patient classification system,staffing for nurses very important

1. Patient classification system
Prepared by:
1- Ahmed Mohammed Zinhom
2- Amira El Sayed
Under supervision:
Prof: Nehad Fekry

2. Objectives:
 At the end of the lecture the student will
be able to:
 Define the pcs.
 Explain the purpose of pcs
 Discuss types of pcs
 Explain the difference between
prototype and factor type pcs.
 Explain formula for nursing work load
Standard.

3. 1. Define:
◦staffing
◦staffing pattern
◦staffing plan
◦staff mixes
2-Enumerate the goal
of staffing.
3-List objectives of
staffing.

4. 3-List types of staffing.
4-Identify methods for use of supplementary staff.
5-Identifiy factors affecting staffing pattern
determination.
6-Defferentiate between the two types of staffing
component.
7-Compare between tow types of patient
classification system.

5. Out Lines:
Introduction
Definition of pcs
Purpose of pcs.
Importance of pcs.
Types &styles of pcs.
Prototype evaluation system.
Factor evaluation system.
Categories of pcs.
Formula for nursing workload standard

6. -Definitions:
◦ staffing
◦ staffing pattern
◦ staffing plan
◦ staff mixes
- The goal of staffing.
- Objectives of staffing.
- Types of staffing pattern.
- Factors affecting staffing pattern
determination.

7.  Introduction:
 Care quality is highest when work load and staffing
resources are properly balanced.
 Serious understaffing impairs care quality, because
overworked nurses lack time to perform essential
protective and therapeutic measures.
 Marked overstaffing impairs care quality by encouraging
excessive socializing among nursing personnel, which
leads to relaxed practice standards and neglect of critical
care measures.
 Understaffing, overstaffing, and an improper staff mix
diminish nurses, job satisfaction and cause excessive
turnover, with significant financial.

8. Definition of staffing
- Staffing refers to the number and mixture of
personnel assigned to work in nursing units at a
given time.
- Is defined as human resources planning to fill positions on
organization with qualified personnel.
- Is process of determining and providing the acceptable
number and mix of nursing personnel to met and produce
desired level of care to meet the patient's demand for care .

9. - Filling position in the organization structure through
identifying work force requirements , inventorying the
people available ,recruitment, selection, placement,
promotion, appraisal, compensation, and training of
needed people.
Staffing pattern:
Is a written plan that specifies the number and
classification type of staff personnel who are needed
to implement a care delivery model for each unit .

10. Staffing plan:
Indicates how many persons of what job
classification should be on duty per each unit
per shift .
Staff mixes:
Is the skill level of individual delivering the
required care ,In nursing it include : technical
nurses and practical nurses.

11. - To provide adequate numbers of the
right mixture of nursing personnel to
give proper care to patients housed in
the unit at a particular time.

12. - Establish a balance between the nursing staff available with
the manpower required ,according to the patients and their
care needs
- Provide sufficient staff to permit a1:1 nurse-patient ratio for
each shift in every critical care unit.

13. - Provide sufficient nursing staff general medical-
surgical ,obstetrics ,pediatrics, and psychiatric units to
permit a 1:5 nurse-patient ratio on day and afternoon
shifts and 1:10 nurse-patient ratio on night shifts.
- Summarize the data on actual versus required staff.
- Improve moral, job satisfaction and quality care with
decrease in turnover and vacancies.

14. - Evaluate staffing practices periodically.
- Recruit qualified personnel.
- Provide new employees with orientation period.
- Develop personnel policies that attract and provide
effective staff member.

15. STAFFING PROCESS

16. Staffing is logical operation that consist of
several interdependent actions, such as:
1)Identifying the type and amount of services
needed by organization client.
2) Determining the personnel categories that
have the knowledge and skill to perform needed
services measures .
3) Predicting the number of personnel in each
job category that will be needed to meet
anticipated services demands .

17. 4)Obtaining budgeted points for the numbers in
each job category needed to service for the
expected types and number of clients.
5) Recruiting personal to fill available positions.
6) Selecting and appointing personnel from
suitable applicant.
7) Combing personnel into desired configuration
by unit and shift.
8) Orienting personnel to fulfill assigned
responsibilities.
9) Assigning responsibilities for client services to
available personnel.

18. Staff classification
1-Professional nurse: Baccalaureate degree.
2-Technical nurse: Secondary Technical
Nursing School . ( Diploma degree).
3-Auxiliary: messenger and transport
personnel.

