ASSIGNMENT

SYSTEM
FOR STAFFING
Jazzyl Keth Tongab
Marvilyn Paltiyan
CASE METHOD

– PATIENT ASSIGNED TO A NURSE FOR TOTAL PATIENT CARE

– 1:1 NURSE/PATIENT RATIO

TOTAL CARE/ CASE
NURSING
HEAD NURSE

STAFF NURSE

PATIENT
CASE METHOD

– ADVANTAGES – DISADVANTAGES
– CONSISTENCY OF CARE – NURSE MAY NOT HAVE
FOR 1 WHOLE SHIFT SAME PATIENT THE NEXT
DAY OF DUTY
– MORE OPPORTUNITY TO
OBSERVE AND MONITOR
PATIENT’S CONDITION
 FUNCTIONAL NURSING

HEAD NURSE/SENIOR NURSE

NURSING
MEDICATION TREATMENT HOUSE KEEPING
ASSISTANT

PATIENT
FUNCTIONAL NURSING

– HIERARCHIAL STRUCTURE PREDOMINATES

– IMPLEMENTS SCIENTIFIC MANAGEMENT

– DIVIDES WORK TO BE DONE

– MEDICATION NURSE
– TREATMENT NURSE
– BEDSIDE NURSE
FUNCTIONAL NURSING

ADVANTAGES DISADVANTAGES
– WORK DONE FASTER  HOLISTIC CARE NOT
ACHIEVED 
FRAGMENTATION OF
NURSING CARE
– WORKERS WORKS FASTER
 NURSE-PATIENT
RELATIONSHIP IS NOT FULLY
– DEVELOPED SKILL IN DEVELOPED
CERTAIN PARTICULAR  EVALUATION OF NURSING
TASK CARE IS POOR
TEAM NURSING

– INTRODUCED IN 1950s DUE TO SCARCITY OF RN’S AFTER

WW II
– BASED ON PHILOSOPHY OF GROUP ACTION TO ACHIEVE
GOAL
– FEATURES:
– NURSING CARE CONFERENCE
– PURPOSE: DEVELOPMENT & REVISION OF NCP

– NURSING CARE PLAN

TEAM NURSING
CHARGE NURSE

TEAM LEADER

NURSING STAFF

PATINTS/CLIENTS
TEAM NURSING

ADVANTAGES DISADVANTAGES
– WORK SHARED WITH – UNPERSONALIZED,
FRAGMENTED PATIENT
OTHERS
CARE
– COMPLEX
COMMUNICATION
– ACCOUNTABILITY AND
RESPONSIBILTY SHARED
WITH OTHERS  CAUSE
CONFUSION
PRIMARY NURSING

 RN GIVES TOTAL CARE TO 4- 6 PATIENTS WHILE ON DUTY

 PRIMARY NURSE
 RESPONSIBLE FOR THE CARE OF THE PATIENT x 24 HOURS
THROUGH OUT HOSPITALIZATION

 ASSOCIATE NURSE
 CARE FOR THE PATIENTS USING THE CARE PLAN DEVELOPED
BY THE PN  WHEN PN IS OFF DUTY
 PRIMARY NURSING

PHYSICIAN HOSP. & COMM.

HEAD NURSE
RESOURCES

PRIMARY NURSE
PATIENT

SECONDARY ASST. SECONDARY ASST.

SRCONDARY NURSE NURSE NURSE
PM NIGHT RELIEVER
PRIMARY NURSING

ADVANTAGES DISADVANTAGES
 DEVELOPED TRUSTING – HIGH COST  HIGHER RN
RELATIONSHIP BETWEEN RN SKILL
& PATIENT AND FAMILY

 DEFINED ACCOUNTABILITY – PROXIMITY OF PATIENT

& RESPONSIBILITY ASSIGMENT

 HOLISTIC/CONTINUITY OF
CARE – OVERLAPPING OF STAFF
FUNCTION
MODULAR OR DISTRICT
NURSING

 MODIFICATION OF TEAM & PRIMARY NURSING

 DIVIDES AREA INTO MODULE/GROUP OF PATIENT
 EACH MODULE CARED BY A TEAM NURSE
 A KIND OF TEAM NURSING
 RN
 PLAN THE CARE
 DELIVER CARE
 DIRECTS PARAPROFESSIONALS ON TECHNICAL ASPECTS OF
CARE
MODULAR NURSING

