STAFFING

Staffing Third managerial function. Hiring and keeping the right people is one of the manager’s most critical responsibility. (Dee Ann Gillies) It involves the following: a. selection of personnel and assignment systems and b. the determination of staffing schedules.

Types of healthcare personnel: RN LPN NA UAP Relatives (SOs) – local setting

Assignment Systems for Staffing Case method Functional nursing Team nursing/ Modular nursing Primary nursing Managed care

Various Assignment Systems: Case method – each patient is assigned to a nurse for total patient care while that nurse is on duty. Functional nursing – implements classic scientific management which emphasizes efficiency, division of labor, and rigid controls.

Various Assignment Systems: Team nursing – achievement of nursing goals through group action. Primary nursing – the RN remains responsible for the care of a client/ patient 24 hours a day throughout the patient’s hospitalization. Modular nursing – modification of team and primary nursing. Used when there is not enough RNs.

Various Assignment Systems: Managed care – is a unit-based care system that can be used with any nursing care delivery system in any clinical setting. It uses standard critical paths with nursing care plans, analyzes the positive and negative variations from the critical paths, and uses them in change of shift reports.

Various Assignment Systems: Case management – focuses on an entire episode of illness. It emphasizes achievement of outcomes in designated time frames with limited resources. It incorporates managed care. Care is coordinated by a case manager. It is sometimes called second-generation primary nursing.

Staffing Schedules Self-scheduling Rotating work shifts Permanent shifts Block or cyclical scheduling Variable staffing

Types of Patient Classification Systems: Descriptive – classifies the patient in the category that most closely describes the care received. The tool used is a narrative on a concise acuity table. Checklist style – divides descriptions of care routines into activity categories, such as eating and bathing.

Patient Classification Systems Time standard or relative value unit (RVU) – assign a value unit (usually a measure of time) to various activities of patient care. To develop patient classification systems, acuity definitions must be established and validated through work sampling.

Examples of Patient Classifications: Warstler (1972) 1. Category I: Self-care (Requires 1 to 2 hours of care) 2. Category II: Minimal care (Requires 3 to 4 hours of care) 3. Category III: Intermediate Care (Requires 5 to 6 hours of care) 4. Category IV: Modified Intensive Care (Requires 7 to 8 hours of care) 5. Category V: Intensive Care (Requires 10 to 14 hours of care)

Examples of Patient Classifications: DOH (1994) Level I – Self-Care or Minimal Care Level II – Intermediate, Partial or Moderate Care Level III – Total Intensive Care Level IV – Critical Care

Examples of Patient Classifications: Regnery (1977) Public Health Nursing Level I – Clients who require a high degree of nursing skill. Level II – Includes families that need regular public health nursing service. Level III – For people requiring occasional service. Level IV – For clients and families requiring limited public health nursing service.

Examples of Patient Classifications: Four-level patient classification Category 1 - Minimal nursing care Category 2 – Moderate nursing care Category 3 – Considerable direct nursing care Category 4 – Intensive nursing care

Examples of Patient Classifications: Four-category system: 1. Self-care 2. Partial care 3. Complete care 4. Intensive care Three-level categories: 1. Minimal care 2. Moderate care 3. Maximal care

Patient Acuity Acuity – level of care, degree of dependence, communicability, and rehabilitation needs. DOH Patient Classification (1994) Level I – Self-Care or Minimal Care Level II – Intermediate, Partial or Moderate Care Level III – Total Intensive Care Level IV – Critical Care

Patient Acuity Nursing Care Hour (NCH) required: Example: 1. Level I – 1.5 hours 2. Level II – 3.0 hours 3. Level III – 4.5 hours 4. Level IV – 6.0 hours

Staffing Pattern Components Personnel Mix – ratio between Professional and Non-professional personnel Level I – 55/45 Level II – 60/40 Level III – 65/35 Level IV – 70/30 or 80/20 Hours of work – 8 to 12 hours shift Distribution of workload AM – 45% PM – 37% Night – 18%

Staffing Formulas Predict patient days by category. Determine NCH required for this patient mix. Distribute hours required over all shifts. Develop staffing pattern considering personnel mix available. Convert hours of care to actual cost.

Determine the number of personnel needed for a 100 bed capacity secondary hospital. 1. Categorize patients according to levels of care: 100 pts. X .65 = 65 needing minimal care 100 pts. X .30 = 30 needing moderate care 100 pts. X .05 = 5 needing intensive care 2. Find the required NCH per day at each category: 65 X 1.5 = 97.5 NCH needed by patients needing minimal care 30 X 3.0 = 90.0 NCH needed by patients needing moderate care 05 X 4.5 = 22.5 NCH needed by patients needing intensive care Total NCH needed by 100 patients = 210 NCH

3. Find the total NCH for 1 year 210 X 365 = 76,650 NCH needed/ year 4. Find the number of nursing personnel needed 76,650 NCH/ year ------------------------------ = 44 nursing personnel 1728 working hrs/year (constant) 5. Determine the personnel mix 44 X .60 (RNs) = 26 RNs 44 X .40 (NAs) = 17.6 or 18 NAs 6. Distribute by Shifts 26 X .45 = 12 RNs (am shift) 18 X .45 = 8 NAs (am shift) 26 X .37 = 10 RNs (pm shift) 18 X .37 = 7 NAs (pm shift) 26 X .18 = 4 RNs (night shift) 18 X .18 = 3 NAs (night shift)

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