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SEMINAR PRESENTATION ON
ESTIMATION OF NURSING STAFF
REQUIRMENTS- ACTIVE ANALYSIS AND
RESEARCH STUDIES

SUBMITTED TO,

Mrs.PRASANNA BALAJI

H.O.D. DEPT OF MEDICAL SURGICAL NURSING

P.I.O.N

SUBMITTED BY,

MOHAN.S

2ND YEAR M.SC

P.I.O.N
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c Staffing is certainly one of the major problems of any nursing organization,

whether it be a hospital, nursing home , health care agency, or in educational
organization. Estimation of staff requirements is important for rendering good
and quality nursing care


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Patient classification system( PCS) ,which quantifies the quality of the nursing care, is essential
to staffing nursing units of hospitals and nursing homes. In selecting or implementing a PCS , a
representative committee of nurse manager can include a representative of hospital
administration, which would decrease skepticism about the PCS.

The primary aim of PCS is to be able to respond to constant variation in the care needs of
patients.

 

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Úc 2ifferentiate intensity of care among definite classes

Úc easure and quantify care to develop a management engineering standard.
Úc atch nursing resources to patient care requirement .
Úc ?elate to time and effort spent on the associated activity.
Úc e economical and convenient to repot and use
Úc e mutually exclusive , continuing new item under more than one unit.
Úc e open to audit.
Úc e understood by those who plan , schedule and control the work.
Úc e individually standardized as to the procedure needed for accomplishment.
Úc Separate requirement for registered nurse from those of other staff.

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Úc The system will establish a unit of measure for nursing, that is , time , which will be used
to determine numbers and kinds of staff needed.
Úc Program costing and formulation of the nursing budget.
Úc Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
Úc 2etermining the values of the productivity equations
 Úc 2etermine the quality: once a standards time element has been established, staffing is
adjusted to meet the aggregate times. A nurse manager can elect to staff below the
standard time to reduce costs.

  The first component of a PCS is a method for grouping patients categories
.Johnson indicates two methods of categorizing patients. Using categorizing method each
patient is rated on independent elements of care, each element is scorded , scores are
summarized and the patient is place din a category based on the total numerical value
obtained.

Johnson describe prototype evaluation with four basic category for a typical patient requiring
one ʹon- one care. Each category addresses activities of daily living , general health, teaching
and emotional support, treatment and medications. 2ata are collected on average time spent
on direct and indirect care.

The second component of a PCS is a set of guidelines describing the way in which patients will
be classified, the frequency of the classification, and the method of reporting data.. The third
component of a PCS is the average amount of the time required for care of a patient in each
category. A method for calculating required nursing care hours is the fourth and final
component of a PCS .


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Patient Care classification using four levels of nursing care intensity

Area of care Category I Category II Category III Category IV

Eating Feeds self Needs some help Cannot feed self Cannot feed self
in preparing but is able to chew any may have
and swallowing difficulty
swallowing
Grooming Almost entirely Need some help in Unable to do Completely
self sufficient bathing, oral much for self dependent
hygiene ͙
Excretion Up and to Needs some help In bed, needs Completely
bathroom alone in getting up to bedpan / urinal dependent
bathroom /urinal placed;
Comfort Self sufficient Needs some help Cannot turn Completely
with adjusting without help, get dependent
position/ bed.. drink, adjust
position of
extremities ͙
General health Good ild symptoms Acute symptoms Critically ill
Treatment Simple ʹ Any Treatment Any treatment Any elaborate/
supervised, simple more than once more than twice delicate procedure
 dressing͙ per shift, foley /shift͙ requiring two
catheter care, nurses, vital signs
I&O͙. more often than
every two hours..
Health education ?outine follow up Initial teaching of ore intensive Teaching of
and teaching teaching care of ostomies; items; teaching of resistive patients,
new diabetics; apprehensive/
patients with mild mildly resistive
adverse reactions patients͙.
to their illness͙
  
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The following are the hours of nursing care needed for each level patient per shift:

Category I Category II Category III Category IV

NCHPP2 for 2.3 2.9 3.4 4.6
2ay shift
NCHPP2 for 2.0 2.3 2.8 3.4
P. (Evening)
shift
NCHPP2 for 0.5 1.0 2.0 2.8
night shift

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1.c Projecting Staffing Needs

Some steps to be taken in projecting staffing needs include:
1.c Identify the components of nursing care and nursing service.
2.c 2efine the standards of patient care to be maintained.
3.c Estimate the average number of nursing hours needed for the required hours.
4.c 2etermine the proportion of nursing hours to be provided by registered nurses and
other nursing service personnel
5.c 2etermine polices regarding these positions and for rotation of personnel.
2.c Computing number of nurses required on a Yearly asis
1.c Find the total number of general nursing hours needed in one year. Average patient
census X average nursing hours per patient for 24 hours X days in week X weeks in
year.
2.c Find the number of general nursing hours needed in one year which should be given
by registered nurses and the number which should be given by ancillary nursing
personnel.
 a.c Number of general nursing hours per year X percent to be given by registered
nurses.
b.c Number of general nursing hours per year X percent to be given be ancillary
nursing personnel.

