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STAFFING IN
NURSING SERVICE
AND EDUCATION
MS.SREEKALA.R
SECOND YEAR MSC

DEFINITION
According to Koontz and O'Donnell
"staffing involves the proper and effective selection,
appraisal and development of personnel to fulfill the roles
designed into a Dale organizational structure"
"keeping the job filled with the right people is the staffing
phase of the management

 According to The Haimann

"staffing is concerned with the placement,
growth, development of all those members of
the organization whose function is to get
things done through the efforts of other
individuals".

 According to Luther
Gallic
" Staffing is the whole
personnel function of
bringing in and training
the staff and maintaining
favorable conditions of
work"

PHILOSOPHY OF
STAFFING
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 favorable job attitudes
will follow as a matter of course.

PHILOSOPHY OF
STAFFING
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.

PHILOSOPHY OF
STAFFING
The behavioral scientist believes that
The behavioral 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
it is possible to match employees knowledge and
skills to patient care needs in a manner that
optimizes job satisfaction and care quality.
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.
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.

Philosophy of staffing
in nursing
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.)
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.
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

 Patient Care Unit Related

Appropriate staffing levels for a patient care unit
reflect analysis of individual and aggregate
patient needs.
There is a critical need to either retire or seriously
question the usefulness of the concept of nursing
hours per patient day (HPPD).
Unit functions necessary to support delivery of
quality patient care must also be considered in
determining staffing levels.

 Staff Related
The specific needs of various patient populations
should determine the appropriate clinical
competencies required of the nurse practicing in
that area.
Registered nurses must have nursing
management support and representation at both
the operational level and the executive level.
Clinical support from experienced RNs should be
readily available to those RNs with less
proficiency.

 Institution/Organization Related
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.
All institutions should have documented
competencies for nursing staff, including agency
or supplemental and travelling RNs, for those
activities that they have been authorized to
perform.
Organizational policies should recognize the
myriad needs of both patients and nursing staff.

FACTORS INFLUENCING
STAFFING

type, philosophy, objectives of the hospital and the

nursing service.
the population served or kind of patients served
whether pay or charity.
the number of patients and severity of their illnessknowledge and ability of nursing personnel are
matched with the actual care needs of patients
availability and characteristics of the nursing staff,
including education, level of preparation, mix of
personnel, number and position.
administrative policies such as rotation, weekends,
and holiday off-duties.
standards of care desired which should be available
and clearly spelled out.

FACTORS INFLUENCING
STAFFING
layout of various nursing units and resources
available within the department such as adequate
equipment, supplies, and materials
budget including the amount allotted to salaries,
fringe benefits, supplies, materials and equipment
professional activities and priorities in nonpatient
activities like involvement I professional
organizations, formal educational development,
participation in research and staff development.
teaching program or the extent of staff
involvement in teaching activities.
expected hours of work per annum of each
employee. This is influenced by 40 hour week law.

NORMS RELATED TO
STAFFING
STAFF INSPECTION UNIT (S.I.U)
BAJAJ COMMITTEE, 1986
HIGH POWER COMMITTEE ON NURSING AND
NURSING PROFESSION (1987-1989)

STAFF INSPECTION
UNIT (S.I.U)
The Staff Inspection Unit was set up in 1964 with
the object of effecting economy in manpower
consistent with administrative efficiency and
evolving performance standards and work norms
in Government offices and Institutions wholly or
substantially dependent on Government Grants.
Its officers also serve as Core Member on the
Committees appointed to scrutinize manpower
requirements of Scientific and Technical
Organizations.
The Staff Inspection Unit (S.I.U.) is the unit which
has recommended the nursing norms in the year
1991-92.

NORMS OF STAFFING
(S I U- staff inspection
unit)
Recommendations of S.I.U:
The norms for providing staff nurses and nursing sisters
in Government hospital has been recommended taking
into account the workload projected in the wards and
the other areas of the hospital.
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.
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 staff nurses fixed by the government
in settlement with the Delhi nurse union in May 1990.

NORMS OF STAFFING
(S I U- staff inspection
unit)
The assistant nursing superintendents are
recommended in the ratio of 1 ANS to every 4
nursing sisters. The ANS will perform the duty
presently performed by nursing sisters and
perform duty in shift also.
The posts of Deputy Nursing Superintendent may
continue at the level of 1 DNS per every 7 ANS
There will be a post of Nursing Superintendent for
every hospital having 250 or more beds.
There will be a post of 1 Chief Nursing Officer for
every hospital having 500 or more beds.

 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).

