1. ORGANIZING
Staffing and Scheduling
MJCN2014

2. Staffing
• 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.
MJCN2014

3. Factors Affecting Staffing
• The type, philosophy, and objectives of
the hospital and the nursing service;
• The population served and the kind of
patient served, whether pay or charity;
• The number of patients and severity of
their illness
• Availability and characteristics of the
nursing staff, including education, level
of preparation, mix of personnel,
number and positions.
MJCN2014

4. • Administrative policies.
• Standards of care desired which
should be available and clearly
spelled out.
• Layout of the various nursing units
and resources available within the
department
• Budget
MJCN2014

5. • Professional activities and priorities in
non-patient activities
• Teaching program or the extent of staff
involvement in teaching activities.
• Expected hours of work per annum of
each employee. This is influenced by
the 40=hour week law; and
• Patterns of work schedule – traditional 5
days per week, 8 hours per day; 4 days
a week, ten hours per day and three
days off; or 3 ½ days of 12 hours per
day and 3 ½ days-off per week.
MJCN2014

6. PATIENT CARE
CLASSIFICATION SYSTEM
• A method of grouping patients
according to the amount of
complexity of their nursing care
requirements and the nursing time
and skill they require.
MJCN2014

7. Requirements
• The number of categories into
which the patients should be
divided;
• The characteristics of patients in
each category;
• The type and number of care
procedures that will be needed by
a typical patient in each category;
and
• The time needed to perform these
procedures that will be required by
a typical patient in each category.MJCN2014

8. Classification Categories
• Level I – Self Care or Minimal Care
Average amt of NCH/pt/day = 1.5
Ratio of Prof to NonProf = 55:45
MJCN2014

9. Classification Categories
Level I-Self
Care or
Minimal Care
-NCH
1.5/pt/day
- Ratio 55:45
-Can take a bath on his own; feed himself; perform his
own ADL.
-For discharge pt; non-emergency, newly admitted
don’t exhibit unusual s/s;
- requires little treatment and observation
Level II –
Moderate
Care or
Intermediate
Care
-NCH 3/pt
- Ratio 60:40
-Need some assistance in bathing, feeding, ambulating
for short period.
-Extreme s/s of illness must have subsided or have not
yet appeared
-May have slight emotional needs
-v/s taking ordered 3x/shift; with IVF/BT; are semi-
conscious and exhibiting some psychosocial or social
problems;
- periodic treatments and/or observations and
/instructions
MJCN2014

10. • Level II – Moderate Care or
Intermediate Care
Average NCH/pt/day = 3
Ration or Prof to NonProf = 60:$0
MJCN2014

11. Classification Categories
Level III –
Total,
Complete or
Intensive
Care
-NCM
6hrs/pt/day
-Ratio 65:35
-Patient are completely dependent upon
the nursing personnel.
-They are provided complete bath, are
fed, may or may not be unconscious,
with marked emotional needs; with v/s
monitoring more than 3x/shift
-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
MJCN2014

12. • Level III – Total, Complete or
Intensive Care
Average NCH/pt/day = 6
Ratio of Prof to NonProf = 65:35
MJCN2014

13. Classification Categories
Level IV-
Highly
Specialized
Critical Care
-NCH 6-9 or
more /pt/day
- Ratio 70:30
or 80:20
-Need maximum level of nursing care
with a ratio of 80 professionals to 20
non-professionals.
-Needs continuous treatment and
observation
-With many medications, IV piggy
backs; v/s monitoring every 15-30
minutes; hourly output.
-There are significant changes in
doctor’s orders
MJCN2014

14. • Level IV – Highly Specialized
Critical Care
Average NCH/pt/day = 6-9 hours
Ratio of Prof to NonProf = 70:30 or
80:30
MJCN2014

15. Categories of Level of Care of Patients: Nursing Care
Hours/Pt/Day & Ratio of Prof-Non Prof
Levels of Care NCH Needed Per
Pt./Day
Ratio of Prof to
Non-Prof
Level I – Self-Care
or Minimal Care
1.50 5:45
Level II Moderate
or Intermediate
Care
3.0 60:40
Level III Total or
Intensive Care
4.5 65:35
Level IV Highly
Specialized or
Critical Care
6.0
7 or higher
70:30
80:20
MJCN2014

