The document discusses staffing in healthcare organizations. It defines staffing and outlines its objectives, which include recruiting competent staff, retaining the right number of staff, and providing training. It also discusses patient classification systems, which group patients according to care needs to help determine staffing requirements. Nurse-patient ratios from different standards are presented for units like general wards, ICUs and ERs. The importance of effective scheduling is highlighted to ensure coverage, continuity of care, flexibility, stability and cost-effectiveness. Different scheduling methods like 10-hour shifts, 12-hour shifts and weekend scheduling alternatives are also outlined.

1. STAFFING
C.Lalramdini
Asst. Prof.
CON, RIPANS

2. DEFINITION
⊳ Staffing may be defined as implementing, planning,
providing, employment and developing human
resources at different grades in institution on order
to implement various complex institutional
activities and fulfil the goals of management.
2

3. According to Koontz and O’ Donnel
⊳ “The managerial functions of staffing involves
manning the organizational structure through proper
and effective selection, appraisal and development of
personnel to fill the roles designed in to the structure”
3

4. Mission of staffing
1) To ensure maximum utilization of resources
2) To discover and obtain competent personnel for various jobs.
3) To ensure the continuity and growth of the enterprise through
adequate staffing.
4)To improve job satisfaction and morale of the employees.
5)To be able to meet crisis/emergency situation.
6)To deliver good quality of care and attain job satisfaction and patient
satisfaction.
4

5. Objectives of Staffing
⊳ To recruit adequate number of human power resources to attain the
goals of management.
⊳ To carry out the managerial functions such as planning, directing and
controlling the organization by recruiting adequate human resources.
⊳ To recruit competent staff.
⊳ To retain right number of staff and utilize their ability to the
maximum.
 To provide training programme to strengthen personnel skills and
abilities of the staff.
⊳ To ensure adequate staffing .
5

6. Philosophy of staffing: The nurse administrator believes that:
⊳ The knowledge and skills of the staff can adequately fulfil
the needs of the patient and thereby ensure both job
satisfaction and quality care.
⊳ Only professionally trained nurse can provide a high
quality of patient care and handle critically ill patients by
providing both technical and interpersonal skills.
⊳ A professional nurse can, not only treat chronically ill
patients, but also provide health education and
rehabilitative care, which is more complex.
6

7. Philosophy of staffing:The nurse administrator believes that:
⊳ By determining patient needs and doing assignments, job
quantification and analysis can be done.
⊳ All sorts of nursing-related plans, e.g. master rotation
plan, duty roster etc. should be done only buy nursing
staff.
⊳ All staffing plan should be delegated to each unit-level
head nurse so that the activities of each ward and details
of each shift are planned well.
7

8. HUMAN RESOURCE
⊳ An organization gets its life through people, for it is solely
through its human resources that all other resources can
be effectively utilized.
⊳ Management guru Peter F.Drucker says,”Knowledge is
the only meaningful resources today”
⊳ In fact, the human resource component is what brings
breath to organization and keep it going.
8

9. Importance of the Staffing Functions
Utilization of resources efficiently
Stronger Organization
Efficient Human Resource
Managerial functions
Organizational performance
Achieve the objective
Figure : Functions of staffing

10. NORMS AND ACTIVITIES

11. Most Hospitals today
follow the Staff
Inspection Unit Norms.In
this activity, the works of
a nursing sister are
common, but the work of
the ward sister remains
similar to staff nurse even
after promotion.
11

12. Recommendations of Staff Inspection Unit
⊳ Norms have taken into account the workload projected in the
wards and other areas of the hospital.
⊳ The post of nursing sisters and staff nurses have been clubbed
together for calculating the two as nursing sisters. A staff nurse
will continue to perform the same duties even after she is
promoted to the level of nursing sisters.
⊳ Out of the entitlements worked out on the basis of the norms, 30%
of post may be sanctioned for nursing sisters. This would improve
the existing ratio of 1 nursing sister to 3.6 staff nurses fixed by the
government with the Delhi Nurse’s Union in May 1990.
12

13. Recommendations of Staff Inspection Unit Cont:
⊳ The assistant nursing superintendent are recommended in the ratio of 1 ANS to
every 4.5 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 7.5 ANS.
⊳ There will be a post of Nursing Superintendent for every hospital having 250 or
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).
13

