UNION CHRISTIAN COLLEGE College of Nursing and Health Related Services City of San Fernando, La Union

STAFFING 3 managerial function Is the process of developing and maintaining staffing patterns and assigning Competent people to fill the role designated for the organizational structures through recruitment, election and development of personnel. The process of determining the number and kind of personnel needed to meet the time requirements for the nursing services. Provides appropriate and adequate personnel to fulfill the organizations objectives Largest and most crucial aspect of administration because the quality of the workers and their performance will determine the degree of achievement of the goal of the nursing department. An arrangement which enables professional nurses to spend more time in patient care supervision and staff development. A complex process that provides a plan for allocation of adequate personnel to do the work of the organization
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Objective: To determine the number and kind of nursing personnel required to provide care of a predetermined standard for a specific group of patients in a particular setting

4 ELEMENTS: 1. Identification of the quality of the product to be rendered to the client 2. Prediction of the number and kind of personnel needed to produce the volume and quality of nursing care required. 3. The selection and management of the nursing staff in specific configuration and the development of assignment patterns for the staff required 24 hours/day, 7 days a week. 4. The evaluation of the staffs effectiveness of the product upon the patient population to whom it is rendered.

STAFFING PROCESS Largest and most crucial aspect of all the function of supervisor Staffing activities resulting in the appointment of individuals to vacant or newly created organization position. a. It is either by attracting them as candidates for employment from outside organization b. By moving them into the position by promoting or transferring them within the organization

STEPS 1. Human Resource Planning designed to ensure that the personnel needs of the organization will be constantly and appropriately met through: a. Analysis of expected skill needs b. Vacancies and department expansions and reductions 2. Recruitment concerned with developing a pool of job candidates in line with the human resource plan a. Newspapers b. Professional journal advertisements c. Employment agencies d. Visits to colleges and university campuses 3. Selection involves evaluating and choosing among job candidates Screening of Staff: a. Application forms and resume b. Letters of reference c. Interview open-ended questions, self-appraisal, direct Induction and Orientation designed to help the selected individuals to fit smoothly into the organization Training and Development aims at increasing the ability of individuals and groups to contribute to organizational objectives. Performance Appraisal the individuals job performance is compared against standards of objectives. Transfers a shift of person from a. One to job to another b. One organizational level or location to another

4. 5. 6. 7.

8. Separation resignation, lay-off, discharge, retirement, death

STAFFING TO MEET FLACTUATING NEEDS 1. Full Time Staff hired to meet average staffing needs of the institution - these are people transferred from less busy area to overloaded area Advantages: 1. Economical for the institution 2. Receives benefits (vacation/sick leave days) Disadvantages: 1. Conscious to time

2. Part Time Staff hired to meet deficiencies due to leaves of full-time staff Advantages: 1. Flexible working hours 2. Reduce staffing shortage Disadvantages: 1. Lesser benefits 2. Commitment of worker

FACTORS FPR EFFECTIVE STAFFING: 1. 2. 3. 4. 5. Daily patient census Daly patient turn-over rate Illness acuity most of the patient Type of medical therapies and surgical procedures Percentage of the time required for the night shift per patient

PRINCIPLES OF STAFFING: 1. 2. 3. 4. 5. Days are planned that there is enough staff present each day to provide essential care At least two professional nurses are on-duty the day shift (7:00am 7:00pm) A day together between day offs for RN and the nurse reliever A day off before and after night duty is given to have proper rest plus a free day for relief At least one person scheduled to provide continuity for each night period

DETERMINANTS OF STAFFING PATTERNS 1. 2. 3. 4. Type of hospital Type of specialties Type of illness Acuity of illness

VARIABLES THAT INFLUENCE DECISION OF STAFFING PATTERN 1. 2. 3. 4. Occupancy rate Salary rate Availability of nurses Organization of the department of nursing a. Structure of authority (centralized/decentralized) 5. Type of institution

SCHEDULING PATTERNS Represents the actual assignment of personnel to units or departments

Objective: To provide the correct configuration of personnel for the work to be done, eliminating understaffing or overstaffing while accommodating.

PATTERN CENTRALIZED

DECENTRALIZED

ADVANTAGE Fair to employees through a. consistent objectives b. impartial application of policies c. opportunities for cost containment through better use of resources Personnel feels that they get more personalized attention Easier staffing HN is given authority and assume responsibility to staff their own unit

DISADVANTAGE Lack of individual treatment of employees

Time consuming for the HN Some SN may receive individual treatment at the expense of others

ALTERNATING OR ROTATING

Creates stress fro SN from AM to PM Affects the persons daily activities Relieves nurses from stress and health related problems Provide social, educational, and psychological advantages Develop sense of belonging to a shift Uses the same schedule repeatedly Personnel scheduled every other weekend off 1 day during the week Uses patient needs to determine the number and mix of staff Time measures are done for direct and indirect patient care Patient classification system is developed Tables are designed to determine the number of patients in each category Provides information to determine staff needs by skill levels (direct care) Allows hr lunch break, hr overlap time between shifts to provide continuity of care. SHIFT: 7-3:30pm, 3-11:30pm, 11-7:30am Every other week-end off staffing pattern SHIFT: 7-5:30pm, 1:11:30pm, 97:30pm Allows at least 4 hours off in between shifts and 4 day weekend every 6 weeks for those who rotate, workweek begins on Sunday and weekend is Saturday & Sunday for all shifts 2-ten hour shifts and one 5 hour shift a 2 week cyclical schedule posts 2 days on, 2 days off, 3 days on, 2 days off SHIFT: 7-5pm, 5-10pm, 9-7am 7-70 PLAN including 10 hrs shift followed by 7 consecutive days Nurses may not develop a appreciation for workload or problems of other shifts

