The goal is to provide is to provide the appropriate numbers and mix of nursing

staff (nursing care hours) to match actual or projected patient care needs
(patient care hours) that will leac to the delivery of effective and efficient
nursing care. There is no singgle or perpect method to achieve efficient and
effective staffing. There are, howefer, key elemnts that contribute to successful
and satisfying staffing. Because staffing requires continuous fine tuning,
variability in patient census during the year is big challenge for nursing
managers. In hospital, the unit may experince a steady census during the 7 days
of the week or a higher census from Monday to Friday. its patient days may
consistenly experience peaks in occupancy in certain months (seasonaly pattern)
such as the months of april, july and october. In hospitalis as well as in other
health care setings, staffing is one of the most pressing challenges nurse
managers face. To determine staffing requrements (number of staff) nurse
managers must examine workload patern for the desigenated unit, departement,
or clinic. For a hospital, this means determining the level of care, average daily
census and hours of care provide 24 hours a day, 7 days a week. The joint
commision (JCAHO, 2002) specifies only that the right number of competent
staff be provide to meet patient needs based on organization selected criteria.
JCAHO does not identify specific levels of nursing of patient care units, or the
type of patient calssification systems to be used. Althought they do not accredit
health care (ANA, 1999) has developed principles for nurse staffing as shown in
box 17-1. ANA recommoneds that health care organization shift from an
industrial,technical professional model and focus on the level of nurse
competency required to provide quality nursing care.

Patient classification systems

Patient classification systems (PCSs), sometimes referred to patient acuity
systems, were developed to determine workload requirements and staffing
needs objectively. To be most effective, patient classification data are collected
midpoint forevery shift by the unit nursing staff and attalyzed before the next
shift to ensure appropriate numbers and mix of nursing staff. Initially, paper and
pencil methoods based on industrial engineering models that incorporated time
and otion study data were used to estimate annual staffing needs and dtermine
the annual personnel budget (Malloch & conovaloff, 199). Theree methods were
commonly used.
1. Descriptive
2. Checklist
3. Time standard
The desriptive systems is a subjective claasification of the patient activities by
category. Four or live categories are used to describe varying levels of care and
dependence. The nurse selected the category that best representation of the
patients. Neither category is an actual representation of the patients needs or
the staffs time. As a result, this type of callsification systems is rarely used
today. The checklist format is another subjective systems in which an acuity level

is determined by indentifying the level of activity within each category for each
patient. Point ascribed for each level af acitivity (eating ,bathing< medications
and so on) are totaled and converted to a level of acuity. For example, a new
mother following a cesarean section can feed herself (1 point), has a foley
catheter in place (3 point), has an intarvenous catheter (3 points), and needs
minimal assitance turning (2point). Totaled, this patient recevies 9 points, which
by the hospitals standards convents to an acuity of 2. The cheklist format
provides a more individualized.