The Nurse-patient
Ratio as per the S.I.U.
Norms
General ward : 1:6
Special wards (pediatrics, burns, neuro surgery,
cardio thoracic, neuro medicine, nursing home,
spinal injury, emergency wards attached to
casuality) : 1:4
Nursery : 1:2
ICU: 1:1
Labour room : 1:1 per table
OT : Major 1:2 per table, minor 1:1 per table
Casualty : I staff per shift
Gynaec casualty 1:35

Injection room for 100 patient 1 staff

OPD : 120-220 Patients 2 staff
221-320 patients 3 staff
321-420 patients 4 staffs
Blood bank :1
Paediatric :2
Immunisation :1
Eye :1
ENT:1
Pre anaesthetic :1
Cath lab :1
Broncho scopy :2

Vaccination: 1
Family planning :2
Medical:2
Dental :2
Central sample collection center:3
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 norms are based on

Hospital Beds.
Chief Nursing Officer:
1 per 500 beds
Nursing Superintendent:
1 per 400 beds or above
D.N.S.:
1 per 300 beds and 1
additional for every 200 beds
A.N.S.:
1 for 100-150 beds or 34 wards
Ward Sister:
1 for 25-30 beds or one
ward. 30% leave reserve
Staff Nurse: 1 for 3 beds in Teaching Hospital in general ward& 1for 5
beds in Non-teaching Hospital +30% Leave reserve.
Extra Nursing staff to be provided for departmental research function.
For OPD and Emergency: 1 staff nurse for 100 patients (1: 100) +
30% leave reserve
For Intensive Care unit (I.C.U.) - 1:1 or (1:3 for each shift) +30% leave
reserve.
It is suggested that for 250 bedded hospitals there should be One
Infection Control Nurse (ICN).

BAJAJ COMMITTEE,
1986
An "Expert Committee for Health Manpower
Planning, Production and Management" was
constituted in 1985 under Dr. J.S. Bajaj, the then
professor at AIIMS.
Manpower is one of the most vital resources for
the labour intensive health services industry.
Health for all (HFA) can be achieved only by
improving the utilization of these resources.

Major recommendations are:-

Formulation of National Medical & Health Education

Policy.
Formulate on of National Health Manpower Policy.
Establishment of an Educational Commission for
Health Sciences (ECHS) on the lines of UGC.
Establishment of Health Science Universities in
various states and union territories.
Establishment of health manpower cells at centre
and in the states.
Vocationalisation of education at 10+2 levels as
regards

health

incentives,

so

related
that

fields

good

with

quality

appropriate
paramedical

personnel may be available in adequate numbers.

Carrying out a realistic health manpower survey.

Hospital Nursing Services 1. Nursing superintendents.

1:200 beds
2. Deputy nursing superintendents 1:300 beds
3. Departmental nursing
7:1000 + 1 Addl:1000 beds
(991 x 7 + 991)
4. Ward nursing 8:200 + 30% leave reserve

supervisors/sisters
5. Staff nurse for wards
1:3 (or 1:9 for each shift)

+30 leave reserve

6. For OPD, Blood Bank, X-ray,

Diabetic clinics, CSR, etc

1:100 (1:5 OPD)
+30% leave reserve

7. For intensive units 1:8 (1:3 for each shift)
(8 beds ICU/200 beds) + 30% leave reserve

8. For specialized deptts and

clinics, OT, Labour room
leave reserve

8:200 + 30%

Community Nursing
Service
Projected population - 991,479,200
assumption) by 2000 AD
1 Community Health Centre population
1 Primary Health Services population in plain area
1 Primary Health Services population in difficult areas
1 Sub-centre population in plain area
1 Sub-centre population for difficult area

(medium
1,000,00
30,000
20,000
5000
3000

 Sub-centre ANM/FHW
323882
Health supervisors /LHV
107960
Primary Health Centres PHN
26439
Community health centre Nurse-midwives
26439
Public health nursing supervisor
7436
Nurse-midwives
52,052
District public health nursing officer
900

HIGH POWER COMMITTEE ON

NURSING AND NURSING PROFESSION
(1987-1989)
High power committee on nursing and nursing
profession was set up by the Government of India
in July 1987,
under the chairmanship of Dr. Jyothi former vicechancellor of SNDT Women University
Mrs. Rajkumari Sood, Nursing Advisor to Union
Government as the member-secretary and CPB
Kurup, Principal, Government College of Nursing,
Bangalore and the then President.
TNAI is also one among the prominent members
of this committee.
Later on the committee was headed by Smt.
Sarojini Varadappan, former Chairman of Central
Social Welfare Board.