– ADVANTAGES

– INCREASED CONTINUITY AND QUALITY OF CARE

– MORE TIME SPENT IN DELIVERY OF CARE

MANAGED CARE

 UNIT-BASED CARE SYSTEM

 USES STANDARD CRITICAL PATH WITH NCP

 CRITICAL PATH METHOD – CPM

 CALCULATE A SINGLE TIME ESTIMATE FOR EACH ACTIVITY, THE
LONGEST POSSIBLE TIME
 COST ESTIMATE FIGURED FOR BOTH NORMAL & CRASH
OPERATING PROCEDURE
▪ NORMAL  THE LEST COST METHOD
▪ CRASH  CONDITION IN LESS THAN NORMAL TIME
CASE MANAGEMENT

– 2ND GENERATION PRIMARY NURSING

– FOCUSES ON ENTIRE EPISODE OF ILLNESS

– CARE IS COORDINATED BY A CASE MANAGER

CASE MANAGEMENT

 INVOLVES:
 CRITICAL PATH S
▪ VISUALIZE OUTCOMES WITHIN A TIME FRAME

 VARIATION ANALYSIS
▪ NOTES POSITIVE OR NEGATIVE CHANGES FROM CRITICAL PATH
▪ CAUSE & CORRECTIVE ACTION TAKEN

 INTERSHIFT REPORTS
CASE MANAGEMENT

– CASE CONSULTATION
– INDICATED WHEN CLIENT’S CONDITION DIFFERS FROM CRITICAL
PATH AS NOTED IN THE INTERSHIFT REPORT

– HEALTH CARE TEAM MEETING

– PROVIDE INTERDISCIPLINARY APPROACH TO PROBLEM SOLVING
COLLABORATIVE
PRACTICE

– INCLUDE
– INTERDISCIPLINARY TEAMS

– NURSE-PHYSICIAN INTERACTION IN JOINT PRACTICE

– NURSE-PHYSICIAN COLLABORATION IN CARE GIVING

PATIENT CLASSIFICATION
SYSTEM

********************** PURPOSES
**
– QUANTIFY THE QUALITY – FOR STAFFING
OF NURSING CARE BY – PROGRAM COSTING AND
MATCHING PATIENTS’ FORMULATING BUDGET
NEEDS TO NUMBER AND – TRACK CHANGES IN
KIND OF NURSING PATIENT CARE METHODS
PERSONNEL USING TIME – DETERMINE VALUES FOR
AS THE UNIT OF PRODUCTIVITY EQUATION
MEASURE – DETERMINE QUALITY
PATIENT CLASSIFICATION
SYSTEM

 NURSE MANAGER MUST DETERMINE THE FOLLOWING

 NUMBER OF CATEGORIES IN WHICH PATIENT SHOULD BE
DIVIDED

 CHARACTERISTIC OF PATIENTS/CATEGORY

 TYPE AND NUMBER OF CARE PROCEDURES NEEDED BY PATIEN

/CATEGORY

 TIME NEEDED TO PERFORM THE PROCEDURES

 PATIENT CARE
CLASSIFICATION SYSTEM

LEVELS OF CARE NCH NEEDED /DAY RATIO OF PROF. TO NON-

PROFESSIONALS

LEVEL I - SELF CARE OR MINIMAL 1.5 55:45

CARE

LEVEL II – MODERATE OR 3.0 60:40

INTERMEDIATE

LEVEL III – TOTAL OR INTENSIVE 4.5 65:35

CARE

KLEVEL IV – HIGHLY SPECIALIZED 6.0 70:30

OR CRITICAL CARE 7 or higher 80:20
PATIENT CARE
CLASSIFICATION SYSTEM

– LEVEL I: Minimal Care or Self care

– Can take a bath on his own
– Perform ADL on his own
– Patient about to be discharge
– Non-emergency cases
– Do not exhibit unusual symptoms
– Requires little treatment
PATIENT CARE
CLASSIFICATION SYSTEM

 LEVEL II: Intermediate or Moderate Care

 Needs assistance in bathing, feeding or ambulating for short
periods of time
 Extreme symptoms have subsided or yet to appear
 Have slight emotional needs
 With IVF or BT
 Semi-conscious
 Have some psychosocial or social problem
 Periodic treatment, observation
PATIENT CARE
CLASSIFICATION SYSTEM

