HUMAN RESOURCE MANAGEMENT

By
Mrs. Smitha. M
Associate Professor
Vijaya College of Nursing
Kottarakkara
 HUMAN RESOURCES FOR HEALTH
I Introduction

Organization is the formal structure of authority calculated to define, distribute and provide
for the co-ordination of the tasks as contribution to the whole. When the aims of the
organization properly design the planning of its institutions and its functional standard, it will
have identified the kind and numbers of personnel it needs.

II.STAFFING

1. Definition

Staffing is the systematic approach to the problem of selecting, training, motivating and
retaining professional and non professional personnel in any organization. It involves
manpower planning to have the right person in the right place.

2. Philosophy

Components of the staffing process as a control system include a staffing study, a master
staffing plan, a scheduling plan, and a nursing management information system (NMIS).

Philosophy of staffing in nursing

Nurse administrators of a hospital nursing department might adopt the following philosophy.

1. Nurse administrators believe that it is possible to match employee‘s knowledge and skills
to patient care needs in a manner that optimizes job satisfaction and care quality.

2. Nurse administrators believe that the technical and humanistic care needs of critically ill
patients are complex that all aspects of that care should be provided by professional nurses.

3. Nurse administrative believe that 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 nurses.

4. Should believe that believe that 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, etc.,).

5. Should believe that 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.

6. Should the staffing plan should be administrated at the unit level by the head nurse, so that
can change based on unit workload and workflow.
3. Objectives of staffing in nursing

1. Provide an all professional nurse staff in critical care units, operating rooms, labor,
delivery unit, emergency room.

2. Provide sufficient staff to permit a 1:1 nurse-patient ratio for each shift in every critical
care unit.

3. Staff the general medical, surgical, Obsteritic and gynecology, pediatric and psychiatric
units to achieve a 2:1 professional –practical nurse ratio.

4. Provide sufficient nursing staff in general medical, surgical, Obsteritic, pediatric and
psychiatric units to permit a 1: 5 nurse-patient ratio on a day and after noon shifts an d1:10
nurse –patient ratio on the night shift.

4. NORMS OF STAFFING

Norms:

Norms are standards that guide, control, and regulate individuals and communities. For
planning nursing manpower we have to follow some norms. The nursing norms are
recommended by various committees, such as;

A. The Staff Inspection Unit (S.I.U.)

B. The Nursing Man Power Committee

C. The High power Committee

D. Dr. Bajaj Committee

E. The staff inspection committee

F. TNAI and

G. INC.

The norms has been recommended taking into account the workload projected in the wards
and the other areas of the hospital. All the above committees and the staff inspection unit
recommended the norms for optimum nurse-patient ratio. Such as 1:3 for Non Teaching
Hospital and 1:5 for the Teaching Hospital.

A. The Staff Inspection Unit (S.I.U.):

The Staff Inspection Unit (S.I.U.) is the unit which has recommended the nursing norms in
the year 1991-92. As per this S.I.U. norm the present nurse-patient ratio is based and
practiced in all central government hospitals.

Recommendations of S.I.U:
1. The norms for providing staff nurses and nursing sisters in Government hospital is given in
annexure to this report. The norm has been recommended taking into account the workload
projected in the wards and the other areas of the hospital.

2. 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.

3. 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 3.6. staff
nurses fixed by the government in settlement with the Delhi nurse union in may 1990.

4. 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.

5. The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS per every
7.5 ANS

6. There will be a post of Nursing Superintendent for every hospital having 250 or beds.

7. There will be a post of 1 Chief Nursing Officer for every hospital having 500 or more beds.

8. 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).

Most of the hospital today is following the S.I.U.norms.

B. BAJAJ COMMITTEE, 1986:

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:-

1. Formulation of National Medical & Health Education Policy.

2. Formulate on of National Health Manpower Policy.

3. Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of

UGC.

4. Establishment of Health Science Universities in various states and union territories.

5. Establishment of health manpower cells at centre and in the states.

6. Vocationalisation of education at 10+2 levels as regards health related fields with
appropriate incentives, so that good quality paramedical personnel may be available in
adequate numbers.