RECOMMENDATIONS OF HIGH POWER

COMMITTEE ON NURSING AND
NURSING PROFESSION

Working conditions of nursing personnel

1. Employment
Uniformity in employment procedures to be made.
2. Job description
.
3. Working hours
4. Work load/ working facilities
5. Pay and allowances
6. Promotional opportunities
7. Career development
8. Accommodation
9. Transport
.
10. Special incentives
11. Occupational hazards
12. Other welfare services

 Additional Facilities for Nurses Working In the

Rural Areas
Family accommodation at sub centre is a must
for safety and security of ANM's /LHV.
Women attendant, selected from the village
must accompany the ANM for visits to other
villages.
The district public health nurse is provided
with a vehicle for field supervision.
Fixed travel allowance with provision of
enhancement from time to time.
Rural allowance as granted to other employees
is paid to nursing personnel

NURSING EDUCATION
There should be 2 levels of nursing personnel professional nurse (degree level) and auxiliary
nurse (vocational nurse). Admission to
professional nursing should be with 12 yrs of
schooling with science. The duration of course
should be 4 yrs at the university level. admission
to vocational /auxiliary nursing should be with 10
yrs of schooling .The duration of course should be
2 yrs in health related vocational stream.
All school of nursing attached to medical college
hospitals is upgraded to degree level in a phased
manner.
All ANM schools and school of nursing attached to
district hospitals be affiliated with senior
secondary boards.

 Post certificate B.Sc. Nursing degree to be

continued to give opportunities to the existing
diploma nurses to continue higher education.
Master in nursing programme to be increased and
strengthened.
Doctoral programme in nursing have to be started
in selected universities.
Central assistance be provided for all levels of
nursing education institutions in terms of budget(
capital and recurring)
Up gradation of degree level institutions be made
in a phased manner as suggested in report.

 Each school should have separate budget till such

time is phased to degree/vocational programme.
The principal of the school should be the drawing
and the disbursing officer.
Nursing personnel should have a complete say in
matters of selection of students. Selection is
based completely on merit. Aptitude test is
introduced for selection of candidates.
All schools to have adequate budget for libraries
and teaching equipments.
All schools to have independent teaching block
called as School Of Nursing with adequate class
room facilities, library room, common room etc as
per the requirements of INC.

 13.Adequate accommodations are provided to students. A

maximum of 3 students to share a room. Rooms to be
furnished with light, study table , chair etc. Adequate
dining room, toilets and bathrooms facilities to be provided
in each hostel as per norms recommended.
14.Students should learn under supervision in the wards.
Tutors/clinical instructors must go to the ward with students.
Students should not be used for the service of the hospital.
15.Community nursing experience should be as per INC
requirements. Necessary transport and accommodation at
PHC be made available for safety, security and meaningful
learning of students.
16.INC requirements for staffing the schools and meeting
the minimum requirements are followed by all schools as
these are statutory requirements.

 Speciality courses at post-graduate level be

developed at certain special centres of excellence
eg; AIIMS.
Institutes like National Institute of Health and
Family welfare, RAK College of Nursing and
several others may develop courses on nursing
administration for senior nursing leading to
doctorate level.
Provision for higher training abroad and exchange
programme is made.

Continuing Education and

Staff Development
Definite policies of deputing 5-10% of staff for
higher studies are made by each state. Provision
for training reserve is made in each institution.
Deputation for higher study is made
compulsory after 5 yrs.
Each nursing personnel must attend 1 or 2
refresher course every year.
Necessary budgetary provision be made.
A National Institute for Nursing Education
Research and Training needs to be established like
NCERT, for development of educational
technology, preparation of textbooks, media, /
manuals for nursing.

NURSING SERVICES:
HOSPITALS/INSTITUTIONS
(URBAN AREAS)
1. Staffing of the hospitals should be as per
norms recommended.
2. District hospitals /non teaching hospitals may
appoint professional teaching nurses in the ratio
of 1; 3 as soon as nurses start qualifying from
these institutions.
3. Students not to be counted for staffing in the
hospitals
4. Adequate supplies and equipments, drugs etc
be made available for practice of nursing.

 5. Nurses to be relieved from non -nursing duties.

6. Duty station for nurses is provided in each
ward.
7. Necessary facilities like central sterile supplies,
linen, drugs are considered for all major hospitals
to improve patient care. Also nurses should not
be made to pay for breakage and losses. All
hospitals should have some systems for regular
assessment of losses.
8. Provision of part time jobs for married nurses
to be considered. (min 16-20hrs/week)

 9. Re-entry by married nurses at the age of 35 or

above may also be considered and such nurse be
given induction courses for updating their
knowledge and skills before employment.
10.Nurses in senior positions like ward sisters,
Asst. nursing superintendents, Deputy NS; N.S
must have courses in management and
administration before promotions.
11.Nurses working in speciality areas must have
courses in specialities. Promotion opportunities for
clinical specialities like administrative posts are
considered for improving quality nursing services.