16. Percentage of Nursing Care
Hours
Type of
Hospital
Minimal
Care
Moderate
Care
Intensive
Care
Highly
Spcl Care
Primary Hosp 70 25 5 -
Secondary
Hosp
65 30 5 -
Tertiary Hosp 30 45 15 10
Spcl tertiary
Hosp
10 25 45 20
MJCN2014

17. 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 80:20MJCN2014

18. Computing for the number of
Nursing Personnel Needed
• Consider sufficient staff to cover all
shifts, off-duties, holidays, leaves,
absences and time for staff
development programs.
• R.A. 5901 – Forty-Hour Week Law
MJCN2014

19. Total No. working-Non working days & hours of
nursing personnel per year
Rights & Privileges Given Each
Personnel Per Year
Working Hours Per Week
40 hours 48 hours
1. Vacation Leave
2. Sick Leave
3. Legal Holidays
4. Special Holidays
5. Special Privileges
6. Off-Duties as per R.A. 5901
7. Continuing Education Program
Total Non-working Days per year
Total working days per year
Total working hours per year
15
15
10
2
3
104
3
152
213
1,704
15
15
10
2
3
52
3
100
265
2,120
MJCN2014

20. Relievers Needed
- To compute for relievers needed, the following should
be considered;
1. Average number of leaves taken each year------ 15
a. vacation 15
b. sick leave 5
2. Holidays -----------------------------------------------------12
3. Special Privileges as per CSC MC#6 s. 1996-------3
4. Continuing Educ. Prog. For professionals------------3
Total Average Leave-------33
MJCN2014

21. To determine the relievers
needed
- divide 33 by number of working days per year
each employee served (whether 213 or 265)
- result will be 0.15 per persons works for 40
hour/week
- result will be 0.12 per persons works for 48
hour/week
- multiply the computed reliever per person by the
computed number of nsg personnel
- this will give you the total number of relievers
MJCN2014

22. Distribution by Shifts
• 45% AM shift, 37 % PM and 18 %
night
MJCN2014

23. 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
MJCN2014

24. 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
MJCN2014

25. 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
MJCN2014

26. 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 noc
Total = 66 nursing attendants
MJCN2014

27. Placement
• Advantages
–Fosters personal growth
–Provides motivating climate for
the employee
–Maximizes productivity
–Organizational goals have better
chances of being met.
MJCN2014

28. • Results of Inappropriate
placement
–Frustration
–Poor quality of work
–Reduced organizational
efficiency
–Rapid turn-over
–Poor image of the agency
MJCN2014

29. Factors to consider
• Inherent in the employee
• Past experience and training
• Culture of the clientele
• Decision-making skills
• Communication skills
MJCN2014

30. Advantages of proper
placement
• Adapt faster
• Feet are lighter
• A lot happier
• Felt confident when supervised
MJCN2014

31. Scheduling
• A timetable showing planned
work days and shifts for
nursing personnel.
MJCN2014

32. Factors considered in Making
Schedules
• Different levels of the nursing staff;
• Adequate coverage for 24 hours,
seven days a week;
• Staggered vacations and holidays;
• Weekends and long stretches of
consecutive working days;
• Evening and night shifts; and
• Floating.
MJCN2014

33. Assessing a scheduling
system
• Ability to cover the needs of the
unit.
• Quality to enhance the nursing
personnel’s knowledge, training
and experience.
• Fairness to the staff
• Stability
• Flexibility
MJCN2014

34. Types of Scheduling
• Centralized Schedule
• Decentralized Schedule
• Cyclical Schedule
MJCN2014

35. Advantages of Cyclical
Schedule
• It is fair to all
• It saves time
• Enables the employee to plan
ahead for their personal needs
• Scheduled leave are more stable
• Productivity is improved.
MJCN2014