PERMANENT

BLOCK OR CYCLICAL

VARIABLE

8-HOUR SHIFT 5-DAY WORK/WEEK HOURS)

(40

10-HOUR SHIFT 4-DAY WORK/WEEK HOURS)

(40

10-HOUR DAY 4-5/6 HOUR SHIFT

Greater fatigue Poor communication Discontinuity of care No overlapping of time

10 HOUR, 7-DAY WORKWEEK

12-HOUR SHIFT 7-DAY WORKWEEK

BAYLON PLAN

VARIATIONS

off Increased continuity of care More consistency of care between workdays and weekends Improved communication Longer time with patient More consistent patient teaching SHIFT: 6:45am-5:15pm, 12:45pm-11:15pm, 9:15pm7:45am Lower staffing requirement Lower cost/patient/day Nurses find they get to know their patient better More time to study charts Can visit patient more frequently Working relationship improved 2 days alternative plan Nurse have option to work 12 hrs days on weekends and be paid for 36 hrs (day shift) 40 hrs (night shift) or work for 5 eight-hour shift (M-F) 8-hour shifts and 2 twelve hr. shift/week for 40 hrs in 4-day week Consecutive 8 hrs shifts (night) from 10:30pm-7am then 7 night off-opted to be paid for 7 hrs for the 16 hrs in excess of the 40 hrs/week rather than accrued time off

Overtime pay is only required for more than 80 hours in a 2 week period

ASSIGNMENT SYSTEMS FOR STAFFING/MODALITIES OF PATIENT CARE 1. FUNCTIONAL - Task-oriented because the emphasis is on task behavior - Nursing care for specific group of patient is divided into task necessary or good patient care - Tasks are assigned according to each nursing team members individual skills and abilities - Stresses efficiency and economy to attain goals - Methods of division of labor is highly mechanistic, rigidity controlled system use of standards of care are precisely defined - Charge-nurse assigns specific tasks to each worker who is responsible for his/her assignment - Operates on a standard set of behavior - Personnel feels secured, but for along period level of satisfaction is decreased Advantage: 1. Get the work done well-lowest possible cost Disadvantage: 1. Patient can get fragmented care 2. Patient feels that no one person is aware of all her/his needs 3. Work becomes repetitious and boring

2. CASE METHOD - Oldest method of giving care - Nurse is responsible for giving care to a particular client - one-to-one nursing - One staff member is responsible for all the needs of one or more patients - Patient feels secured and care is better

3. TEAM - Team of staff members is jointly responsible for the care of group of patients - Each staff member cares for certain patients on the team but the responsibility is shared

Objectives:

The leader coordinates the activities of the team members Members are considered equal

1. To provide comprehensive and continuous nursing and to promote individualized nursing care by means of the NCP and Team conferences. 2. Requires all team members to participate in executing and evaluating care plans. 3. Emphasizes need for cooperation, coordination and teamwork. 4. Identification of patients problems focus for determining the tasks to be performed by each team member.

Team Leader (RN) 1. Assigns the duties of each member at the beginning of the shift 2. Plans and coordinates the care for each patient 3. Serves as a resource person for team members

4. PRIMARY CARE NURSING Nurse is able to form a meaningful relationship with a patient o Makes decisions about patients care o Assume responsibility for the patient and his health care needs o Interview and assess the patient o Evaluate data received o Plan and direct the care for 24 hr-period Founded on the philosophy that patients, not task, are the central focus of professional nurse A comprehensive, continuous and coordinated nursing process for meeting the total needs of each patient Accomplished through the efforts of a qualified primary care nurse who has: o Autonomy o Accountability o Authority

STAFFING FORMULA 1. Categorize patients according to level of case needed E.g. 100 x .65 = 65 patients under minimal care 100 x .30 = 30 patients under intermediate care 100 x .05 = 5 patients under intensive care

2. Find/Compute nursing care hour (NCH) needed by patient per categorized level/day Level I = 65 x 1.5 = 97.5 NCH Level II = 30 x 3 = 90 NCH Level III = 5 x 4.5 = 22.5 NCH Total: 210 NCH/day

3. Find the NCH of 100 patients/yr 210 x 365 = 76,650 NCH/day

4. Find the total number of personnel needed 76,650 NCH/yr 2080 WH/yr (260 x 8 WH/day) or 52 weeks x 40 WH/week) = 36.85 x 0.095 = 3.50 or 4 number of relievers

5. Categorize into professional and sub-professional 36.85 x .60 = 22.11 or 22 professionals 36.85 x .40 = 14.74 or 15 sub-professionals Note: Ratio of professional and sub-professional Level I 60:40 minimal Level II 65:35 intermediate Level III 70:30 intensive

6. Distribute into shift Professional: 22 x .45 = 9.9 or 10 nurses 7-3 shift 22 x .37 = 8.14 or 8 nurses 3-11 shift 22 x .18 = 3.96 or 4 nurses 11-7 shift

Sub-professional:

15 x .45 = 6.75 or 7 nurses 7-3 shift 15 x .37 = 5.55 or 6 nurses 3-11 shift 15 x .18 = 2.7 or 3 nurses 11-7 shift