STAFFING

(Written Output)

Submitted to: Mr. Julius Lapasaran

Submitted by: Andrade, Kassandra Kristel Bucoy, Raymark Daham, Farzana Gonzales, Mary Suzzette Hadjiula, Nihma Lim, Mark Vincent Lim, Melissa Roselle Ngo, Jason BSN IV-A NCM 105a August 4, 2011

STAFFING Staffing is the third phase of the management process. In staffing, the nursemanager recruits, selects, places, and indoctrinates personnel to accomplish the goals of the organization. Staffing is important in the health care organizations because such organizations require many employees to accomplish its objective. Moreover, health care organizations are open 24 hours a day, 365 days a year, and client demands and needs are often variable. According to Theo Haimann, Staffing pertains to recruitment, selection, development and compensation of subordinates. It is a process of determining and providing acceptable number of workers to produce the desired level of care to meet the patients demand. The purpose of staffing is to provide each nursing unit with an appropriate number of workers in each category to perform nursing tasks required. Nature of Staffing Function 1. Staffing is an important managerial function 2. Staffing is a continuous activity 3. The basis of staffing function is efficient management of personnels 4. Staffing helps in placing right men at the right job. 5. Staffing is performed by all managers Factors Affecting Staffing Type, philosophy and objectives of the hospital Number of patients and severity of their illness Characteristics of the nursing staff Budget including the amount allotted to salaries, benefits, supplies, materials Teaching program or the extent of staff involvement Expected hours of work per annum Patterns of work schedule Sequential Steps in Staffing 1. Determine the number and types of personnel needed to fulfill the philosophy, meet fiscal planning responsibilities, and carry out the chosen patient care delivery system selected by the organization. 2. Recruit, interview, select, and assign personnel based on established job description and performance standards. 3. Use organizational resources for induction and orientation. 4. Ascertain that each employee is adequately socialized to organization values and unit norms. 5. Use creative and flexible scheduling based on patient care needs to increase productivity and retention.

STAFFING PROCESS Predicting Staffing Needs Predicting staffing needs or requirements is a crucial management skill because it enables the manager to avoid staffing crises. Managers must consider the patient delivery care system used, the education and knowledge level of needed staff, budget constraints, historical staffing needs and availability, and the diversity of the patient population to be served. Recruitment It is the process of actively seeking out or attracting applicants for existing positions, and it should be an ongoing process. The manager may be greatly or minimally involved with recruiting, interviewing, and selecting personnel depending on (a) size of the institution, (b) existence of a separate personnel department, (c) presence of a nurse recruiter, (d) use of centralized and decentralized nursing management. The more decentralized nursing management and the less complex the personnel department, the greater the involvement of lower-level managers in selecting personnel for individual units or departments. On the contrary, when organizations use nurserecruiters, a collaborative relationship must exist between managers and recruiters. Managers must be aware of recruitment constraints, and the recruiter must be aware of individual department needs and culture. The Initial Contact Many prospective employees will make their first contact with an organization through human resources department or the recruiter. Generally, these individuals are directed to complete an application and set-up an appointment for an interview. Interviewing as a Selection Tool An interview is defined as a verbal interaction between individuals for a particular purpose. The purposes or goals of the selection interview are threefold: a.) interviewer seeks to obtain information to determine the applicants suitability for the available position; b.) applicant obtains adequate information to make intelligent decision about accepting the job, should it be offered; c.) the applicant will continue to have respect for and goodwill toward the organization. Interviews may be structured or unstructured. A structured interview requires greater planning time because questions must be developed in advance that address the specific job requirements, information must be offered about the skills and qualities being sought, examples of the applicants experience must be received, and the

willingness or motivation of the applicant to do the job must be determined. The unstructured interview, on the other hand, requires little planning; questions are not prepared in advance, and often the interviewer does more talking than the applicant. Overcoming Interview Limitations Prepare for the Interview Use a Team Approach Develop a Structured Interview Format for Each Job Application Use Scenarios to Determine Decision-Making Ability Conduct Multiple Interviews