 The committee recommends that Gazetted ranks

be allowed for nurses working as ward sister and
above (minimum class II gazetted). Similarly the
post of Health Supervisor (female) is allowed
gazetted rank and district public health nurse be
given the status equal to district medical/ health
officers.

Community Nursing
Services

Appointment of ANM/LHV to be recommended.

1 ANMfor 2500 population (2 per sub centre)
1 ANM for 1500 populationfor hilly areas
1 health supervisorfor7500 population (for
supervision of 3 ANM's)
1 public health nursefor 1 PHC (30000 population
to supervise 4 Health Supervisors)
1 Public Health Nursing Officer for 100000
population (community health centre)
2 district public health nursing for each district.

Norms recommended for nursing

service and education in hospital
setting.
1. Nursing Superintendent -1: 200 beds (hospitals with
200 or more beds).
2. Deputy Nursing Superintendent. - 1: 300 beds
( wherever beds are over 200)
3. Assistant Nursing Superintendent - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave
reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30%
leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients
( 1 bed : 5 out patients) 30% leave reserve
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialized departments such as operation theatre,
labour room etc- 1: 25 30% leave reserve.

INDIAN NURSING
COUNCIL (INC)
The Indian Nursing Council is an Autonomous
Body under the Government of India and was
constituted by the Central Government under the
Indian Nursing Council Act, 1947 of parliament.
It was established in 1949 for the purpose of
providing uniform standards in nursing education
and reciprocity in nursing registration throughout
the country.
Nurses registered in one state were not registered
in another state before this time.
The condition of mutual recognition by the state
nurses registration councils, called reciprocity was
possibly only if uniform standards of nursing
education were maintained.

Staff

Sister( Departmental

nurse

each

assistant

1:3

shift)
1:25

superintendent
1 for 3-4 weeks

Surgical ward 1:3

1:25

1 for 3-4 weeks

Orthopedic

1:3

1:25

1 for 3-4 weeks

ward
Pediatric

1:3

1:25

1 for 3-4 weeks

ward
Gynecology

1:3

1:25

1 for 3-4 weeks

ward
Maternity

1:3

1:25

1 for 3-4 weeks

Medical ward

ward

including

newborns

sister/
nursing

ICU

1:1(24

CCU

hours)
1:1(24

Nephrology

hours)
1:1(24

hours)

department

sister/assistant

nursing

superintendent for 3-4 units

Neurology

& 1:1(24

and

hours)

neurosurgery
Special wards- 1:1(24
eye, ENT etc.
Operation

hours)
3
for

theatre

hours

Casuality

clubbed together

table
and 2-3

24 1
per
staff 1

department

sister/asst

nursing superintendent for

4-5 operating rooms
1
department

Staffing pattern according to the

Indian Nursing Council (relaxed till
2012)

Collegiate programme-A
Qualifications and experience of teachers of college of nursing1. Professor-cum-Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years of teaching
experience
2. Professor-cum- Vice Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years in teaching
3. Reader/Associate Professor
-Masters Degree in Nursing
Total 7 years of experience with minimum of 3 years in teaching
4. Lecturer
Masters Degree in Nursing with 3 years of experience.
5. Tutor/Clinical Instructor
M.Sc.(N) or B.Sc. (N) with 1 year experience or Basic B.Sc. (N) with
post basic diploma in clinical specialty

For B.Sc and M.Sc

nursing:
Annual intake of 60 students for B.Sc (N) and 25 for M.Sc (N) programme

B.Sc (N)
M.Sc (N)
Professor cum 1

principal
Professor cum 1

vice principal
Reader/Associ

Lecturer

Tutor/clinical

19

24

ate professor

instructor
Total

 GNM and B.Sc. (N) with 60 annual intake in each

programme
Professor cum principal 1
Professor cum vice principal 1
Reader/Associate professor 1
Lecturer 4
Tutor/clinical instructor
35

Total 42

Basic B.Sc (N)

Admission capacity
Annual intake 40-60 61-100
Professor cum principal 1 1
Professor cum vice principal 1 1
Reader/Associate professor 1 1
Lecturer 2 4
Tutor/clinical instructor
19 33
Total 24 40

 Teacher student ratio= 1:10

(All nursing faculty
including Principal and Vice principal)
Two M.Sc (N) qualified teaching faculty to start
college of nursing for proposed less than or equal
to 60 students and 4 M.Sc (N) qualified teaching
faculty for proposed 61 to 100 students and by
fourth year they should have 5 and 7 M.Sc (N)
qualified teaching faculty respectively, preferably
with one in each specialty.