7. Carrying out a realistic health manpower survey.

In relation to nursing, the Bajaj Committee recommended staffing norms for nursing
manpower requirements for hospital nursing services and requirements for community
health centres and primary health centres on the basis of calculations as follow:

Hospital Nursing Services-

1. Nursing superintendents - 1:200 beds

2 .Deputy nursing superintendents - 1:300 beds

3. Departmental nursing - 7:1000+1 Addl:1000beds (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 departments and clinics,

OT, Labour room - 8:200 + 30% leave reserve

Community Nursing Service

Projected population - 991,479,200 (medium assumption) by 2000 AD

1 Community Health Centre - 1,000,00 population

1 Primary Health Services - 30,000 population in plain area

1 Primary Health Services - 20,000 population in difficult areas

1 Sub-centre - 5000 population in plain area

1 Sub-centre - 3000 population for difficult area

It also requires nursing manpower to cater to the needs of the rural community as follows:

Manpower requirements by 2000 AD:

 1. Sub-centre ANM/FHW - 323882
2. Health supervisors /LHV - 107960
3. Primary Health Centres PHN - 26439
4. Community health centre Nurse-midwives - 26439
5. Public health nursing supervisor - 7436
6. Nurse-midwives - 52,052
7. District public health nursing officer - 900

In additional to the above, 74361 Traditional Birth Attendants will be required.

C. 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 vice-chancellor 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
CentralSocialWelfareBoard.
The terms of reference of the Committee are:

1. To look into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in the rural and urban areas.

2. To study and recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care, both in the hospitals and community.

3. To look into the training of all categories and levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels o health services and education.

4. To study and clarify the role of nursing personnel in the health care delivery system
including their interaction with other members of the health team at every level of health
service management.

5. To examine the need for organised nursing services at the national, state, district and local
levels with particular reference to the need for planning service with the overall health care
system of the country at the respective levels.

6. To look into all other aspects, the Committee will hold consultations with the State
Governments.

RECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND

NURSING PROFESSION

A. Working conditions of nursing personnel

1. Employment: Uniformity in employment procedures to be made. Recruitment rules are
made for all categories of nursing posts. The qualifications and experience required or these
be made throughout the country.

2. Job description: Job description of all categories of nursing personnel is prepared by the
central government to provide guidelines.

3. Working hours: The weekly working hours should be reduced to 40 hrs per week.
Straight shift should be implemented in all states. Extra working hours to be compensated
either by leave or by extra emoluments depending on the state policy . Nurses to be given
weekly day off and all the gazetted holidays as per the government rules.

4. Work load/ working facilities : Nursing norms for patient care and community care to be
adopted as recommended by the committee. Hospitals to develop central sterile supply
departments, central linen services, and central drug supply system. Group D employees are
responsible for housekeeping department. Policies for breakage and losses to be developed
and nurses not are made responsible for breakage and losses.

5. Pay and allowances : Uniformity of pay scales of all categories of nursing personnel is not
feasible. However special allowance for nursing personnel, i.e.; uniform allowance, washing,
mess allowance etc should be uniform throughout the country.

6. Promotional opportunities: The committee recommends that along with education and
experience, there is a need to increase the number of posts in the supervisory cadre, and for
making provision of guidance and supervision during evening and night shifts in the hospital.
Each nurse must have 3 promotions during the service period. Promotion is based on merit
cum seniority. Promotion to the senior most administrative teaching posts is made only by
open selection. In cases of stagnation, selection grade and running scales to be given.

7. Career development: Provision of deputation for higher studies after 5 yrs of regular
services be made by all states. The policy of giving deputation to 5 -10 % of each category
be worked out by each state.

8. Accommodation: As far as possible, the nursing staff should be considered for priority
allotment of accommodation near to work place. Apartment type of accommodation is built
where married/unmarried nurses can be allowed to live. Housing colonies for hospital s must
be considered in long run.