19. Components of Staffing
1- Staffing pattern:
it is the number and mix of personnel that should
be on duty per each unit per shift, per day.
2- Staffing plan:
It determines the number of nursing personnel that
must be hired to deliver nursing care on the
nursing units.

20. There are three essential methods of nurse staffing
pattern:
I. The traditional fixed staffing pattern.
II. The controlled variable staffing pattern.
III. The semi-flexible staffing pattern.
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21. I. The traditional fixed staffing pattern:
In this method the staffing pattern is built around a fixed
projected maximum workload requirement.
Limitation of this method: it ignores the fluctuation in the work
load(patients condition and number) or staff member
condition(shortage ,absenteeism)
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22. II. The controlled variable staffing pattern:
In this method, the units are staffed below the maximum
workload conditions and staff is then supplemented as
needed.
Although this is very effective method for staffing , it creates
dissatisfaction among staff.
Method for use of supplementary staff:
1. Borrowing method
2. Floating method
3. On – call staff
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23.  Methods used in supplementary staff :
A) Borrowing method
This common method of borrowing staff from unit to
unit .to help those who have too little staff .
:The problem with this method is that
1- the staff often resent being transferred from unit to unit
2- the head nurse never admits that she has more nurses .

24. B) Floating method
This is a better method for managing staffing needs . Nurses who
are permanent workers but don't belong to any special units are
used to fill any shortage in staff
Advantage :-
1- help to manage the day to day variations in work volume .
2- some nurses like this method to gives her chance to work with different types of
patient.
C) on-call staff
 Usually on-call staff is filled with fixed staff that receive extra pay for being on call
whether they are called or not .
 This method is useful in OR , ICU

25. III. The semi-flexible staffing pattern:
In this method , about 10% to 15% of staff are fixed
and the rest flexible (supplementary) and the
volume is adjusted to match workload needs.
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26. 1. Nursing organization factors.
2. Patient factors.
3. Staff factors.
4. Health organization factors.
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27. Factors affecting staffing pattern
Nursing organization factors
1.Patient care objectives
2.Determined level of patient care
3.Nursing division
4.Assignment system
5.Services to staff

28. Patient factors
from the organization
Variety of patient conditions
Acuity
Length of stay
Patient number
Age groups ( pediatric , adults )
General health status and health goals

29. Staff factors
1- Job description
2- Educational level of staff
3- Experience level of staff
4- work ethics of staff members
5- Expectation of staff
6- staff number available

30. Health organization factors:
1- financial resources available
2- Personal polices
3- Support services within the
organization
4- Numbers of beds per units
5- Budget available

31. Methods of determining the staffing pattern
1- The traditional system
1 - The number of beds per unit ( one
nurse per 4-6 beds), or
2 - The average census of patients per
unit ( one nurse per 4 patients).

32. The distribution of nurses is based on the nurse
manager' opinion of the proportion of care that is
needed on each shift and the adequate staff number
to provide that care.
Example: Days: 45% of the staff
Evenings 35% of the staff
Nights 20% of the staff
The traditional system ignored that the
group of patients might need more care
than another group of the same number.

33. 2- The advanced system
A- PATIENT CLASSIFICATION.
B- TASK QUANTIFICATION.

34. Focuses on patient needs. Patients are
grouped according to the acuity of their
needs and the degree of their dependency
on nurses. The patients grouped according
to their nursing needs into 3 or more
groups:
Group 1: Self care
Group 2: Partial or intermediate care
Group 3: Intensive or total care

35. For example:-Determining nursing care hour by patient classification
system in medical-surgical unit by
No of pts Acuity level of care Associated hours of care Total No of hr
needed
3 I 2 6
10 II 6 60
11 III 7 77
2 IV 9 18
36 161

36. Task quantification system
Focuses on nursing tasks. To be performed.
Common nursing tasks are either direct nursing
care ( in the presence of the patient as in giving
medication, measuring vital signs…..) or indirect
nursing care ( away from the patients as in
preparing medication , documentation in patients'
files, giving instructions or educative
sessions……)

37. I. Staffing plan:
Indicates scheme mathematically derived to indicate how many
people of what classification must be hired in order to deliver
staffing pattern.
Staffing pattern determine positions which required to the unit
or the hospital, but staffing plan determine the number of
workers to fill those position.
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38. •Methods of staffing plan:
1- Using calendar days:
Divided the number of days in the year by the number of days actually
worked per nurse per year to drive the number of staff required to fill
one position for the year.
Example :
In some Hospitals in the ICU:
1. The nurse worked 17 days per month
2. So actual working days/year=17×12=204 days
3. The number of nurses needed to fill one position of professional nurse =
364/204=1.8 worker.
4. The number of nurses to fill 6 positions of LPN/year = 6*1.8=11 nurses.