 LEVEL III: Intensive, Total, Complete Care

 Completely dependent on nursing personnel
 On continuous O2 therapy
 With chest or abdominal tubes
 Requires close observations
 LEVEL IV: Highly Specialized Critical Care
 Needs continuous treatment & observations
 VS q 15 minutes
 Hourly I & O
 Significant changes in Doctor’s order
 PERCENTAGE OF PATIENT AT
VARIOUS LEVEL OF
CARE/TYPE OF HOSPITAL
TYPE OF HOSPITAL MINIMAL CARE MODERATE INTENSIVE CARE HIGHLY
CARE SPECIALIZED CARE

PRIMARY 70 25 5 -

SECONDARY 65 30 5 -

TERTIARY 30 45 15 10

SPECIAL TERTIARY 10 25 45 20
COMPUTING FOR NUMBER OF
NURSING PERSONNEL
NEEDED
– Ensure that there is sufficient staff to:
– Cover all shifts
– Off duties
– Holidays
– Leaves
– Absences
– Time for staff development
COMPUTING FOR NUMBER OF
NURSING PERSONNEL
NEEDED

 RA 5901: Forty-Hour Week Law

 EMPLOYEES WILL WORK 40 HOURS/WEEK FOR:
▪ Hospitals with 100 bed capacity or more
▪ Community population with at least 1 million population
 However;
 ANURSE WILL RENDER 48 HOURS/WEEK WITH ONLY I DAY
OFF DUTY A WEEK IF
▪ Hospitals with less than 1oo bed capacity
▪ Communities with less than 1 million population
STAFFING FORMULA

1. Categorize the number of patients according to the levels of

care needed.
 Multiply total # of patient by % of patient at each Level of
Care
 Ex. Find the # of Nursing Personnel needed for 250 bed
capacity in a tertiary hospital
▪ 250 patients x .30 = 75 patients needing minimal care – L1
▪ 250 patients x .45 = 112.5 patient needing moderate care – L2
▪ 250 patients x .15 = 37.5 patients need intensive care – L3
▪ 250 patients x .01 = 25 patients needed highly specialized nursing
care – L4
Staffing formula

2. Find the # of NCH needed by patients at each level of care /day

▪ A. find the number of patients at each level by the average number of
NCH needed/day
▪ B. get the sum of NCH needed at various level
 75 patients x 1.5 NCH needed at Level I = 112.5
 112.5 patients x 3 NCH needed at Level II = 337.5
 37.5 patients x 4.5 NCH needed at level III= 168.75
 25 patients x 6 NCH needed at Level IV = 150
_______
total 768.75
NCH/day
STAFFING FORMULA

3. Find the total NCH needed by given no. of patient or bed

capacity/ year
 total NCH needed/day x total number of days in a year
 768.75 x 365 days/year = 280,593.75 NCH/year

4. Find the actual working hours rendered by each nursing

personnel per year
 8 hours x 213 working day/year = 1,704 working hours/year
STAFFING FORMULA

5. Find the total # of nursing personnel needed

 Total NCH /year = 280,593.75 = 165 TNP
working hrs/year 1,704

 Find the number of reliever

▪ Total Nsg. Personnel x 0.15 (For those working 40 hours a
week) = 165 x 0.15 = 25
▪ total Nsg. Personnel x 0.12 (For those working 48 hours a week)

 Add no. of relievers to no. of nursing personnel needed

▪ 165 + 25 = 190 nursing care personnel needed
STAFFING FORMULA

6. Categorize as to professional and non-professional personnel

 Ratio of professional to non-professional in tertiary hospital is 65:35
▪ 190 x .65 = 124 professional nurses
▪ 190 x .35 = 66 nursing attendants

7. Distribute by shift
 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
STAFFING FORMULA

7. Distribute nursing attendants/ shift

– 66 nursing attendant x .45 = 30 nsg. Attendant AM shift
– 66 nursing attendant x .37 = 24 nsg. Attendant PM shift
– 66 nursing attendant x .18 = 12 nsg. attendant
NCH/ patient / day : according
to classification/unit

– The Hospital Nursing Service Administration Manual of

DOH has recommended the following NCH for patients in
various nursing units of hospitals
----------------------------------------
--

CASES NCH/PT/DAY PROF TO NONPROF 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. PATHOLIGIC NURSERY 2.8 55:45

7. ER/ICU/RR 6.0 70:30

8. CCU 6.0 80:20