14. The Nurse-patient Ratio as per the S.I.U. Norms
14
1. General Ward
2. Special Ward - ( pediatrics,
burns, neuro surgery, cardio
thoracic, neuro medicine, nursing
home, spinal injury, emergency
wards attached to casuality)
1:6
1:4
3. Nursery 1:2
4. I.C.U. •1:1(Nothing mentioned about the shifts)
5. Labour Room •1:l per table
6. O.T. •Major - 1 :2 per table
•Minor - 1:l per table

15. 7.Casualty
⊳ a) Casualty (Main)
⊳ Attendance up to 100 patient per
day
⊳ Thereafter for every additional
attendance of 35 patients per
day
⊳ 3 Staff Nurse/Nursing sister
for 24 hours i.e.
⊳ 1 per shift
⊳ 1 Staff
⊳ Nurse/Nursing Sister
15

16. 7.Casualty
⊳ b) Burns
⊳ Attendance up to 15 Patient per
day
⊳ Thereafter for every additional
attendance of 10 patients per
day
⊳ 3 Staff Nurse/Nursing Sister
for 24 hours i.e.
⊳ 1 per shift
⊳ 1 Staff
⊳ Nurse/Nursing Sister
16

17. 7.Casualty :
⊳ c) Orthopaedics
⊳ Attendance up to 45 patient per
day
⊳ Thereafter for every additional
attendance of 15 patients per
day
⊳
⊳ 3 Staff Nurse/Nursing Sister
for 24 hours i.e.
⊳ 1 per shift
⊳ 1 Staff
⊳ Nurse/Nursing Sister
17

18. 7.Casualty :
⊳ d) Gynae/Obstetrics Attendance
up to 40 patients per day
⊳ Thereafter for every additional
attendance of 15 patients per
day
⊳
⊳
⊳ 3 Staff Nurse/Nursing Sister
for 24 hours i.e.
⊳ 1 per shift
⊳ For every additional
attendance of 15 patient per
day
⊳ 1 Staff Nurse/ Nursing Sister
18

19. The Nurse-patient Ratio as per the S.I.U. Norms
19
8. Injection room OPD Attendance upto 100
patients per day 1 staff
nurse
120-220 patients: 2 staff
nurses
221-320 patients: 3 staff
nurses
321-420 patients: 4 staff
nurses

20. 20
9. OPD
NAME OF THE
DEPARTMENT
· Blood bank
· Paediatric
· Immunization
· Eye
· ENT
· Pre anaesthetic
· Cardio lab
· Bronchoscopy lab
· Vaccination anti rabis
· Family planning
1
2
2
1
1
1
1
1
1
2
The Nurse-patient Ratio as per the S.I.U. Norms

21. The Nurse-patient Ratio as per the S.I.U. Norms
21
9. OPD
NAME OF THE DEPARTMENT
· Family planning
· Medical
Surgical
· Dental
· Central sample collection centre
· Orthopaedic
· Gyne
· Xray
· Skin
· V D centre
· Chemotherapy
· Neurology
· Microbiology
· Psychiatry
· Burns
2
1
1
1
1
2
2
3
2
2
2
1
2
1
2

22. 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.
22

23. Nurse Patient Norms as per TNAI and INC
1. Chief Nursing Officer :1 per 500 beds
2. Nursing Superintendent :1 per 400 beds or above
3. D.NS. :1 per 300 beds and 1 additional for every 200 beds
4. A.N.S. :1 for 100-150 beds or 3-4 wards
5. Ward Sister :1 for 25-30 beds or one ward. 30% leave reserve
6. Staff Nurse :1 for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in
Non-teaching Hospital +30% Leave reserve
7. Extra Nursing staff to be provided for departmental research function.
8. For OPD and Emergency :1 staff nurse for 100 patients (1 : 100 ) + 30% leave
reserve
9. For Intensive Care unit: (I.C.U.)- 1:l or (1:3 for each shift ) +30% leave reserve.
10.It is suggested that for 250 bedded hospital there should be One Infection Control
Nurse (ICN) 23

