, no longer require intensive, moderate, or maximum care Require dx studies, Minimal therapy Awaiting elective surgery, Home environment temporarily makes discharge undesirable 2. Intermediate or Moderate Care Intermediate or Moderate Care requires some help from the nursing staff with special treatments. Given to moderately ill Recovering from immediate effects of a serious illness or operation May be ambulatory for short periods (needs assistance)

3. Total Care Total Care Patients those who are bedridden and who lack strength and mobility to do average daily living. Needs close attention Requires nurse to initiate, supervise, and perform most of the activities Requires frequent medication 4. Intensive Care Intensive Care Patients those who are critically ill and in constant danger of death or serious injury. Acutely ill patients w/ high level of nurse dependency Unstable condition w/c requires frequent evaluation with adjustment of therapy

Managers Responsibilities in Meeting Staffing Needs

The manager must ascertain that adequate numbers and an appropriate mix of personnel are available to meet daily unit needs and organizational goals. It is important that staffing patterns and scheduling policies must be administered fairly as well as economically because they both directly affect the daily lives of all personnel.

LEADERSHIP ROLES MANAGEMENT FUNCTIONS 1. Identifies creative and flexible1. Provides adequate staffing to meet staffing methods to meet the needs ofpatient care needs according to the the patients, staff and thephilosophy of the organization. organization. 2. Uses organizational goals and 2. Is knowledgeable regardingpatient classification tools to minimize contemporary methods of schedulingunderstaffing and overstaffing as and staffing. patient census and acuity fluctuate. 3. Assumes a responsibility toward3. Schedules staff in a fiscally staffing that builds trust andresponsible manner. encourages a team approach. 4. Develops fair and uniform 4. Periodically examines the unitscheduling policies and communicates standard of productivity to determinethese clearly to all staff. if changes are needed. 5. Ascertains that scheduling policies 5. Is alert to extraneous factors thatare not in violation of local and have an impact on staffing. national labor laws, organizational 6. Is ethically accountable to patientspolicies or union contracts. and employees for adequate and safe6. Assumes accountability for quality staffing. and fiscal control of staffing. 7. Plans for staffing shortages so7. Evaluates scheduling and staffing patient care goals will be met. procedures and policies on a regular