Evaluation of the Interview Interviewers should plan post-interview time to evaluate the applicants interview performance. Two aspects must carry the most weight: 1. The requirements for the job- Regardless of how interesting or friendly people are, unless they have the basic skills for the job, they will not be successful at meeting the expectations of the position. 2. Personal bias It is important for the interviewer to examine any negative feelings that occurred during the interview. Often, the negative feelings have no relation to the criteria necessary for the success of the position. Legal Aspects of Interviewing Interview inquiries regarding age, marital status, children, race, sexual preference, financial or credit status, national origin, or religion are illegal because they are deemed discriminatory. Selection It is the process if choosing from among applicants the best-qualified individual or individuals for a particular job or position. It involves verifying the applicants qualifications, checking his or her work history, and deciding if the applicants qualifications fit the organizations expectations. Process: Adequate applicants pool Preemployment screening Completion of application Reference Checks, Preemployment Testing, Physical Examination, Employment interview Employer decision Notification of applicants

Placement New staff nurses can be placed in units where they can work at their own pace and feel comfortable Experienced and well-trained nurses adapt faster, but still need orientation to their new jobs. Traditionally in our culture, male nurses are seldom placed in maternity units. Nurses with masters degree in Nursing are easily placed in positions requiring such degrees as specified by PNA of 2002 (RA 9173)

Proper placement will: Foster Personal growth Provide a motivating climate for the employee Maximize productivity Organizational goals have better chances of being met Inappropriate placement often results to: Frustration Poor quality of work Reduced organizational efficiency Rapid turn-over Poor image for the agency Factors to consider: past experience and training culture of the clientele decision-making skills communication skills Indoctrination It refers to the planned, guided adjustment of an employee to the organization and the work environment. It has 3 phases: induction, orientation, and socialization. It seeks to: establish favorable attitudes; provide necessary information and education; instill a feeling of belonging and acceptance. Induction Includes all activities that educate the new employee about the organization and employment and personnel policies and procedures. Orientation Includes activities that are more specific for the position. The next phase could take place in the staff development department The third phase would be individual orientation for each department

Job Descriptions Job description is a statement that sets the duties and responsibilities of a specific job. It is an important to: a. make certain that responsibilities are wisely delegated b. that work is efficiently distributed c. that talents are fully used, and d. morale is maintained Content of Job Descriptions 1. Identifying Data Position Title: Staff Nurse Department: Nursing Supervisors Title: Head/Senior Nurse 2. Job Summary 3. Qualification Requirements 4. Job Relationships 5. Specific and Actual Functions and Activities Uses of Job Descriptions 1. For recruitment and selection of qualified personnel 2. To orient new employees to their jobs; 3.For job placement, transfer or dismissal; 4. As an aid for evaluating the performance of an employee 5. For budgetary purposes 6. For determining departmental functions and relationships to help define the organizational structure; 7. For classifying levels of nursing functions according to skill levels required; 8. To identify training needs; 9. As basis for staffing; and 10. To serve as channel of communication

PATIENT CARE CLASSIFICATION SYSTEM It is a method of grouping patients according to the following: amount and complexity of their nursing care requirements; nursing time and skill they require. To develop a workable patient classification system, the nurse manager must determine the following: The no. of categories into w/c the patients should be divided; The characteristics of patients in each category; The type and no. of care procedures that will be needed by a typical patient in each category; The time needed to perform these procedures that will be required by a typical patient in each category.

Classification Categories Level I-Self Care or Minimal Care patient can perform ADLs about to be discharged non-emergency newly admitted dont exhibit unusual s/s requires little treatment/observation and/or instruction Level II-Moderate Care or Intermediate Care need some assistance for a short period of time extreme Signs must have subsided or have not yet appeared slight emotional needs V/S ordered 3x per shift w/ IVF or BT semi-conscious exhibiting some psychosocial/social problems periodic treatments, observations and/or instructions Level III-Total, Complete or Intensive Care completely dependent may or not be conscious w/ marked emotional needs V/S > 3x per shift continuous O2 therapy w/ chest or abdominal tubes close observation (every 30 mins.)

Level IV-Highly Specialized Critical Care maximum nursing care continuous treatment and observation w/ many medications, IV piggybacks V/S every 15-30 mins. hourly output significant changes in doctors orders care hrs=6-9 or more

CATEGORIES OR LEVELS OF CARE OF PATIENTS, NURSING CARE HOURS NEEDED PER PATIENT PER DAY AND RATIO OF PROFESSIONAL TO NON-PROFESSIONALS Levels of Care Level I Self Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care NCH Needed Per Pt. Per Ratio of Prof. to NonDay Prof. 1.50 3.0 4.5 6.0 7 or higher 5:45 60:40 65:35 70:30 80:20