24. For specialized
departments, such as
Operation Theatre,
Labour Room, etc. 1:25
+30% leave reserve.
norms are not based on
Nursing Hours or
Patient's Needs here.
24

25. PATIENT
CLASSIFICATION
SYSTEM

26. ⊳ The patient classification system (PCS)group
patients as per the complexity and amount of
their nursing care necessities. The intention of
PCS is to evaluate patients, group them with
other patients having similar needs and
attributes patient in a different group.
26

27. 1.The PCS provides a method of
quantitatively estimating and
assessing patients need in
relation to nursing care. It is a
way of determining the amount
and type of care a patient
requires as well as providing a
means to standardizing nursing
care practice.
Importance of Patient Classification System
2. As economic issues have
become important , health care
decisions making and the PCS
provide an input to how
nursing care is delivered, the
amount of time required, the
costs involved, they also
evaluate cost-effectiveness
care.
27

28. 3.The PCS can be used as a
valid and reliable instrument to
measure the acuity level of
patients in terms of nursing
workload and number of
nursing staff needed, as well as
variations in nursing care.
4.This help to simplify staff
allocation and scheduling.
Importance of Patient Classification System
5.This system can also be used
effectively for long-range
staffing, budgeting, management
planning, quality management
programmes, compliance with
licensing and industry standards
and regulations.
28

29. There are three types of PCS
1.Factor Evaluation
System
Patient needs are
scored on multiple
care descriptors.
2.Common Care
Descriptor
It describes typical
patients and their
varrying needs level.
3.Diagnostic Related
group
This is grouping
patients for
prospective payment.
29
Types of Patient Classification System

30. 1.Factor evaluation system
⊳ Patient needs are scored on multiple care descriptors
⊳ Most of health care agencies use this PCS where several care elements or
descriptors are identified.
⊳ Each element is divided into sub elements and a standard time is determined
for accomplishing each element.
⊳ The descriptors used to measure a patients’ dependency needs are activities
of daily living, feeding, grooming, toileting, comfort measures and mobility.
⊳ The requirement to assist a patient with each activity is quantified from the
least amount of time required to the greatest amount of time required, e.g.
self-feeding versus tube-feeding.
30

31. 2.Common Care Descriptors.
⊳ It describes typical patients and their varying needs level. e.g.
hygiene, nutrition, medications, fluid management, skin and wound
care, respiratory care , circulatory care, elimination, mobility, special
diagnostic and treatment procedures, health teaching and daily
activities of living.
⊳ After care descriptors have been selected, the levels of care and
intensity are defined for each descriptors. Each level is differentiated
by the amount of nursing time and frequency it requires.
31

32. 1. Factor system can be cited
as objective because
mentioning special
indicators or factors linked
up with patient care
facilities to ascertain
objectivity by the rater.
Common Care Descriptors.
2. The evaluation prototype
system is regarded as subjective.
It uses broad descriptive
categories to report the patient
and his or her requirements .
32

33. Category-I
Patient with acute illness
will have their illness
reversed, the main goal
being to counter their
illness so that it subsides
and restore their health.
Category-II
Patient diagnosed with
chronic illness but had an
acute illness will be treated
completely to reduce the
disability and complication
level.The family members
will be given help in
managing the patient so
that he/she returns to
normal life after the
radication of the illness.
Category-III
Patient diagnosed to
have disability due to
chronic disease but
having the possibility
to return to optimum
level of functioning
through rehabilitation
methods with the help
of the health agency
supported by the
hospital..
33
Features for distinctive patient in each of the category

34. Category-IV
Patient diagnosed with
chronic illness who cannot
be cared for by the family
members since the disease
has resulted in complications
and thus would need
constant hospital support.
Features for distinctive patient in each of the category
Category-V
Patients are in the terminal
stage of their illness and
requires specific team
members to recue them
from death. Therefore, the
PCS system plans the care
specific to each category of
illness.
34

