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ESTIMATING OF NURSING STAFFREQUIREMENT – Activity Analysis PRESENTED BY MRS HEENA MEHTA S. Y. M.Sc. Nursing
INTRODUCTION• Staffing is one of the major problems of any nursing organizations whether it to be a hospital, home health care agency, or another type of facility.• Nurse staffing methodology should be an orderly, systematic process, based upon sound rationale, applied to determine the number and kind of nursing personnel required to provide the nursing care as per the standards of nursing practice to a group of patients in a particular sense.
INTRODUCTION• The end results is the prediction of the kind and number of staff required to give care of patients. In practice the terms staffing and scheduling are sometimes used interchangeably.• Although they are closely related as the two sides of a coin there are practical differences as follows:
INTRODUCTION• Staffing is determining how many people of what specific skills are needed and make them available• Scheduling is determining who, by name and skill , will do what work and when (specific time period)
MEANING• Staffing as largely a part of organizing, establishing the framework within which the work will get done, while scheduling is essentially a refined component of planning.• The concept of good staffing determines and provides the acceptable number of personnel to produce a desired level of care to meet the patient’s demand of care
MEANING• When the demand of patients needs increases or decreases in a ward. It is necessary to reassign nurses to balance the staff as per needs.• The dynamic staffing and allocation process is accomplished by taking staff from one ward to another or by posting extra nurses on relieving duty.
• Allocation provides information to adjust the scheduled staff to meet daily workload demand of each unit.• This component is concerned with the balancing of staff to fluctuation of work load among similar nursing units through personnel allocation and selective patient’s placement.
ALLOCATION• Appropriate selection of staff in the departments according to their capabilities would help nurses to provide efficient nursing care to the patient.
Objectives of Allocation Procedure• The objectives of allocation procedure is to reassign working days and days off to nursing staff so that:• To provide quality patient care• To avoid over staffing or under staffing in a unit and• To facilitate a desirable distribution of day off for nursing personnel
Criteria for Effective Staffing Procedure• An effective allocation procedure meets the following criteria:• Coverage: the number of nurses assigned to be on duty should be in relation to the minimum number of nurses required• Quality: the total number of patient care should be planned in such a way that trained nurses are available for patient care of 24 hours a day. It should also cover off days on rotation.
Criteria for Effective Staffing Procedure• Stability: allocation procedure must be consistent with leave and rotation policy. Each nurse must know her off, privileged leave etc.• Flexibility: the allocation policy must provide for flexibility e.g., if a request for days off or leave comes as emergency, that should be taken care of.• Objectives: there should be fairness in allocation and scheduling shift duties
Allocation procedure• Patient’s classification system does not measure the amount of care required by patients.• However the category of patient fails within the unit can be correlated with the total amount of nursing care required by that patient.• The result of patient classification and measurement of nursing services provided are combined to obtain the hours and minutes of direct patient care for each class of patient for each shift during the period of observation
Allocation procedure• The total minutes or hours of care for any population of patients in unit can be arriving at the services required for the given number of patients. The estimated workload is presented in terms of the total amount of care required.• A workload sheet is used to calculate the mean number of nursing hours required in that unit.• Various methods are adopted to classify the patients and to assess nursing hours needed by per day by each category of patients.
