STAFFING &

SCHEDULING
Ruby A. Paderes RN.,MN
WHAT IS
STAFFING?
• 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.
What are the factors affecting
staffing?
• 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
• 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.
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.
 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
 Classification Categories
Level I-Self -Can take a bath on his own; feed himself; perform his
Care or own ADL.
Minimal Care
-For discharge pt; non-emergency, newly admitted
-NCH
don’t exhibit unusual s/s;
1.5/pt/day
- requires little treatment and observation
- Ratio 55:45
Level II – -Need some assistance in bathing, feeding, ambulating
Moderate for short period.
Care or -Extreme s/s of illness must have subsided or have not
Intermediate yet appeared
Care -May have slight emotional needs
-NCH 3/pt -v/s taking ordered 3x/shift; with IVF/BT; are semi-
- Ratio 60:40 conscious and exhibiting some psychosocial or social
problems;
- periodic treatments and/or observations and
/instructions
 Level III – -Patient are completely dependent upon
Total,
Complete or the nursing personnel.
Intensive -They are provided complete bath, are
Care
fed, may or may not be unconscious,
with marked emotional needs; with v/s
-NCM
6hrs/pt/day
monitoring more than 3x/shift
-Ratio 65:35 -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
 Level IV- -Need maximum level of nursing care
Highly
Specialized with a ratio of 80 professionals to 20
Critical Care non-professionals.
-NCH 6-9 or
-Needs continuous treatment and
more /pt/day observation
- Ratio 70:30 -With many medications, IV piggy
or 80:20
backs; v/s monitoring every 15-30
minutes; hourly output.
-There are significant changes in
doctor’s orders
Categories of Level of Care of Patients: Nursing Care
Hours/Pt/Day & Ratio of Prof-Non Prof

Levels of Care NCH Needed Per Ratio of Prof to

Pt./Day Non-Prof
Level I – Self-Care 1.50 5:45
or Minimal Care
Level II Moderate 3.0 60:40
or Intermediate
Care
Level II Total or 4.5 65:35
Intensive Care
Level IV Highly 6.0 70:30
Specialized or 7 or higher 80:20
Critical Care
Percentage of patients at various levels of care
per type of hospital

Type of Hospital Minimal Moderate Intensive Highly

Care Care Care Spl. Care

Primary Hospital 70 25 5 -

Secondary Hospital 65 30 5 -

Tertiary Hospital 30 45 15 10

Special 10 25 45 20
Tertiary
Hospital
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.
Computing for the number of nursing
personnel needed
 Total No. working-Non working days & hours of
nursing personnel per year

Rights & Privileges Given Each Working Hours Per Week

40 hours 48 hours
Personnel Per Year
1.Vacation Leave 15 15
2.Sick Leave 15 15
3.Legal Holidays 10 10
4.Special Holidays 2 2
3
5.Special Privileges 3
52
6.Off-Duties as per R.A. 5901 104 3
7.Continuing Education Program 3 100
Total Non-working Days per 152 265
year 213 2,120
Total working days per year 1,704
 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
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
• 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
• 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
What is scheduling?
 implementation of staffing pattern by
assigning personnel to work specific
hours and days in a specific unit or area.
Centralized scheduling:

The schedule done by the upper manager for all

nurses in all departments manually or by
computer.
 Decentralized scheduling

When managers are given authority and assume

responsibility, they can staff their own units
through decentralized scheduling.
 Self scheduling

a system that is coordinated by staff nurses.

Staff may negotiate before and after work and
during break and lunchtime.
Alternating or rotating work shifts

It may take 2-3 days to 2 weeks for a

person to adjust to a different sleep-wake
cycle.
 Permanent shift

relieve nurses from

stress and health related problems
associated with alternating and rotating
shifts.
Block, cyclical, scheduling

Block, or cyclical, scheduling uses the same

schedule repeatedly. The schedule repeat
itself every 6 weeks.
Eight hour shift in a five day workweek

5-day, 40-hours workweek

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.
Twelve-hour shift in seven day workweek

The better use of personnel lower staffing

requirements; this consequently lowers the cost
per patient day.