9. Transport: During odd hours, calamities etc arrangements for transport must be made for
safety and security of nursing personnel.

10. Special incentives: Scheme of special incentives in terms of awards, special increment
for meritorious work for nurses working in each state/district/PHC to be worked out.

11. Occupational hazards : Medical facilities as provided by the central government by

extended by the state government to nursing personnel till such times medical services are
provided free to all the nursing personnel. Risk allowance to be paid to nursing personnel
working in the rural and urban area.

12. Other welfare services: Hospitals should provide welfare measures like crèche facilities
for children of working staff, children education allowance, as granted to other employees, be
paid to nursing personnel.

Additional Facilities for Nurses Working In the Rural Areas

a. Family accommodation at sub centre is a must for safety and security of ANM's /LHV.

b. Women attendant, selected from the village must accompany the ANM for visits to other
villages.

c. The district public health nurse is provided with a vehicle for field supervision.

d. Fixed travel allowance with provision of enhancement from time to time.

e. Rural allowance as granted to other employees is paid to nursing personnel.

B. NURSING EDUCATION :

Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education.

The committee recommends that;

1. 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.

2. All school of nursing attached to medical college hospitals is upgraded to degree level in a
phased manner.

3. All ANM schools and school of nursing attached to district hospitals be affiliated with
senior secondary boards.

4. Post certificate B.Sc. Nursing degree to be continued to give opportunities to the existing
diploma nurses to continue higher education.

5. Master in nursing programme to be increased and strengthened.

6. Doctoral programme in nursing have to be started in selected universities.

7. Central assistance be provided for all levels of nursing education institutions in terms of
budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in
report.

9. 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.

10. 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.

11. All schools to have adequate budget for libraries and teaching equipments.

12. 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.

Continuing Education and Staff Development

1. 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.

2. Deputation for higher study is made compulsory after 5 yrs.

3. Each nursing personnel must attend 1 or 2 refresher course every year.

4. Necessary budgetary provision be made.

5. 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.

C. NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)

Definite nursing policies regarding nursing practice are available in each institution. These
policies should be based upon:

a) Qualification/recruitment rules

b) Job description/job specifications

c) Organizational chart of the institutions

d) Nursing care standards for different categories of patients.

NURSING POLICIES FOR NURSING PRACTICE

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.
The committee strongly recommends that minimum standards of basic equipment needed
for each patient be studied , norms laid down and provided to enable nurses to perform some
of the basic nursing functions . Also there should be a separate budget head for nursing
equipment and supplies in each hospitals/ PHC. The NS and PHN should be a member of the
purchase and condemnation committee.

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

1. Appointment of ANM/LHV to be recommended - 1 ANM for 2500 population (2 per

sub centre)–
2. 1 ANM for 1500 population for hilly areas - 1 health supervisor for 7500 population
(for supervision of 3 ANM's)
3. 1 public health nurse for 1 PHC (30000 population to supervise 4 Health Supervisors)
4. 1 Public Health Nursing Officer for 100000 population (community health centre)
5. 2 district public health nursing for each district.
ANM/LHV promoted to supervisory posts must undergo courses in administration
and management.
6. Specific standing orders are made available for each ANM/LHV to function
effectively in the field.
7. Adequate provision of supplies, drugs etc are made.

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.

Functions of Indian Nursing Council.

1. To establish and monitor a uniform standard of nursing education for nurses midwife,
Auxiliary Nurse-Midwives and health visitors by doing inspection of the institutions.
2. To recognize the qualifications under section 10(2)(4) of the Indian Nursing Council
Act, 1947 for the purpose of registration and employment in India and abroad.
3. To give approval for registration of Indian and Foreign Nurses possessing foreign
qualification under section 11(2) (a) of the Indian Nursing Council Act, 1947.
4. To prescribe the syllabus & regulations for nursing programs.
5. Power to withdraw the recognition of qualification under section 14 of the Act in case
the institution fails to maintain its standards under Section 14 (1)(b) that an institution
recognized by a State Council for the training of nurses, midwives, auxiliary nurse
midwives or health visitors does not satisfy the requirements of the Council.
6. To advise the State Nursing Councils, Examining Boards, State Governments and
Central Government in various important items regarding Nursing Education in the
Country.