• Following is an example of nursing care conducted by college of nursing, Delhi and T.N.A.I.. Accordingly patients are classified under 3 categories:• Completely dependent• Partially dependent• Ambulatory
Allocation procedureGoddard’s classified the patient’s dependency into 5 categories:• Totally ambulant• Partially bed fast• Bed fast but not helpless• Partially helpless• Totally helpless
Another classification system presented by E.A. Schmied• A patient who requires only minimal amount of nursing care (an average of 2.8 nursing hours per 24 hours)• A patient who requires average amount of nursing care (an average of 4.3 nursing hours per 24 hours)• A patient who requires above average nursing care (an average of 5.6 nursing hours per 24 hours)• A patient who requires maximum nursing care (an average of 8.6 nursing hours per 24 hours)
• According to the study conducted in college of nursing, Delhi, the nursing hours needed by per category of patient in 24 hours assessed as given below: Category of Morning Shift Evening Shift Night Shift Total Patient I Completely 3.27 2.50 1.47 7.24 Dependent II Partially 1.62 0.91 0.55 3.08 Dependent III Ambulatory 1.20 0.70 0.17 2.07 6.09 4.11 2.10 12.29
• Now, we will learn how to allocate nurses in each unit. Suppose a ward having 30 patients in which 10 patients are ambulatory, 15 patient’s partially dependent and 5 patients are completely dependent.• There are 3 equal hours shift duty and we need to allocate nurses for 24 hours. We know work load as well as classification of patients. It is very simple to calculate. The following table is self explanatory to the known method of calculation:
Category of Daily average Total patient Calculation per Totalpatient time per patient category of in 24 hours patientI 7.24 5 7. 24 ×5 36.20 CompletelydependentII 3.08 15 3.08 × 15 46.20PartiallydependentIII 2.07 10 2.07 × 10 20.70AmbulatorypatientTotal work load for 30 patients = 103 hours 103.10 hours
• Each nurse is expected to work = 8 Hrs/ day• Total number of Nurses required = 103/8 = 13• = 13 nurses approximately• Provision of day off, Casual leave, Earned leave and other permitted Gazetted about 116 days/year. To meet leave vacancies extra nurses required;• = 116/365 ×103/8• = 4.09 nurses• Total nurses required = 13 + 4 = 17 Nurses.
• When we know the total number of allocation we must also know to calculate the number of nurses required in each shift.• We have already been acquainted with nursing hours requirement per patient per category per shift.• We have 30 patients and we have 17 nurses at our disposal. Let us learn the calculation from the given below:
Category of patient Morning shift Evening shift Night shift nursing nursing hours nursing hours hoursI 5 completely 3.27 ×5 = 16.35 2.5×5=12.50 1.45×5=7.25dependentII 15 Partially 1.62×15 = 24.30 0.91×15 = 13.65 0.56 ×15= 8.40dependent patientsIII 10 Ambulatory 1.2×10 = 12.00 0.7×10 = 7 0.17 ×10 = 1.70Total Nursing units 52.65 33.15 17.35time in each shiftHrs Total = 103.15 Hours
• Staff requirement in each shift according to workload in each shift• Staff in morning shift = 52.65 ×13/103.15= 7• Staff in evening shift = 33.15 ×13/103.15 = 4• Staff in night shift = 13 – (7+4) = 2• So we have to allocate 7 nurses in morning shift, 4 in evening and 2 in nigh shift
CONCLUSION• In the above method we have seen that in order to allocate nurse in each unit, we have acquainted with several approaches. The first approach is an empirical approach in which the supervisor or head nurse requests a certain number of personnel according to how many nurses she thinks are necessary to perform the work in that unit. This approach does not provide a ratio of professional to non- professional persons.
• A second approach is based on the nursing hours required by each category of personnel in each shift in 24 hours. Nursing care hours are based on total number of patients in each category. Again no set standard for nursing hours are available
• Activity analysis or task analysis of each person and how long he does each task is another approach to allocate nurses. A work load index is used as an approach for allocation of nurses in wards, This is based on a realistic evaluation of patient care requirements:
• The ward sisters must send census report of their unit daily to nurse administrator along with the types of patients admitted in their unit. It gives an idea of census fluctuations, patient classification problems, in appropriate staffing in that unit and other variances. It gives a clue for forecasting need of nursing personnel monthly and yearly
BIBLIOGRAPHY• Koontz H, Weihrich H . Essentials of management an international perspective. (Ist edn). New Delhi: Tata Mc Graw Hill publishers; 2007.• Koontz H, Weihrich H. Management a global perspective. 1st edn. New Delhi: Tata Mc. Graw Hill publishers;2001.
• Beyers Marjorie. Nurse executives’ perspectives on succession planning. JONA. Vol 36. June 2006.• Berkow S, Jaggi J& Fogelson R. Fourteen unit attributes to guide staffing. JONA.vol 37, no.3 mar 2007.• Basavanthappa BT. Nursing administration. 1st edn. New Delhi: Jaypee brothers medical publishers (p) ltd; 2000.• Wise PS. Leading and managing in nursing. 1st edn. Philadelphia: Mosby publications; 1995