39. 2-using the care hours:-
Calculate P.T hours/unit/shift.
Calculate the total number of nursing hours
required/year.
Calculate the number of staff required to deliver those
hours.
Calculate the number of positions required to deliver
that staff.

40. Example :
In the chemotherapy unit
The patient needs 2 hours of care.
The patient come to take this therapy daily=20.
So the number of patient care hours = 2×20=40h/day.
The number of hours in one shift= 8h.
Then the nurse required to give these hours= 40/8= 5 P.N
The number of workers to fill one position of nurse=1.65
So the number of nurses required to fill 5 positions of P.N =
5*1.65=8nurses

41. •Factors influencing staffing plan:
Job description.
Personnel policies.
Variability in patient care requirement.
Budged resources.
Equipment, supplies and technology.
Staff category.
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42. Criteria for Effective Staffing
Procedure
An effective allocation procedure meets the
following criteria:
Coverage: the number of nurses assigned to be on
duty should be in relation to the minimum number
of nurses required
Quality: the total number of patient care should be
planned in such a way that trained nurses are
available for patient care of 24 hours a day. It should
also cover off days on rotation.

43. Criteria for Effective Staffing
Procedure
Stability: allocation procedure must be consistent
with leave and rotation policy. Each nurse must
know her off, privileged leave etc.
Flexibility: the allocation policy must provide for
flexibility e.g., if a request for days off or leave
comes as emergency, that should be taken care of.
Objectives: there should be fairness in allocation
and scheduling shift duties

44. Written staffing policies should be readily available
in at least the following areas :-
1- Vacations
2- Holidays
3- Sick leave
4- Weekend off
5- Over time
6- Part – time
7-Absenteeism
8-Emergency day off

45. II. Staffing pattern:
Staffing pattern prediction:
To predict the personnel allocation and scheduling system the manager
has to the amount and type of nursing care needed in each nursing
unit(nursing workload).
Work load component:
.1Indirect care : which is consist in each unit
.2Direct care: activities which is varies according to the number and
type of patient (patient classification).

46. Patient classification system

47.  Definition :
 A patient classification system is a method for grouping
patients
According to the amount and complexity of their nursing care
requirements.
 Is a system developed to objectively determine workload
requirement, Staffing needs and work hours.
 It serves as a tool to measure patient needs, care giver
interventions and skills level required to meet this needs
 In most classification systems, patient are grouped
according to their dependency on care givers or the amoun
of caretaker time and ability employed in caring for them.

48.  Purposes of pcs:
1. Determine the required nursing hours needed to provide safe
and efficient patient care based on standards of care and
practice
2. Determine the number and category of staff (skill mix)
needed for providing quality of patient care.
3. Provide data on each patient care unite that directs and
support staffing in decision making
4. Assess level and support services required.
5. Enhance staff satisfaction through stress free work
environment
6. Categorize patients according their needs and the time and
skill needed to satisfy each category needs.
7. Determine work load and nursing care requirements.
8. Recognize time for nursing care needed.

49.  Importanceofpcs:
1.Improvepatientsatisfactionbyprovidingrequiredtimetothe
patientaccordingtohisherneeds.
2.Enhancestaffsatisfactionbydeterminingstaffingneedsand
thosedecreasingworkload.
3.MonitorprovisionofqualitynursingcareAccordingto
internationalstandardinsafeworkenvironment.

50.  Characteristics:
1.Differentiate between intensityofcare amongdefinite classes
2.Match nursingresourcesto patientcare requirementrelate to
time and effortspend on associated activity
3.Economicaland convenientto use .
4.Global
5.Objective
6. Flexible
7. Easyto understand

51. 1-The activity of living
2-feeding
3-Grooming
4-Toileting
5-Comfort measures
6-Mobility

52. Types or Styles of pcs:
Pcs is also known as patient acuity systems and are used to
assist nurse leader to determine workload, requirements and
staffing needs(sullivan,2005)
There are different kind of pcs available, but according to
Sullivan ,the three most commonly used pcs as following:
1.Descriptive :-
The nurse chooses the category that best describes the patient
2. The check list style :
The nurse checks the activity level for each patient in each
category and totals the points for each patient to determine the
level of care
3. Time standard method:
Another method which charge nurse assigns time value based on
various activities that need to be completed for the patient