Computing number of nurses assigned on weekly basis

1.c Find the total number of general nursing hours needed in one week. Average patient
censes X average nursing hours per patient in 24 hours X days in week.
2.c Find the number of general nursing hours needed in the week which should be given by
registered nurses and the number which could be given by ancillary nursing personnel.
a.c Number of general nursing hours per week X percent to be given by registered
nurses.
b.c Number of general nursing hours per week X percent to be given by ancillary nurses.

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1.c To determine the number of nursing staff for staffing a hospital involves establishing the
number of work days available for service per nurse per year.

Example : Analysis of how the days are used;

2ays in the year 365

2ays off 1 day/week 52
Casual leave 12
Privilege leave 30
1 Saturday /month 12
Public Holidays 18
Sick Leave 8
Total non-working days 132

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So
1 nurse = 233 working days /year
Example, 20 nurse means 20X233= 4660 hours
4660/365= 12.8 (13).
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?equirement for staffing are based on whatever standard unit of measurement for
productivity is used in a given unit. A formula for calculating nursing care hours per
patient day (NCH/PP2) is reviewed.
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As a result, patient classification systems (PCS), also known as workload management or patient
acuity tools, were developed in the 1960s.

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There are 3 factors: quality, quantity, and utilization of personnel.

Quality and Quantity:

This factor depends on the appropriate education or training provided to the nursing
personnel for the kind of service they are being prepared for i.e., professional, skilled,
routine or ancillary.

Utilization of personnel: Nursing personnel must be assigned work in such a way that
her/his knowledge and skills learnt are based used for the purpose she was educated or
trained.

Other factors affecting staffing

1.c Acutely Ill : Where the life saving is the priority or bed ridden condition which
might require 8-10 hours / patient /day ie., direct nursing care in 24 hours or
nurse patient ratio may have to be 1:1, 2:1,3:1͙
2.c oderately Ill: here 3.5 HP2 are required in 24 hours or nurse patient ration of
1:3 in teaching hospitals and 1:5 non-teaching hospitals.
3.c ildly Ill: this required 1-2 HP2 and for such patients 1:6 or 1:10.
4.c Fluctuation of workload: workload is not constant.
5.c Number of medical staff: In PHC , 30,000 to 50,000 population getting care from
3 to 4 medical staff but only 1 PHN gives care for all͙ like in hospital the ratio is
vary from medical and nursing staff.



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any different approaches to nurse staffing and scheduling are being tried in an effort to
satisfy needs of the employees and meet workload demands for patient care . These include
game theory, modified workweeks (10 or 12hours shifts), team rotation, premium day,
weekend nurse staffing .Such approaches should support the underlying purpose, mission,
philosophy and objectives of the organization and the division of nursing and should be well
defined in a staffing philosophy, statement and policies.



cccThis using 10 and 12 hour shifts and other methods are common place.
A nurse administrator should be sure work schedules are fulfilling the staffing philosophy and
policies, particularly with regard to efficiency. Also , such schedules should not be imposed on
the nursing staff but should show a mutual benefits to employer, employees and the client
served.