35. 3.Diagnostic –Related Groups
⊳ This is grouping patients for prospective payment.
⊳ This system sets a predetermined price for patient hospital care of Medicine recipient’s
according to the patient’s placement in 1 to 467 diagnostic related groups(DRGs).
⊳ The DRG strategy is a system of grouping patients according to demographic,
diagnostic and therapeutic characteristics that correlate with their use of hospital
facilities.
⊳ Under this prospective payment system, hospital are paid a fixed price for all inpatients,
according to the DRG into which they are classified at the time of discharge from the
hospital. If the hospital cost for the patient care is less than the fixed rate, the hospital
makes a profit. If the cost exceeds the fixed rate, the hospital is at a lost.
⊳ The DRG system provides incentives for early hospital discharge but the quality of care
is affected.
35

36. Sheduling
36

37. Introduction
⊳ In nursing management of any unit, time
planning for the worker is a pre-requisite for
successful nursing operations because the
scheduling of working and nonworking hours
directly affects the employees' productivity,
work satisfaction and job tenure.
37

38. Definition
⊳ Scheduling is defined
as a pattern of on-off
duty hours for
employees in a
particular unit.
38

39. Definition
⊳ Assigning
appropriate number
of staff to complete
each day’s work.
39

40. Purposes of scheduling:
⊳ To provide equality nursing care by appropriate staffing and
avoiding excess staff workload.
⊳ To be fair in providing equal distribution of days off for all staff while
scheduling work.
⊳ To avoid confusion in work environment which help the staff to
complete the task appropriately on time.
⊳ To help the staff to learn their work schedules in advance so that
they can streamline their work accordingly.
⊳ To accomplish the goals of the nursing management unit.
⊳ To help the staff handling emergency situation by adding staff from
less busy unit.
40

41. Principles of Planning Duty Roster:
1. Coverage: Nursing coverage must be provided 24h a day, 7 days
a week with the right number and mix of staff.
2. Continuity: Continuity of quality and quality care.
3. Flexibility: The ability of the scheduling system to handle change
and consider individual preferences as much as possible.
4. Stability: The extent to which nurses know in advance their future
days off and on duty consistent with stable staffing policies.
5. Cost effectiveness: The ability to assign the needed staff without
overstaffing, and also ensuring maximum utilization of a nurse’s
time and skills.
41

42. Methods of Scheduling
10-h day
scheduling
01 02
12-h day
shift
03
Premium
Vacation night
04
Flexible
role
scheduling
The
weekend
alternative
05 06
Team
rotation
08
Cross
training
07
Premium day
weekend
Modified Work Week

43. 10-h day scheduling
The staff work for 10 hour duty shifts per week with 6
hour of overlapping. These overlapping hours are
utilized by planning staff welfare programme and
patient-centred conference, which benefit the staff.
43

44. 12-h shift:
The nurse works for 12h for seven shifts in 2 weeks,
has 3 days work and 4 days off in the week, and 4 days
work and 3 days off in the second week. Nurses are
paid extra 84-h of total work. This type of scheduling
helps the nurse to give better nursing care. It also
added to the benefit for them as they can save money
and manage their personal lives.
44

45. Premium Vacation night:
This type of scheduling includes providing additional 5
working days off for the staff who is ready to work
continuously in night duty for specific period of time.
E.g. for 6 months.
45

46. A flexible role scheduling
This type of scheduling have an advantage of
meeting the staff requirement in the units
where the workload is high. In such situation,
the staff are scheduled and rotated equally ,
which improves the quality care and job
satisfaction.
46

47. The weekend alternative:
In this method, weekends are alternated. So the
staff can use it to attend their continued nursing
education programme or they can utilize it for their
personal reasons. Usually nurses work from Monday
to Friday and have their weekends off. They work
for 12-h shift and are paid for 40-hours along with
additional benefits.
47

48. Team rotation:
This means continuous rotation of the specific
nurse team in a particular unit where each member
has to work in a coordinated manner with the team.
48

49. Premium day weekend:
In this kind of scheduling, one extra day off is given
to the staff who offers to work voluntarily for one
more extra day apart from the formal scheduled
plan.
49

50. Cross training:
It is one of the flexible scheduling wherein the
nurses are crossed scheduled to different units,
which help them to get expertise in all areas of
nursing unit. But this scheduling requires orientation
and ongoing staff development programme to
prevent errors in the continuity of the nursing care.
50

51. Duty Roster
51

52. 52
⊳ In nursing management planning, the duty
roster is an important requirement to
implement quality nursing care
successfully., because proper planning and
executing of the duty roster will directly
affect the functioning, efficiency and job
satisfaction.