36. Rotating Work Shifts
• Common in most hospitals.
MJCN2014

37. Assessing a Scheduling System
1. Ability to cover the needs of the unit
2. quality to enhance the nursing personnel's
knowledge, training and experience
3. fairness to the staff – fair share of
weekends, holiday offs, rotation patters for the
whole year including assignment to “difficult”
or “light” or “undesirable” units or shifts
4. stability – the schedule must be harmonized
with their family or social activities of the
nurse staff
5. flexibility – ability to handle changes brought
by emergency leaves.
MJCN2014

38. Make a schedule in a weekly or
monthly basis and do cycle
system with the staff under the
area assigned for fairness and
flexibility.
MJCN2014

39. A one-week cyclical schedule
Personnel S M T W T F S
7/3 Headnurse/Senior Nurse x x
Staff Nurse x x
Nsg. Att. x x
3/11 Staff Nurse x x
Nsg. Att. x x
11/7 Staff Nurse x x
Nsg. Att. x x
Gen. Rel. 3/11; 11/7 S. nurse 3/11 3/11 11/7 x x 3/11 11/7
N. Att. 3/11 11/7 x 7/3 3/11 11/7 x
MJCN2014

40. Organizing Patient Care
MJCN2014

41. • What is our focus……
• Why are we here…….
• ….patients now more than ever
need reassurance that they are
indeed the focus of the
healthcare team - Joan
Shinkus Clark
MJCN2014

42. Traditional Modes of Care Delivery
• Total Patient Care
• Functional Nursing
• Team and Modular Nursing
• Primary Nursing
• Case Management
MJCN2014

43. • Care delivery modalities (modes)
affect autonomy and job
satisfaction.
• Direct pt care functions are actually
caring for pt.
• Indirect pt care functions are like
being able to self schedule,
charting
MJCN2014

44. Total Patient Care
• Total patient care - nurses assume total
responsibility for meeting all needs of assigned
patients during their time on duty
– ICU
– Form of primary nursing
MJCN2014

45. Functional Method
• Functional nursing - work assignment by
functions or tasks, such as passing medicine,
doing dressing changes, giving baths, or taking
vital signs
• Assignment by function.
MJCN2014

46. Team Nursing
• Team nursing - a team of RNs, and aides
under the supervision of one nurse, called the
team leader
MJCN2014

47. Primary Nursing
• Primary nursing is an approach in which a
nurse has responsibility and accountability for
the continuous guidance of specific clients from
hospital admission through discharge
MJCN2014

48. Case Management
• Case management in acute care hospital
nursing has been defined as a system of client
care delivery that focuses on the achievement
of client outcomes within effective and
appropriate time frames and resources
MJCN2014

49. CASE MANAGEMENT SERVICE
AREAS
MJCN2014
Category Service Setting
Acute
Orthopedics, cardiovascular, critical care, high-risk perinatal, oncology,
emergency department
Subacute Skilled nursing centers, rehabilitation units
Ambulatory Physician's office, clinics
Long-term care Nursing homes, group homes, assisted-living facilities
Insurance
companies
Health maintenance organizations (HMOs), preferred provider organizations
(PPOs), workers' compensation, Medicaid, Medicare
Community
Nurse-managed centers, home health agencies, urgent care centers, schools,
rural settings

50. Disease Management
• Common high-cost, high-resource utilization
diseases
• Population-based health care
– Covered lives
• Continuous health improvement
MJCN2014

51. Job descriptions
• It is a written statements, found in
policy manuals that describe the duties
and functions of the various jobs
within the organization.
• They outline the scope of authority,
responsibility, and accountability
involved in each position.
MJCN2014

52. Job descriptions
• It should provide
1. the broad general
guidelines under which the
individual will function
2. the basis for performance
evaluation of the person
working in that role
MJCN2014

53. Contents of a Job
Description
• 1. Identifying Data
• 2. Job Summary
• 3. Qualification Requirements
MJCN2014

54. Uses of Job Description
• 1. For recruitment and selection
of qualified personnel
• 2. To orient new employees to
their jobs
• 3. For job placement, transfer or
dismissal
• 4. As an aid in evaluating the
performance of an employee
MJCN2014