THE EXISTING NORM BY INC WITH REGARD TO NURSING STAFF FOR

WARDS AND SPECIAL UNITS:

Area / Ward Staff nurse Sister(each shift) Departmental sister/ assistant

 nursing superintendent

Medical ward 1:3 1:25 1 for 3-4 weeks

Surgical ward 1:3 1:25 1 for 3-4 weeks

Orthopedic ward 1:3 1:25 1 for 3-4 weeks

Pediatric ward 1:3 1:25 1 for 3-4 weeks

Gynecology ward 1:3 1:25 1 for 3-4 weeks

Maternity ward

including newborns 1:3 1:25 1 for 3-4 weeks

ICU 1:1(24 hours) 1

CCU 1:1(24 hours) 1

Nephrology 1:1(24 hours) 1 1 department sister/assistant

nursing superintendent for 3-4
units clubbed together
Neurology & and
neurosurgery : 1:1(24 hours) 1
Special wards- eye,

ENT etc. 1:1(24 hours) 1

Operation theatre 3 for 24

hours per table 1 1 department sister/assistant

nursing superintendent for
4-5 operating rooms
Casuality and 2-3 staff nurses 1 1department
sister/Asst.Nsg
Superintendent
emergency unit depending on the
number of beds

Staffing pattern according to the Indian Nursing Council (relaxed till 2012) Collegiate
programme

Qualifications and experience of teachers of college of nursing

1. 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)

1. Professor cum principal - 1

2. Professor cum vice principal - 1

3. Reader/Associate professor - 2 2

4. Lecturer - 2 3

5. Tutor/clinical instructor - 19

Total 24 5

One in each specialty and all the M.Sc. (N) qualified teaching faculty will participate in both
programmes. Teacher-student ratio = 1:10

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-physics 5. Psychology

6. Nutrition 7. English 8. Computer 9. Hindi/Any other language

10. Any other- clinical discipliners 11. Physical education

The above teachers should have post graduate qualification with teaching experience in
respective area

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 REQUIRMENTS- ACTIVE ANALYSIS AND

RESEARCH STUDIES

INTRODUCTION

Staffing is certainly one of the major problems of any nursing organization, whether it be a
hospital, nursing home, health care agency, or in educational organization. Estimation of staff
requirements is important for rendering good and quality nursing care.

Patient Classification Systems

Patient classification system (PCS), which quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals and nursing homes. In selecting or
implementing a PCS, a representative committee of nurse manager can include a
representative of hospital administration, which would decrease skepticism about the PCS.

The primary aim of PCS is to be able to respond to constant variation in the care needs of
patients.

Characteristics

1. Differentiate intensity of care among definite classes

2. Measure and quantify care to develop a management engineering standard.
3. Match nursing resources to patient care requirement .
4. Relate to time and effort spent on the associated activity.
5. Be economical and convenient to repot and use
6. Be mutually exclusive , continuing new item under more than one unit.
7. Be open to audit.
8. Be understood by those who plan , schedule and control the work.
9. Be individually standardized as to the procedure needed for accomplishment.
10. Separate requirement for registered nurse from those of other staff.

Purposes

1 The system will establish a unit of measure for nursing, that is , time , which will be
used to determine numbers and kinds of staff needed.
 2 Program costing and formulation of the nursing budget.
3 Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
4 Determining the values of the productivity equations
5 Determine the quality: once a standards time element has been established, staffing is
adjusted to meet the aggregate times. A nurse manager can elect to staff below the
standard time to reduce costs.

Components:

1. The first component of a PCS is a method for grouping patient’s categories: Johnson
indicates two methods of categorizing patients. Using categorizing method each
patient is rated on independent elements of care, each element is scored, scores are
summarized and the patient is placed in a category based on the total numerical value
obtained.
2. The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of
reporting data.
3. The third component of a PCS is the average amount of the time required for care of a
patient in each category. A method for calculating required nursing care hours is the
fourth and final component of a PCS.