Part time teachers and external teachers:

1. Microbiology
2. Bio-chemistry
3. Sociology.
4. Bio-physic
5. Psychology
6.
Nutrition
7. English
8. Computer
9. Hindi/Any other language
10.Any other- clinical discipliners
11.Physical education

School of nursing-B
Qualification of teaching staff 1. Professor cum principal M.Sc. (N) with 3
years of teaching experience or B.Sc.(N) basic or
post basic with 5 years of teaching experience.
2. Professor cum vice principal M.Sc. (N) or B.Sc.
(N) (Basic)/Post basic with 3 years of teaching
experience.
3. Tutor/clinical instructor
M.Sc. (N) or B.Sc. (N)
(Basic) / Post basic or diploma in nursing
education and Administration with two years of
professional experience.

 For School of nursing with 60 students i.e. an

annual intake of 20 students:
Teaching faculty
No. required
Principal 1
Vice-principal 1
Tutor 4
Additional tutor for interns
1

Total 7
Teacher student ratio should be 1:10 for student
sanctioned strength.

ESTIMATION OF
NURSING STAFF
REQUIREMENTS

Patient Care Classification

System
The patient care classification system is a method
of grouping patients according to the amount and
complexity of their nursing care requirements and
the nursing time and skill they require.
This assessment can serve in determining the
amount of nursing care required, generally within
24 hours, as well as the category of nursing
personnel who should provide that care.
As a result, of patient classification systems (PCS),
also known as workload management, or patient
acuity tools, were developed in the 1960s

TYPES
The critical indicator PCS
uses broad indicators such as bathing, diet,
intravenous fluids and medications, and
positioning to categorize patient care activities.
The summative task type
requires the nurse to note for frequency of
occurrence of specific activities, treatments, and
procedures for each patient

 To develop a workable patient classification

system, the nurse manager must determine the
following:
1. The number of categories into which the
patients should be divided;
2. The characteristics of patients in each
category;
3. The type and number of care procedures that
will be needed by a typical patient in each
category; and
4. 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 take a bath on his own, feed himself,
feed and perform his activities of daily living.
Falling under this category are patients about to
be discharged, those in non-emergency, those
newly admitted, do not exhibit unusual
symptoms, and requires little
treatment/observation and/or instruction.
Average amount of nursing care hours per patient
per day is 1.5.
Ratio of professional and non-professional nursing
personnel is 55:45.

 Level II
Moderate Care or Intermediate Care
Patients under this level need some assistance
in bathing, feeding, or ambulating for short
periods of time. Extreme symptoms of their illness
must have subsided of have not yet appeared.
Patients may have slight emotional needs, with
vital signs ordered up to three times per shift,
intravenous fluids or blood transfusion; are semiconscious and exhibiting some psychosocial or
social problems; periodic and treatments, and/or
observations and/or instructions.
Average nursing care hours per patient per day is
3 and the ratio of professional to non-professional
personnel is 60:40.

 Level III
Total, Complete or Intensive Care
Patients under this category are completely
dependent upon the nursing personnel.
They are provided complete bath, are fed, may or
may not be unconscious, with marked emotional
needs, with vital signs more than three times per
shift, may be on continuous oxygen therapy, and
with chest or abdominal tubes.
They require close observation at least every 30
minutes for impending hemorrhage, with hypo or
hypertension and/or cardiac arrhythmia.
The nursing care hours per patient per day is 6
with a professional to non-professional ratio of

 Level IV
Highly Specialized Critical Care
Patients under this level need maximum nursing
care with a ratio of 80 professionals to 20 nonprofessionals.
Patients need continuous treatment and
observation; with many medications, IV piggy
backs; vital signs every 15-30 minutes; hourly
output.
There are significant changes in doctors orders
and care hours per patient per day may range
from 6-9 more, and the ratio of professionals to
non-professionals also ranges from 70:30 to
80:20.

Categories or levels of care of patients, nursing care hours

needed per patient per day and ratio of professionals to nonprofessionals

Level I1.50 55:45

Self Care or Minimal Care
Level II 3.060:40
Moderate or Intermediate Care
Level III 4.565:35
Total or Intensive Care
Level IV 6.0
70:30
Highly Specialized or Critical Care
80:20

7 or higher

Nursing care hours per patient per day according to

classification of patients by units.
Cases/Patients

NCH/Pt/day

Prof. to Non Prof.

General 3.5

Ratio
60:40

Medicine
2. Medical

3.4

60:40

3. Surgical

3.4

60:40

4. Obstetrics

3.0

60:40

5. Pediatrics

4.6

70:30

Pathologic 2.8

55:45

1.

6.

Nursery
7. ER/ICU/RR

6.0

70:30

8. CCU

6.0

80:20

Percentage of patients at various

levels of care per type of hospital

Percentage of Patients in Various Levels of Care

Type of Hospital

Minimal Care

Moderate Care

Intensive Care

Highly Spl. Care

Primary Hospital

70

25

Secondary Hospital

65

30

Tertiary Hospital

30

45

15

10

Tertiary 10

25

45

20

Spl.