Úc One modification of the worksheet is four 10 hour shifts per week in organized time
increments. One problem with this model is time overlaps of 6 hours per 24 ʹhour day.
The overlap can be used for patient ʹcentered conference, nursing care assessment and
planning and staff development. It can be done by hour or by a block of 3-4 hours.
Starting and ending time for the 10 hours shifts can be modified to provide minimal
overlaps, the 4- hour gap being staffed by part-time or tempory workers
Úc A second scheduling modification is the 12 hour shift, on which nurses work even shifts ,
on which nurses work seven shift in 2 weeks: three on , four off: four on, three off . they
work a total 84 hours and are paid of overtime. Twelve hour shifts and flexible staffing
have been reported to have improved care and saved money because nurses can better
manage their home and personal lives.
Úc The weekend alternatives : another variation of flexible scheduling is the weekend
alternative. Nurses work two 12 hour shifts and are paid for 40 hours plus benefits. They
can use the weekdays for continued education or other personal needs. The weekend
scheduled has several variations. Nurses working onday through Friday have all
weekends off.
Úc Other modified approaches : team rotation is a method of cyclic staffing in which a
nursing team is scheduled as a unit .It would be used if the team nursing modality were
a team practice.
Úc Premium day weekend: nursing staffing is a scheduling pattern that gives the nurse an
extra day off duty, called a premium day, when he/she volunteers to work one
additional weekend worked beyond those required by nurse staffing policy. This
technique does not add directly to hospital costs.
Úc Premium vacation night: staffing follows the same principle as does premium day
weekend staffing. An example would be the policy of giving extra 5 working days of
vacation to every nurse who works a permanent night shifts for a specific period of time
, say 3, 4, or 6 months.
Úc A flexible role: this programme has enabled the hospitals to better meet the staffing
needs of units whenever workload increases. Since establishment of the resources
acuity nurse position, nurses position, nurse͛s morale has improved because they know
 short-term helps is more readily available and will be more equitably distributed among
units.
Úc Cross training: It can improve flexible scheduling. Nurses can be prepared through cross-
training to function effectively in more than one area of expertise. To prevent errors and
incidence job satisfaction during cross training nurses assigned to units and in pools
require complete orientation and ongoing staff development.


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Planning the duty schedule does not always match personnel with preferences. This is one
major dissatisfaction among clinical nurses. Posting the number of nurses needed by time slot
and allowing nurses to put colored pins in slots to select their own times can improve
satisfaction with the schedule.

Hanson defines a management information system as ͞an array components designed to

transform a collective set of data into knowledge that is directly useful and applicable in the
process of directing and controlling resources and their application to the achievement of
specific objectives͟.

The following process for establishing any IS:

1.c State the management objective clearly.

2.c Identify the actions required to meet the objective.
3.c Identify the responsible position in the organization.
4.c Identify the information required to meet the objective.
5.c 2etermine the data required to produce the needed information.
6.c 2etermine the system͛s requirement for processing the data.
7.c 2evelop a flowchart.



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Productivity is commonly defined as output divided by input. Hanson translates this definition
into following:

?equired staff hours

×100
Provided staff hours
Example

380 hours
X 100 = 95% productivity
400 hours

Productivity can be increased by decreasing the provided staff hours holding the required staff
hours constant or increasing them.

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In developing a model for an IS, Hanson indicates several formulas for translating data into
information. He indicates that in addition to the productivity formula, hours per patient day
(HPP2) are a data element that can provide meaningful information when provided for an
extended period of time.
HPP2 is determined by the formula

Staff hours
Patient days

For example,
52000
2883
Answer = 18 HPP2
Another useful formula
1.c udget utilization

Provided HPP2
X 100 = budget utilization
udgeted HPP2

Example
18.03 % so, answer is 112.7% udget utilization.
16

2.c udget adequacy

udgeted HPP2 X100 , this is known as udget adequacy
?equired HPP2

16/18.03= 88.74% budget adequacy.

STAFFING PATTERN c
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Staffing of colleges of nursing at university level and schools of nursing at hospital level with
handful of nurse teachers for clinical and public health nursing practice much is to be desired.
2ue to lack of trained nurse teachers majority of he classes are taken by the doctors or other
non teachers who cannot relate their subject to the practice. Every subject taught in nursing
must be taught by nurses only to that extent which can be and should be translated in to
practice.

As per INC Staffing norms to the Nursing Institution is

B.Sc. (N) and M.Sc. (N)
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ost of the hospitals have the chief nurse but not in an executive position. She acts more like a
middle level manager and she may be assisted by one, two or eight assistants to look after a
hospitals.

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1.c T asavanthappa. Community health nursing. 1st edition. New 2elhi: Jaypee brothers; 2003

2.c T asavanthappa. Nursing administration. Ist edn. New 2elhi: Jaypee brothers; 2000.

3.c anagement and leadership for nurse managers, second edition, russel c.swansburg

4.c Function of nursing management- Nursing management- open access articles on nursing
management http://currentnursing.com/nursing_management/staffing_nursing_units.html

5.c Staff Inspection Unitc

http://finmin.nic.in/the_ministry/dept_expenditure/staff_inspection_unit/index.html

6.c Staffing in nursing management

http://www.scribd.com/doc/16245136/Staffing-in-Nursing-anagement

7.c Staffing in the 21st Century: New Challenges and Strategic Opportunities
http://jom.sagepub.com/content/32/6/868.abstract