53. Definition
⊳ Scheduling the duty
roster is defined as
assigning the
specific work in
slotted unit.
53

54. Specific scheduling policies in duty roster:
⊳ A policy for a person, by title, who is responsible for
preparing the roster.
⊳ The time period to be covered by each schedule.
⊳ The number of weeks or days in advanced that the roster
should be posted.
⊳ The total of on-duty hours for each employee.
⊳ The beginning and ending hours of each shift and
breaktimes.
54

55. Specific scheduling policies in duty roster:
⊳ The number of shifts between which each employee must
rotate, days off, weekends, offs per month and minimum
days off.
⊳ The number of paid holidays and vacation days ; vocation
scheduling.
⊳ The procedure for handling emergency request, and
number of sequential work days.
⊳ Shift pattern(7:30am-12:30 pm -,10-,12-h shifts) with
different combination of working days and off days.
55

56. Steps in planning the duty roster:
⊳ A skeleton plan is made in pencil to allow alterations.
⊳ List the names in order of seniority.
⊳ Put special requests in ink to avoid eraser.
⊳ Insert days off, noting busier days.
⊳ It is important not to have too many nurse off duty at the
same time.
⊳ When placing days off in the schedule, refer to previous
roster so that days off are reasonably spaced and
weekend offs are shared.
56

57. Steps in planning the duty roster:cont
⊳ At the shifts, balancing senior and junior nurses for each
shift, ensuring that there is a senior nurse on duty to take
charge and that the trained nurses evenly distributed.
⊳ Totalled the number of staff on duty for each shift.
⊳ The roster maybe planned weekly or monthly or it may be
a fixed one.
⊳ All the above steps can be modified based on the policies
of each organization to suit its working conditions.
57

58. Holidays:
⊳ The nurse in-charge should be aware of the holidays
allotted to each of the staff nurses, who should also be fully
aware of the holidays allotted to him or her.
⊳ Nurses should be encourage to plan their holidays ahead of
time.
⊳ Only a certain number of staff should be allowed to take
their holidays simultaneously.This number is usually dicided
between the charge nurse and the nurse administrator.
58

59. Guide to compiling duty roster (Part-A)
⊳ Use the roster sheet as provided by health agencies.
⊳ Do not cut sheets: always use the full size and fill one sheet
before going to a new one.
⊳ Compile the roster for one full calendar month in advcanced.
⊳ Fill in headings: name of dept,month,dates and days if the week.
⊳ Rule lines in red to devide into complete weeks, e.g.from
yesterday of the previous week to Friday of the following week.
59

60. Guide to compiling duty roster (Part-A)
⊳ Write full name and Designation of each staff member in the left had
column.
⊳ Ensure that the names of all staff, including those on leave and new
members, are recorded accurately.
⊳ When leaves the dept.through transfer or resignation draw two lines in
red through the remaining days of the month, indicating the new dept,
or resignation or end of contract.
⊳ Enter leave by ruling a line between the agreed days. For e,g, 30 days
AL + 45 days ML:15.12.2007-27.02.2008.
⊳ Use accepted symbols only.
60

61. Guide to compiling duty roster (Part-B)
⊳ Before starting, check request book for any special requests.
⊳ Also shifts M(morning), A(afternoon),N(night) should be written
in blue felt pen.
⊳ DO(day off),PH(public health holiday), should be written in top
right corner. PH6, etc.
⊳ Asterisk (*) the name of the staff nurse incharge of each shift.
⊳ Count numbers on each shifts according to grade, total and
record on the roster.
61

62. Guide to compiling duty roster (Part-B)cont:
⊳ Duty roster should be submitted to the NS for checking and
approval one week before it comes into force.
⊳ Staff who resign at anytime during the year are only
entitled on the number of PHs occurring up to the date of
resignation .
⊳ Copy of the completed roster, checked and signed by the
ward incharge and nursing officer is to be submitted to the
Nursing Administration not later than the 26th /27th day of
each month.
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66. Thanks! Any questions?
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