Hospital

Computing for the

Number of Nursing
Personnel
Needed
The Forty-Hour Week
Law (Republic Act 5901),
provides that employees working in hospitals with
100-bed capacity and up will work only 40 hours a
week.
This also applies to employees working in
agencies with at least one million population.
Employees working in agencies with less than one
hundred-bed capacity or in agencies located in
communities with less than one million population
will work forty-eight hours a week and therefore
will get only one off-duty a week.

 There are also benefits that have to be enjoyed by

each personnel regardless of the working hours
per week.
The latest is the granting of the three-day special
privilege to government employees by the Civil
Service Commission as per Memorandum Circular
No. 6, series of 1996,
which may be spent for birthdays, weddings,
anniversaries, funerals (mourning), relocation,
enrollment or graduation leave, hospitalization,
and accident leaves.

Total number of working and nonworking days and hours of nursing

personnel per year

Rights

and

Privileges

Given Working Hours Per Week

Each Personnel
Per Year

40 Hours

48 Hours

a) 1. Vacation Leave

15

15

2. Sick Leave

15

15

3. Legal Holidays

10

10

4. Special Holidays

5. Special Privileges

6. Off-Duties as per R.A. 5901

104

52

7.

Continuing

Education 3

Program

Total

Non-Working

______
Days

3
______

Per 152

100

Year
Total Working Days Per Year

213

265

Total Working Hours Per Year

1,704

2,120

 Relievers Needed

To compute for relievers needed, the following

should be considered:
1. Average number of leaves taken each year - - - - - 15
a. Vacation Leave - - - - - - - - - - - - - - - - - - - - - - 10
b. Sick Leave - - - - - - - - - - - - - - - - - - - - - - - - - - 5
2. Holidays - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 12
3. Special Privileges as per CSC MC#6 s.1996 - - - - - -3
4. Continuing Education Program for Professionals

 To determine the relievers needed,

divide 33 (the average number of working days an
employee is absent per year) by the number of
working days per year that each employee serves
(whether 213 or 265).
This will be 0.15 per person who works 40 hours
per week and 0.12 per person for those working
48 hours per week.
Multiply the computed reliever per person by the
computed number of nursing personnel. This will
give the total number of relievers needed.

Distribution by Shifts
Studies have shown that the morning or day shift
needs the most number of nursing personnel at
45 to 51 percent;
for the afternoon shift 34 to 37 percent; and for
the night shift 15 to 18 percent.
In the Philippines the distribution usually followed
is 45 percent for the morning shift, 37 percent for
the afternoon shift, and 18 shift for the night shifts

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
2. Find the total number of nursing care hours
needed by the patients at each category level.
a. Find the number of patients at each level by
the average number of nursing care hours needed
per day.
b. Get the sum of the nursing care hours needed
at the various levels.

Staffing Formula
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.
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.
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

 c. Add the number of relievers to the number of

nursing personnel needed.
6. Categorize the nursing personnel into
professionals and non-professionals. Multiply the
number of nursing personnel according to the
ratio of professionals to non-professionals.
7. Distribute by shifts

Find the number of nursing personnel needed for

500 patients in a tertiary hospital

1. Categorize the patients according to level of

care needed.

500 (pts) x .30 = 150

patients needing
minimal care

500 (pts) x .45 = 225

patients needing
moderate care

500 (pts) x .15 = 75

patients need
intensive care

500 (pts) x .10 = 50 patients need highly

specialized nursing care

500

 2. Find the number of nursing care hours (NCH)

needed by patients at each level of care per day.

150 pts x 1.5 (NCH needed at Level I)

=
225 NCH/day

225.5 pts x 3 (NCH needed at Level II)

=
675 NCH/day

75 pts x 4.5 (NCH needed at Level III)

=
337.5 NCH/day

50 pts x 6 (NCH needed at Level IV)

=
300 NCH/day

Total
1537.5 NCH/day

 3. Find the total NCH needed by 500 patients per

year.
1537.5 x 365 (days/year) = 561,187.50 NCH/year

 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. Total NCH per year = 561,187.50 = 329
Working hrs/year
1,704
b. Relief x Total Nursing Personnel = 329 x 0.15 =
49
c. Total Nursing Personnel needed
329 + 49 =
378

 6. Categorize to professional and nonprofessional personnel. Ratio of professionals to

non-professionals in a tertiary hospital is 65:35.
378 x .65 = 246 professional nurses
378 x .35 = 132 nursing attendants

7. Distribute by shifts.
246 nurses x .45 = 111 nurses on AM shift
246 nurses x .37 =
91 nurses on PM shift
246 nurses x .18 = _ 44 _nurses on night shift
Total
246 nurses
132 Nursing attendants x .45 =
59 Nursing
attendants on AM shift

132 Nursing attendants x .37 =

49 Nursing
attendants on PM shift

132 Nursing attendants x .18 = _ 24 _Nursing

attendants on night shift

Total
132 Nursing
Attendants

 It should be noted that the above personnel are

only for the in-patients. Therefore, additional
personnel should be hired for those in supervisory
and administrative positions and for those in
special units such as the Operating Room, the
Delivery Room, the Emergency Room, and OutPatient Department.

