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STAFFING IN NURSING UNITS
This page was last updated on 28-01-2010
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 Introduction

Staffing is a selection, training, motivating and retaining of a personnel in the organization. Nurse staffing is a constant challenge for health care facilities. Before the selection of the employees, one has to make analysis of the particular job, which is required in the organization, then comes the selection of personnel.

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.
  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
  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.
  • 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.

  • 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

  • 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.

  • 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:

  1. Patient Care Unit Related
    1. Appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate patient needs.
    2. There is a critical need to either retire or seriously question the usefulness of the concept of nursing hours per patient day (HPPD).
    3. Unit functions necessary to support delivery of quality patient care must also be considered in determining staffing levels.
  2. Staff Related
    1. The specific needs of various patient populations should determine the appropriate clinical competencies required of the nurse practicing in that area.
    2. Registered nurses must have nursing management support and representation at both the operational level and the executive level.
    3. Clinical support from experienced RNs should be readily available to those RNs with less proficiency.
  3. Institution/Organization Related
    1. 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.
    2. 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.
    3. Organizational policies should recognize the myriad needs of both patients and nursing staff.

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

Norms

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 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).

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

2. Special Ward - ( pediatrics, burns, neuro surgery, cardio thoracic, neuro medicine, nursing home, spinal injury, emergency wards attached to casuality)

1:6

1:4

 

3.      Nursery

1:2 

4.      I.C.U.

  • 1:1(Nothing mentioned about the shifts)

5.      Labour Room

  • 1:l per table

6.      O.T.

  • Major - 1 :2 per table
  • Minor - 1:l per table

7.      Casualty- 

a. Casualty main attendance up to 100 patients per day thereafter

 

b.for every additional attendance of 35 patients

c.       gynae/ obstetric attendance

 

d.      thereafter every additional attendance of 15 patients.

 

3 staff nurses for 24 hours, 1:1per shift.

 

1:35

 

·3 staff nurses for 24 hours, 1:1/ shift

 

1:15

8.  Injection room OPD

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

·        Paediatric

·        Immunization

·        Eye

·        ENT

·        Pre anaesthetic

·        Cardio lab

·        Bronchoscopy lab

·        Vaccination anti rabis

·        Family planning

·        Medical

·        Dental

·        Central sample collection centre

·        Orthopaedic

·        Gyne

·        Xray

·        Skin

·        V D centre

·        Chemotherapy

·        Neurology

·        Microbiology

·        Psychiatry

·        Burns

 

 

 

1

2

2

1

1

1

1

1

1

2

1

1

1

1

2

2

3

2

2

2

1

2

1

2

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
  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.

Research Inputs

1. Fourteen unit attributes to guide staffing (ref-7)

Using the nursing executive center’s hospital data base, researchers contacted a cross section of leading hospitals nationwide, balanced by size, geography, location and teaching status. For each hospital, the senior most  nursing leader, usually a chief nurse or vice president of patient care services was asked to participate in a 1 hr interview with center researchers. The fourteen attributes identified includes: patient at risk for deteriorating rapidly, wide fluctuation in the patients volume,wide disparity in patient type and treatment, high level of admission, discharge and transfer, high degree of nursing autonomy(less physician oversight), high proportion of protocol driven care, complex patient care needs post discharge, premium on interdisciplinary communication, high percentage of patient with comorbidities, premium on highly technical skills, high level of ADL transports, Heightened observational needs, high percentage of obese patients and premium on multitasking.

2. Nurse staffing and patient outcomes (ref-8)

The authors from the University of Lowa, investigated nurse staffing and patient outcomes in 42 inpatient nursing care units in a large university hospital. Acute care unit level data were collected from hospital records to examine the relationships among total hours of nursing care, RN skill mix, and adverse patient outcomes, which included medication errors, patient falls, pressure ulcers, patient complaints, infections and death. They found that the proportion of hours of RN care was inversely related to the unit rates of medication errors, pressure ulcers, patient complaints, infections and deaths. An unexpected finding was that as the RN proportion increased, the rates of adverse outcomes decreased, up to the level of 87.5%, after which adverse outcomes rates also began to increase. Our explanation may be that better reporting resulted when more RNs were working.

References:

  1. Basavanthappa BT. Nursing administration. Ist edn. New Delhi: Jaypee brothers medical publishers (p) ltd; 2000.

  2. Wise PS. Leading and managing in nursing. Ist edn. Philadelphia: Mosby publications; 1995.

  3. Koontz H, Weihrich H . Essentials of management an international perspective. (Ist edn). New Delhi: Tata Mc Graw Hill publishers; 2007.

  4. Koontz H, Weihrich H. Management a global perspective. 1st  edn. New Delhi: Tata Mc. Graw Hill publishers;2001.

  5. Anthony MK, Theresa S, Glick J,  Duffy M, Paschall F. Leadership and nurse retention, the pivotal role of nurse managers. JONA. Vol 35, Mar 2005.

  6. Beyers Marjorie. Nurse executives’ perspectives on succession planning. JONA. Vol 36. June 2006.

  7. Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide staffing. JONA.vol 37, no.3 mar 2007.

  8. Blegen MA, Goode C J& Reed L. Nurse staffing and patient outcomes. Nurs res. 1998; 47(1):43-50.


 

 
 
 
 
 
             
 

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