Staffing By: Mahmoud Awad Mohammed Khalil Wadee Zen Aden Ibrahim Eid Alaashaban To:missSamahIshteh
Out line • Definition • Introduction • Patient classification systems • Determining nursing care hours • Determining FTEs • Determining staffing mix • Determining distribution of staff
Objective After completing this presentation , you will able to: • Determine staffing need • Demonstrate how to use patient classification systems to calculate nursing care hours necessary • Calculate FTEs • Determine the appropriate staffing mix and distribution of staff
Definitions Of Staffing • Staffing refers to the number and composition of personnel assigned to work in a unit at a given time. • Staffing is the end result in prediction of the kind and number of staff required to give care to patient.
Staffing • Staffing is an important responsibility of nursing manager. • The higher the proportion of registered nurses with more hours of care provided by them, the higher is quality care received by patient according to landmark study
The goal of staffing is to provide the appropriate numbers and mix of nursing staff (nursing care hours) to match actual or projected patient care needs (patient care hours) to provide effective and efficient nursing care. • To determine the number of staff needed, manager must examine workload patterns for the designated unite, department, or clinic.
The American Nursing Association (ANA 2005) has developed principles for nursing staffing as shown down: • Patient care unit related: • Appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate patient needs. • There is a critical need to either retire or seriously question the usefulness of concept of nursing hours per patient day. • Unit functions necessary to support delivery of quality patient care.
B. Staff related • The specific need of various patient populations should determine the appropriate clinical competencies required of the nurse practicing in that area. • Registered nurses must have nursing management support and representation at both the operational level and the executive level. • Clinical support from experienced RN should be available to those RN with less proficiency.
C. Institution\Organization related • Organizational policy should reflect an organizational climate that values registered nurses and other employees as strategic assets and exhibits a true commitment to filling budgeted positions in a timely manner. • All institutions should have documented competencies for nursing staff, including agency or supplemental and traveling RN, for those activities that they have been authorized to perform. • Organizational policies should recognize the myriad needs of both patient and nursing staff.
Patient Classification System • PCSs referred to as patient acuity system, use patient needs to determine workload requirements and staffing need objectively. • To be most effective, patient classification data are collected midpoint for every shift by the unit nursing staff and analyzed before the next shift to ensure appropriate numbers and mix of nursing staff. • This system would accurately predict the number and skill level of nurses needed for the next shift
Determine Nursing Care Hours • NCHs: patient workload trends are analyzed for each day of the week (each hour in critical care) or for a specific patient diagnosis to determine staffing needs. • E.g. if 26 patient with the following acuities required 161 nursing care hours, then an average of 6.19 nursing hours per patient per day (NHPPD) are required. NHPPD are calculated by dividing the total nursing care hours by the total census (number of patients).
There are no specific standards for nursing care hours (NCHs) for any of patient or patient care unit. • NCHs may vary on the average from 5 to 7 hours of care for patient on medical and/ or surgical unit, to 10 to 24 hours of care for selected patient, such as new, severely burned patient.
Determining Full Time Equivalent • FTEs equals 40 hours of work per week for 52 weeks, or 2080 hours per year. • In 2 week pay period, one FTE would equal 80 hours. • For computational purposes, one FTE can be filled by one person or a commination of staff with comparable expertise. For example, one nurse may work 24 hours per week, and tow other nurses may each work 8 hours per week. Together, the three nurses fill one FTE (24+8+8=40).
FTEs equals 40 hours of work per week for 52 weeks, or 2080 hours per year. • In 2 week pay period, one FTE would equal 80 hours. • For computational purposes, one FTE can be filled by one person or a commination of staff with comparable expertise. For example, one nurse may work 24 hours per week, and tow other nurses may each work 8 hours per week. Together, the three nurses fill one FTE (24+8+8=40).
Example Total patient days = = 26 patient per day. Data: Number of hours worked per FTE in weeks = 80 Number of days of coverage in 2 weeks = 14 Average daily census = 26 Average nursing care hours (from PCS) = 6.15 Formula: X= X= = = 27.98, or 28 FTEs
A second technique uses nursing care hours and annual hours of work provided by one FTE: Data: Number of hours worked per FTE in 1 year = 2080 Total nursing care hours (from PCs) = 161 Formula: x = x = = = 28.25, or 28 FTEs
One person working full time usually works 80 hours (ten 8 hour shift) in 2 week period. • However, to staff an 8-hour shift takes 1.4 FTES, ONE PERSON WORKING TEN 8-HOUR SHIFT (1.0 FTE) and another person working four 8-hour shifts (0.4 FTE) in order to provide for the full time persons 2 days off every week.
Determining Staffing Mix • The same data used to determine FTEs are used to identify staffing mix. • For example, for patient care need involving general hygiene care, feeding, transferring, or turning patient, licensed practical nurses (LPNs) or unlicensed assistive personnel (UAPs) can be used.
For patient care needs involving frequent assessments, patient education, or discharge planning, RNs will be needed because of the skills required. • A high RN skill mix allows for greater staffing flexibility. • Again, information on typical or usual patient needs is obtained by using trends from the patient classification system.
Determining Distribution of Staff • For many patient care unit , the distribution of staff varies from shift and by days of week. patient census on a surgical unit will probably fluctuate throughout the week, with a higher census Monday through Thursday and a lower census over the weekend.
The workload on many units also varies within the 24 hour period. The care demands on ta surgical unit will be heaviest early in the morning hours prior to the start of the surgical schedule, mid morning when the unit receiving patient from critical care unit, late in the afternoon when patient return from the post anesthesia recovery unit and in the evening hours when same day surgical patient are discharged.
Block Staffing • Involves scheduling a set staff mix for every shift. • However, there may be trends in peak work load hours in emergency departments, when additional staff (RN, UAP, or secretary) beyond the block staff are necessary department may be from 6:00 pm to 10:00 pm to accommodate patient needs after physicians offices close or from 10:00 am to 3:00 am to accommodate alcohol related injuries.