A Head Nurse is provided for every nursing

unit. Likewise, a Nursing Superior is provided 1) to
cover every shift in each clinical department or
area specialty unit; 2) for each geographical area
in hospitals beyond one hundred (100) beds and;
3) for each functional area such as Training,
Research, Infection Control, and Locality
Management.

TYPES OF STAFFING
CENTRALISE
D

TOP LEVEL
MANAGERS

DECENTRALI
SED

WARD
SISTERS

CENTRALISED
Advantages:
The managers role is limited to making minor
adjustments and providing input.
The manager continues to have ultimate
responsibility for seeing that adequate personnel are
available to meet the needs of the organization.
It is fairer to all employees because policies tend to
be employed more consistently and impartially.
It allows for the most efficient (cost effective) use of
resources since the more units that can be considered
together, the easier it is to deal with variations in
patient census and staffing needs.

 Disadvantages:
It does not provide as much flexibility for the
worker, nor can it account as well for a workers
desires or special needs.
Managers may be less responsive to personnel
budget control if they have limited responsibility
in scheduling and staffing matters.

DECENTRALISED
Advantages:
The unit manager understands the needs of the
unit and staff intimately, which leads to increased
likelihood that sound staffing decisions will be
made.
The staff feels more in control of their work
environment because they are able to take
personal scheduling requests directly to their
immediate supervisor.
It leads to increased autonomy and flexibility,
thus, decreasing nurse attrition.

 Disadvantages:
It carries the risk that employees will be treated
unequally or inconsistently.
The manager may be viewed as granting rewards
or punishments through the staffing schedule.
It is time consuming for the manager and often
promotes more special pleading than
centralized staffing.
The major difficulty is ensuring high-quality
staffing decisions throughout the organization.

Staff self-scheduling
It was developed in 1960s where it allowed nurses
in a unit to work together to construct their own
schedules rather than have schedules created by
management.
Employees are typically given four to six week
schedule worksheets to fill out several weeks in
advance of when the schedule is to begin.
These employees typically have one to two weeks
to fill in the blanks on the schedule, following
whatever guidelines or requirements are set by
the management (i.e., number of weekend shifts
that must be worked, maximum number of
consecutive shifts) (Hung, 2002).
The nurse-manager then reviews the worksheet to
make sure all the guidelines or requirements have

 Use of supplemental staffing from outside registries and

float pools
Agency nurses or travel nurses are usually directly
employed by an external broker and work for premium pay
(2-3 times that of regularly employed staff), without
benefits.
While such staff provide scheduling relief, especially in
response to unanticipated increases in census or patient
acuity, their continuous use is expensive and can result in
poor continuity of care.
Some hospitals have created their own internal
supplemental staff by hiring per-diem employees and
creating float pools.
Per-diem staff generally has flexibility to choose if and when
they want to work. In exchange for this flexibility, they
receive higher rate of pay, but usually no benefits.

Ethical Accountability for

Staffing
The manager has ethical accountability both to patients
and staff. Their needs should be met.
Regardless of the difficulties inherent in PCSs and the
assignment of nursing care hours, they remain a method for
controlling the staffing function of management.
As long as managers realize that all systems have
weaknesses and as long as they periodically evaluate the
system, managers will be able to initiate the needed change.
It is critical, however, for managers to make every effort
to base unit staffing on their organizations patient
classification system.
It is important for managers to use staff to provide safe
and effective care economically.
Managers must increase staffing when patient acuity rises
as well as decrease staffing when acuity is low; to do
otherwise is demoralizing to the staff.

 Shift staffing based on patient acuity system does, however,

allow for more consistent staffing and is better able to identify
overstaffing and understaffing on a more timely basis.
o This is a fairer method of allocating staff.
o The disadvantage of shift-based staffing is that it is timeconsuming and somewhat subjective, because acuity or
classification systems leave much to be determined by the person
assigning the acuity levels.
o The greater the degree of objectivity and accuracy in any
system, the longer time required to make staffing computations.
Perhaps the greatest danger in staffing by acuity is that many
organizations are unable to supply the extra staff when the
system shows unit understaffing. However, the same organization
may use the acuity-based staffing system to justify reducing staff
on an overstaffed unit. Therefore, a staffing classification system
can be demotivating if used inconsistently or incorrectly.

