3. • Is the process of determining and
providing the acceptable number and mix
of nursing personnel to produce a desired
level of care to meet the patient’s demand.
• Purpose: to provide each nursing unit
with an appropriate and acceptable
number of workers in each category to
perform the nursing tasks required.
5. • 1. The type, philosophy and objectives of
the hospital and the nursing service
• 2. the population served or the kind of
patients served whether pay or charity
• 3. the number of patients and severity of
their illness-knowledge and ability of
nursing personnel are matched with the
actual care needs of patients
6. • 4. Availability and characteristics of the
nursing staff, including education, level
of preparation, mix of personnel,
number and position:
• 5. administrative policies such as rotation,
weekends and holiday off-duties
• 6. standards of care desired which should
be available and clearly spelled out.
7. Patient Care Classification System
• It 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.
• Purpose:
• 1. Serve in determining the amount of nursing
care required, generally within 24 hours.
• 2. to determine the category of nursing
personnel who should provide that
care.
8. Nursing Care hours per patient/day
according to classification of patients
per units
Cases/Patients NCH/Pt/Day Prof to Non Prof
Ratio
1. General Medicine 3.5 60:40
2. Medical 3.4 60:40
3. Surgical 3.4 60:40
4. Obstetrics 3.0 60:40
5. Pediatrics 4.6 70:30
6. Pathologic Nursery 2.8 55:45
7. ER/ICU/RR 6.0 70:30
8. CCU 6.0 80:20
9. Classification Categories
Level I-Self
Care or
Minimal Care
-NCH
1.5/pt/day
- Ratio 55:45
-Can take a bath on his own; feed himself; perform his
own ADL.
-For discharge pt; non-emergency, newly admitted
don’t exhibit unusual s/s;
- requires little treatment and observation
Level II –
Moderate
Care or
Intermediate
Care
-NCH 3/pt
- Ratio 60:40
-Need some assistance in bathing, feeding, ambulating
for short period.
-Extreme s/s of illness must have subsided or have not
yet appeared
-May have slight emotional needs
-v/s taking ordered 3x/shift; with IVF/BT; are semi-
conscious and exhibiting some psychosocial or social
problems;
- periodic treatments and/or observations and
/instructions
10. Level III –
Total,
Complete or
Intensive
Care
-NCM
6hrs/pt/day
-Ratio 65:35
-Patient 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 v/s
monitoring more than 3x/shift
-Maybe on continuous oxygen therapy,
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
11. Level IV-
Highly
Specialized
Critical Care
-NCH 6-9 or
more /pt/day
- Ratio 70:30
or 80:20
-Need maximum level of nursing care
with a ratio of 80 professionals to 20
non-professionals.
-Needs continuous treatment and
observation
-With many medications, IV piggy
backs; v/s monitoring every 15-30
minutes; hourly output.
-There are significant changes in
doctor’s orders
12. Categories of Level of Care of Patients: Nursing Care
Hours/Pt/Day & Ratio of Prof-Non Prof
Levels of Care NCH Needed Per
Pt./Day
Ratio of Prof to
Non-Prof
Level I – Self-Care
or Minimal Care
1.50 5:45
Level II Moderate
or Intermediate
Care
3.0 60:40
Level II Total or
Intensive Care
4.5 65:35
Level IV Highly
Specialized or
Critical Care
6.0
7 or higher
70:30
80:20
13. Percentage of patients at various levels of care
per type of hospital
Type of Hospital Minimal
Care
Moderate
Care
Intensive
Care
Highly
Spl. Care
Primary Hospital 70 25 5 -
Secondary Hospital 65 30 5 -
Tertiary Hospital 30 45 15 10
Special Tertiary
Hospital
10 25 45 20
14. Distribution by Shifts
Morning or day shift 45 to 51 percent.
Afternoon shift 34 to 37 percent
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.
16. Total No. working-Non working days & hours of
nursing personnel per year
Rights & Privileges Given Each
Personnel Per Year
Working Hours Per Week
40 hours 48 hours
1. Vacation Leave
2. Sick Leave
3. Legal Holidays
4. Special Holidays
5. Special Privileges
6. Off-Duties as per R.A. 5901
7. Continuing Education Program
Total Non-working Days per
year
Total working days per year
Total working hours per year
15
15
10
2
3
104
3
152
213
1,704
15
15
10
2
3
52
3
100
265
2,120
17. Staffing Formula
To illustrate: Find the number of nursing according
to levels of care needed.
1. Categorize the patients according to levels of
care needed
250 pts x 0.30 = 75 pts needing minimal care
250 pts x 0.45 = 112.5 pts needing moderate
care
250 pts x 0.15 = 37.5 pts needed intensive
care
250 pts x 0.01 = 25 pts need highly specialized
250 nsg care
18. 2. 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 MCH/day
112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day
37.5 pts x 4.5 (NCH needed at Level II) = 168.75 NCH/day
25 pts x 6 (NCH needed at Level IV) = 150 NCH/day
Total 768.75 NCH/day
3. Find the total NCH needed by 250 patients per year.
768.75 x 365 (days/yr) = 280,593.75 NCH/year
19. • 4. 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 = 280,593.75 = 165
• Working hrs/year 1,704
• b. relief x total nsg. Personnel = 165 x 0.15 = 25
• c. total nursing personnel needed 165 + 25 = 190
20. • 6. Categorize to professional and non-professional personnel
ratio of prof to non-prof in a tertiary hospital is 65:35
• 190 x .65 = 134 professional nurses
• 190 x .35 = 66 nursing attendants
• 7. Distribute by 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 attendents x .18 = 12 nursing attendants on night shift
Total = 66 nursing attendants
29. Eight hour shift in a five day workweek
5-day, 40-hours workweek
30. Ten hour shift in Four day workweek
The main problem was fatigue. The long
weekends and off were attractions. There
is time to finish work, peak work loads can
be covered, and there is decreased
overtime and decreased costs.
31. Twelve-hour shift in seven day workweek
The better use of personnel lower staffing
requirements; this consequently lowers the cost
per patient day.
32. Activity:
1. Categorize the patients according to levels of care needed.
2. Find the number of nursing care hours (NCH) needed by patients at each
level of care per day.
3. Find the total NCH needed by 500 patients per year.
4. Find the actual working hours rendered by each nursing personnel per
year.
5. Find the total number of nursing personnel needed.
Total NCH per year
Working hrs/year
b. relief x total nsg. Personnel
c. total nursing personnel needed
33. • 6. Categorize to professional and non-professional personnel
ratio of prof to non-prof in a tertiary hospital is 65:35
• 7. Distribute by shifts