Patient Care Classification

Patient Care classification using four levels of nursing care intensity

Area of care Category I Category II Category III Category IV

Eating Feeds self Needs some Cannot feed self Cannot feed self
helpin preparing but is able to any may have
chew and difficulty
swallowing swallowing

Grooming Almost entirely Need some help Unable to do Completely

self sufficient in bathing, oral much for self dependent
hygiene
Excretion Up and to Needs some In bed, needs Completely
bathroom alone help in getting bedpan / urinal dependent
up to placed
bathroom /urinal

Comfort Self sufficient Needs some Cannot turn Completely

help with
without help, get dependent
adjusting drink, adjust
position/ bed..position of
extremities
General health Good Mild symptoms Acute symptoms Critically ill
Treatment Simple – Any Treatment Any treatment Any elaborate/
supervised, more than once more than delicate
 simple dressing per shift, foley twice /shift procedure
catheter care, requiring two
I&O nurses, vital
signs more often
than every two
hours.

Health Routine follow Initial teaching More intensive Teaching of

education and up teaching of care of items; teaching resistive patients
teaching ostomies; new of apprehensive/
diabetics; mildly resistive
patients with patients
mild adverse
reactions to their
illness

Calculating Staffing Needs

The following are the hours of nursing care needed for each level patient per shift:

Category I Category II Category III Category IV

NCHPPD for 2.3 2.9 3.4 4.6
Day shift
NCHPPD for 2.0 2.3 2.8 3.4
P.M (Evening)
shift

NCHPPD for 0.5 1.0 2.0 2.8

night shift
* NCHPPD – Nursing Care Hour For Patient Per Day

A guide to staffing nursing services

1. Projecting Staffing Needs

Some steps to be taken in projecting staffing needs include:
a. Identify the components of nursing care and nursing service.
b. Define the standards of patient care to be maintained.
c. Estimate the average number of nursing hours needed for the required hours.
d. Determine the proportion of nursing hours to be provided by registered nurses and
other nursing service personnel
e. Determine polices regarding these positions and for rotation of personnel.

2. Computing number of nurses required on a Yearly Basis

a. Find the total number of general nursing hours needed in one year.

Average patient census X average nursing hours per patient for 24 hours X days in week X
weeks in year.

b. Find the number of general nursing hours needed in one year which should be given by
registered nurses and the number which should be given by ancillary nursing personnel.

i. Number of general nursing hours per year X percent to be given by registered

nurses.

ii. Number of general nursing hours per year X percent to be given be ancillary
nursing personnel.

Computing number of nurses assigned on weekly basis

a. Find the total number of general nursing hours needed in one week. Average patient censes
X average nursing hours per patient in 24 hours X days in week.

b. Find the number of general nursing hours needed in the week which should be given by
registered nurses and the number which could be given by ancillary nursing personnel.

i. Number of general nursing hours per week X percent to be given by registered

nurses.

ii. Number of general nursing hours per week X percent to be given by ancillary
nurses.

One method for determining the nursing staff of a hospital

1.To determine the number of nursing staff for staffing a hospital involves establishing the
number of work days available for service per nurse per year.

Example: Analysis of how the days are used;

Days in the year - 365

Days off 1 day/week - 52

Casual leave - 12

Privilege leave (EL) - 30

1 Saturday /month - 12

Public Holidays - 18

Sick Leave -8

Total non-working days - 132

Total working days /nurse/year - 233

So 1 nurse = 233 working days /year

Example, 20 nurse means 20X233= 4660 hours 4660/365= 12.8 (13).

b. Work load measurement tools

Requirement for staffing are based on whatever standard unit of measurement for
productivity is used in a given unit. A formula for calculating nursing care hours per patient
day (NCH/PPD) is reviewed.

NCH/PPD = Nursing hours worked in 24 hours

As a result, patient classification systems (PCS), also known as workload management or

patient acuity tools, were developed in the 1960s.