53. Othertypesofpcs:
i. Prototypeevaluationsystem.
Factorevaluationsystem

54. Prototype evaluation system:
Describes typical patientand varyingneed levels.
Characteristics are listed in five care categoryas follows:
1.CategoryI:patient with acute non chronic, episodic disease
or disabilitywho will return to the pre illness level of
functioning&the care goal complete elimination of the
existinghealth problem
2.CategoryII :patient with chronic disease on which is
superimposed on acute episode of illness, who have the
potential to return to the pre episodic level of functioningand
the care goal managingchronic health problem bypatient
and familywithout ongoingsupport from agency.

55. 1. Category III : patient with chronic disease or disability
where return pre illness level functioning in not possible but
there is potential to increase the level of functioning,
rehabilitation to maximize level of functioning through
continuing agency support .
2. Category IV : patient with chronic disease or disability
who cant be maintained at home without ongoing agency
support ,for whom the care goal is maintenance at home at
maximum level of functioning through ongoing agency
support.
3. Category V :
Patient with en stage illness for whom the care goal is
assurance of comfort and dignity throughout two
terminal stage of illness

56. Factorsevaluationsystem:
inthefactorevaluationsystemnumberofcriticalcaredescriptors
areidentifiedandpatientcareneedsarescoredaccordingpatient
dependencylevel

57. Categories of patient classification systems :
 Category1:Self-carerequiring from1to2hours perday
.
 Category2:Minimal carerequiring from3to4 hours .
 Category3:Intermediate carerequiring from5to6
hours
 Category4:Modified intensive carerequiring from7to
8 hours .
 Category5:Intensive carerequiring from10to14 hours

58. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
1- HOW WELL DOES THE PATIENT
CLASSIFICATION SYSTEM ACCOUNT FOR
VARIATIONS IN PATIENT NEEDS FOR
HOSPITAL SERVICES?
IDENTIFYING PATIENT NEEDS.
 EASY AND QUACK ADAPTATION WITH CHANGED
PATIENT NEEDS.
 RESOURCES .
 FLEXIBLE.

59. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
2- How strong Is the Patient Classification
System?
 refers to the ability of the system to maintain
its properties despite changes in the data used to
create or operate the system , persons using
system.

60. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
3- How Reliable Are Patient Assignments to
Category?
 Reliability should be assessed at several levels :
 primary data which as (sex, age, vital signs and lab
test results , diagnosis,…)
 category assignment (require subjective
Judgment)

61. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
4- How Does the Patient Classification
System Affect Economic Incentives?
admission status (emergency vs. non
emergency), Because emergency
admissions have significantly higher
costs and lengths of stay.

62. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
5- To What Extent Is the Patient Classification
System Meaningful to Care providers?
 care providers must understand the system
 knowing PCS importance
 resources.

63. Criteria for Evaluating the Usefulness of Patient
Classification Systems:
6- How Feasible and valuable Is the System To
Use?
classification systems that use more detailed
data, revision, easy to use, understand.
should be capable by computer to minimize
cost , save time and enhance feasibility

64. Measurement of pcs :
NCH /PPD = NURSING HOURS WORKED IN 24 HOURS
PATIENT CENSUS

65. Using the care hours for developing staffing pattern
Hospitals used the patient care hours for developing staffing pattern, can
calculate the staffing plan using the care hours methods.
For example:----------------------------------------------------------X
Estimating a core staff per shift
Bed number in surgical unit= 25 bed
The average daily census for 6 month = 19 patients
The average daily care hour to be provided= 5 hour per pt/24 hour.
Total hours of care will be needed= 19x5= 95 hours.
If the work day is 8 hours , then 95 divided on 8
= 11.9 or 12 FTE staff needed to unit for 24 hour.

66. Total of 12 EFT x 7 days / week = 84 shift / work------------
--------------------x
If the employee work 5 hours shift / week, then 84
5 = 16.8 the number of EFT needed.
The needed on each shift and the adequate staff number
to provide that care.
Example: days: 45% of staff
45x16.8/100=7.56=8
Evenings 35% of the staff
35x16.8/100=5.88=6
Nights 20% of the staff
20x16.8/100=3.34=3

67. TotalNigh
t
Eve
ning
DayCate
gory
9
5
3
2
1
-
3
2
1
4
2
2
RNs
LPN
Other
17368Total