ORGANIZING THE NURSING SERVICE Distribution by Shifts Studies have shown that the morning or day shift needs the most number of nursing personnel at 45 to 51%; for the afternoon shift 34 to 37%; and for the night shift 15 to 18%. The distribution usually followed in the Philippines: 45%- morning shift, 37% afternoon shift, and 18% for the night shift. Staffing Formula 1. Categorize the number of patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care (whether minimal, intermediate, intensive or highly specialized). Example: Categorize the patients according to levels of care needed: 250 (pts) x .30 = 75 patients needing minimal care 250 (pts) x .45 = 112.5 patients needing moderate care 250 (pts) x .15 = 37.5 patients needing intensive care 250 (pts) x .01 = 25 patients needing highly specialized nsg. care 2. Find the total number of nursing care hours needed by the patients at each category level Find the number of patients at each level by the average number of nursing care hours needed per day. Get the sum of the nursing care hours needed at the various levels. Example: Find the number of nursing care hours (NCH) needed by patients at each level of care per day 75 (pts) x 1.5 (NCH needed at level I) = 112.5 NCH/day 112.5 x 3 (NCH needed at level II) = 337.5 NCH/day 37.5 x 4.5 (NCH needed at level III) = 168.75 NCH/day 25 x 6 (NCH needed at level IV) = 150 NCH/day _ total: 768.75 NCH/day 3. Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year Example: Find the total NCH needed by 250 patients per year 768.75 x 365(days/year) = 280,593.75 NCH/year

4. Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year. Example: Find the actual working hours rendered by each nursing personnel per year 8(hrs/day) x 213 (working days/year) = 1,704 (working hours/year) 5. Find the total number of nursing personnel needed. A. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year B. Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week) C. Add the number of reliever to the number of nursing personnel needed. Find the total number of nursing personnel needed A. Total NCH per year= 280, 593.75 = 165 Working hrs/ year 1,704 B. relief x total nsg personnel 165 x .15 = 25 C. Total nursing personnel needed 165 + 25 = 190 6. Categorize to professional and non-professional personnel. Ratio of professionals to non-professionals in a tertiary hospital is 65:35 190 x .65 = 124 professional nurses 190 x .35 = 66 nursing attendants 7. Distribute the shifts 124 nurses x .45 = 56 nurses on AM shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x .18 = 22 nurses on night shift total: 124 nurses 66 nsg attendants x .45 = 30 nsg attendants on AM shift 66 nsg attendants x .37 = 24 nsg attendants on PM shift 66 nsg attendants x .18 = 22 nsg attendants on night shift total: 66 nursing attendants

 Additional personnel should be hired for those in supervisory and administrative positions and for those in special units such as the OR, DR, ER, and OPD. A head nurse is provided for every nursing unit A nursing superior is provided To cover every shift in each clinical department or area specialty unit For each geographical area in hospitals beyond 100 beds For each functioning area such as Training, Research, Infection control and Locality Management Although roomed-in babies in the mothers unit are not included in the patient census, they are given service such as bathing, changing of diapers, and the like. Additional staff should be provided for these babies Hospitals are now centers for wellness. Therefore, additional personnel is necessary for health education classes both at the in-patient and out-patient units

SCHEDULING Timetable showing planned work days and shifts for nursing personnel. Factors Considered in Making Schedules Different levels of nursing staff Adequate coverage for 24 hours, seven days a week Staggered vacations and holidays Weekends Long stretches of consecutive working days Evening and night shifts floating Assessing a Scheduling System 1. Ability to cover the needs of the unit 2. Quality to enhance the nursing personnels knowledge, training, and experience 3. Fairness to the staff 4. Stability 5. Flexibility Types of Scheduling Centralized schedule Decentralized schedule

Cyclical schedule Scheduling variables should be considered: Length of scheduling period whether 2 or 4 weeks Shift rotation Week-ends off Holidays off Vacation leaves Special days Scheduled events in the hospital, training programs, or meetings Job categories Continuing professional education programs Advantages of cyclical schedule It is fair to all. It saves time as the schedule does not have to be redone every week or two. It enables employee to plan ahead for their personal needs preventing frequent changes in schedule Scheduled leave coverage such as vacation, holidays and sick leaves are more stable. Productivity is improved. Rotating Work Shifts Most common in hospitals. Equal share of morning, afternoon, and night shifts. Permanent shifts Frequent or daily changes in work shifts