 Employees have the right to expect a reasonable

workload. Managers must ensure that adequate staffing
exists to meet the needs of staff and patients.
Managers who constantly expect employees to work
extra shifts, stay overtime and carry unreasonable
patient assignments are not being ethically accountable.
Effective managers, however, do not focus totally on
numbers of personnel, but look at all components of
productivity; they examine nursing duties, job
descriptions, patient care organization, staffing mix, and
staff competencies.
Management must work just as hard as the staff in
meeting patient needs; and that the organizations
overriding philosophy is based on patient interest and
not on financial gain.

STAFFING POLICIES
. Personnel policy is one of the policies in the
organization which lays down decision making
criteria in line with overall purposes in the area of
man power planning.

FORMULATION OF
PERSONNEL POLICIES:

APPRAISING
APPRAISING
THE
THE POLICY
POLICY::

COMMUNIC
COMMUNIC
ATING
ATING OF
OF
THE
THE POLICY
POLICY

FACT
FACT
FINDING:
FINDING:

ADOPTING
ADOPTING AND
AND
LAUNCHING
LAUNCHING THE
THE
POLICY
POLICY

DISCUSS
DISCUSS THE
THE
PROPOSED
PROPOSED
POLICY
POLICY

REPORTING
REPORTING
OF
OF THE
THE
PROPOSED
PROPOSED
POLICY
POLICY

WRITING
WRITING

THE
THE
PROPOSED
PROPOSED
POLICY
POLICY

FACTORS INFLUENCING
PERSONNEL POLICIES:

Law of the country

Social values and customs
Management philosophy and values
Stage of development
Financial position of the firm
Union objectives and practices
Type of work force.

CONTENTS OF
PERSONNEL POLICY

EMPLOYMENT
Minimum requirement of qualifications for the job
Source of recruitment
Selection of devices such as tests and interviews.
DEVELOPMENT
Induction, transfer, promotions.
Bases and types of training.
Executives and workers development programmes.
COMPENSATION
Equitable and adequate remuneration.
Non-monetary rewards.
Profit sharing and incentive plans.
Bonus.

INTEGRATION
Efficient system of communication
Handling of grievances.
Recognition of labor unions.
Workers participation in management.
WORKING CONDITION AND MOTIVATION
Welfare measures for health, safety and high
morale.
Safety programmes.
Welfare services like canteen, rest room,
recreational activities, insurance etc.
Financial and non -financial rewards for
motivation.

CHARACERISTICS OF
PERSONNEL POLICIES
They should present the principle that will
guide the organizations actions and reflect a faith
in the ethical value of employees.
They should be stated in the broadest possible
terms so as to serve as a guide in practice now
and in future.
They should be formulated after taking the
long range plans and needs of the organization.
They should be flexible to cover a normal
range of activities

CHARACERISTICS OF
PERSONNEL POLICIES
They should be stable to preclude excessive
alterations.
They must be developed with the active
participation of management and employees.
They should be definite so that it is easy to
understand.
They should be communicated in writing so as
to remove any confusion

ADVANTAGES OF
PERSONNEL POLICY
Helps managers at various levels of decision
centers to act with confidence without the need for
consulting superiors every time.
Ensures prompt action for taking decision within
the overall framework of the objectives of the
organization whenever any situation arises.
Provide a rational and continuous system of
achieving results through better control.
Clearly lay down and liberates the management
from their personnel biases and self- interest.
Ensures long term welfare of employees and make
good relation between management and workers.
Makes the employees aware of where they stand
in the organization and creates confidence in them.

ROLES AND FUNCTIONS

OF NURSE MANAGERS

PRE EMPLOYMENT
ROLES
Plans for future needs proactively.
Predicts the future by being knowledgeable regarding
current and historical staffing events.
Identifies and recruits gifted individuals to the
organization.
Serves as a role model for recruitment.
Is self-aware regarding personal biases during pre
-employment process.
Uses interview process as a means to promote the
organizational image.
Assigns new personnel to positions that facilitate
success.

 FUNCTIONS:
Ensures that there is adequate skilled work force
to meet the goals of the organization.
Shares responsibilities for the recruitment of staff.
Plans and structures appropriate interview
activities.
Uses techniques that increase the validity and
reliability of selection process.

INDOCTRINATION
ROLES:
He or she is expected to :
Periodically review induction and orientation program to
ascertain that they are meeting the unit needs.
Generates enthusiasm in employees in meeting
organizational goals.
Serves as role model.
Encourages mentorship
Supervision and correction.
Supports employees having problems with
resocialization.
Assist employees in developing personal strategies to
cope with role transition.