Important Factors of staffing

There are 3 factors: quality, quantity, and utilization of personnel.

a. Quality and Quantity: This factor depends on the appropriate education or training
provided to the nursing personnel for the kind of service they are being prepared for i.e.,
professional, skilled, routine or ancillary. Utilization of personnel: Nursing personnel must be
assigned work in such a way that her/his knowledge and skills learnt are based used for the
purpose she was educated or trained.

b.Other factors affecting staffing

1. Acutely Ill : Where the life saving is the priority or bed ridden condition which might
require 8-10 hours / patient /day ie., direct nursing care in 24 hours or nurse patient ratio may
have to be 1:1, 2:1,3:1… etc...

2. Moderately Ill: Here 3.5 HPD are required in 24 hours or nurse patient ration of 1:3 in
teaching hospitals and 1:5 non-teaching hospitals.

3. Mildly Ill: this required 1-2 HPD and for such patients 1:6 or 1:10.

4.Fluctuation of workload: workload is not constant. So some fluctuations will occur.

5. Number of medical staff: In PHC , 30,000 to 50,000 population getting care from 3 to 4
medical staff but only 1 PHN gives care for all like in hospital the ratio is vary from medical
and nursing staff.

Modified approaches to nurse staffing and scheduling

Many different approaches to nurse staffing and scheduling are being tried in an effort to
satisfy needs of the employees and meet workload demands for patient care. These include
game theory, modified workweeks (10 or 12hours shifts), team rotation, premium day,
weekend nurse staffing. Such approaches should support the underlying purpose, mission,
philosophy and objectives of the organization and the division of nursing and should be well
defined in a staffing philosophy, statement and policies.

Modified work week: This using 10 and 12 hour shifts and other methods are common
place. A nurse administrator should fulfill the staffing philosophy and policies, particularly
with regard to efficiency. Also, such schedules should not be imposed on the nursing staff but
should show a mutual benefits to employer, employees and the client served.

a) One modification of the worksheet is four 10 hour shifts per week in organized time
increments. One problem with this model is time overlaps of 6 hours per 24 –hour day. The
overlap can be used for patient –centered conference, nursing care assessment and planning
and staff development. It can be done by hour or by a block of 3-4 hours. Starting and ending
time for the 10 hours shifts can be modified to provide minimal overlaps, the 4- hour gap
being staffed by part-time or temporary workers.

b) A second scheduling modification is the 12 hour shift, on which nurses work even shifts ,
on which nurses work seven shift in 2 weeks: three on , four off: four on, three off . They
work a total 84 hours and are paid of overtime. Twelve hour shifts and flexible staffing have
been reported to have improved care and saved money because nurses can better manage
their home and personal lives.

c) The weekend alternatives: another variation of flexible scheduling is the weekend

alternative. Nurses work two 12 hour shifts and are paid for 40 hours plus benefits. They can
use the weekdays for continued education or other personal needs. The weekend scheduled
has several variations. Nurses working Monday through Friday have all weekends off.

d) Other modified approaches: Team rotation is a method of cyclic staffing in which a

nursing team is scheduled as a unit. It would be used if the team nursing modality were a
team practice.

e) Premium day weekend: nursing staffing is a scheduling pattern that gives the nurse an
extra day off duty, called a premium day, when he/she volunteers to work one additional
weekend worked beyond those required by nurse staffing policy. This technique does not add
directly to hospital costs.

f) Premium vacation night: staffing follows the same principle as does premium day weekend
staffing. An example would be the policy of night shifts for a specific period of time , say 3,
4, or 6 months.

A flexible role: this programme has enabled the hospitals to better meet the staffing needs of
units whenever workload increases. Since establishment of the resources acuity nurse
position, nurses position, nurse‘s morale has improved because they know shortterm helps is
more readily available and will be more equitably distributed among units.

Cross training: It can improve flexible scheduling. Nurses can be prepared through cross-
training to function effectively in more than one area of expertise. To prevent errors and
incidence job satisfaction during cross training nurses assigned to units and in pools require
complete orientation and ongoing staff development.