55. Uses of Job Description
• 5. For budgetary purposes
• 6. For determining departmental
functions and relationships to
help define the organizational
structure
• 7. To serve as channel of
communication.MJCN2014

56. Uses of Job Description
• 8. For classifying levels of nursing
functions according to skill levels
required.
• 9. To identify training needs
• 10. As basis for staffing
MJCN2014

57. Developing Job descriptions
• Contents
– Identifying data
– Job summary
– Qualification requirements
– Job relationships
– Specific and actual functions and
activities
MJCN2014

58. Uses of Job Description
• For recruitment and selection of
qualified applicants
• To orient new employees to their
jobs
• For job placement, transfer or
dismissal
• As an aid in evaluating the
performance of an employee
MJCN2014

59. • For budgetary purposes;
• For determining departmental
functions and relationships to
help define the organizational
structure;
• For classifying levels of nursing
functions according to skill levels
required;
• To identify training needs;
• As basis for staffing; and
• To serve as channel of
communication.
MJCN2014

60. DISCIPLINE

62. MEANING
The word “discipline” is derived from
the Latin word “disciplina”, which
means teaching, learning and
growing.

63. TYPES OF DISCIPLINE
1. Self controlled discipline
2. Enforced Discipline

64. INDISCIPLINE:-
Indiscipline means disorderliness,
insubordination and not following
the rules and regulation of an
organization.


65. Causes of indiscipline:-
• Non-placement of the right person
on the right job
• Undesirable behaviour of senior
officials.
• Faulty evaluation of persons and
situations by executives leads of
favoritism.
• Lack of upward communication.
• Leadership which is weak, flexible,
incompetent and distrustful.

66. • Defective supervision and an absence of good
supervisors who know good techniques, who
are in a position to appreciate critically the
efforts or their subordinates.
• Lack of properly drawn rules and regulations.
• Workers’ personal problems, their fears,
apprehensions, hopes and aspirations; and
their lack of confidence in and their inability to
adjust with their superior and equals.
• Worker’s reactions to rigidity and multiplicity of
rules and their improper interpretation.
• Intolerably bad working conditions.

67. • Inborn tendencies to flout rules.
• Absence of enlightened, sympathetic
and scientific management.
• Errors of judgement on the part of the
supervisor or the top management.
• Improper co-ordination, delegation of
authority and fixing of responsibility.
• Discrimination based on caste, colour,
creed, sex, language, and place in
matters of selection, promotion,
transfer, placement and discrimination
in imposing penalties and handling out
rewards.

68. APPROACHES TO DISCIPLINE:-
The different approaches to
discipline include;
• Human relation approach: In
human relation approach the
employee is. helped to correct his
deviations
• Human resources approach:
Under the human resources
approach, the employee is treated
as resource and the act of
indiscipline are dealt by
considering the failure in the area
of development, maintenance and
utilization of human resources.

69. • Group discipline approach: The
group as a whole sets the standards
of discipline, and punishments for
the deviations. The individual
employees are awarded
punishments for their violation under
the group discipline approach.
• Leadership approach: In this
approach, every supervisor
administers the rules of discipline
and guides, trains and controls the
subordinates regarding disciplinary
rules.

70. • Judicial approach: In judicial
approach, indisciplinary cases
are dealt on the basis of
legislation and court decisions.
The Industrial Employment Act,
1946, to a certain extent,
prescribed the correct procedure
that should be followed before
awarding punishment to an
employee in India.

71. PRINCIPLES FOR MAINTENANCE OF
DISCIPLINE:-
The most important principles to be
observed in the maintenance of
discipline have been outlined by
Yoder, Heneman, Turnbull and
Harold Stone. They are:
 All the rules should be framed in co-
operation and collaboration with the
representatives of employees.
 All the rules should be appraised at
frequent and regular interval to
ensure that they are, and continue to
be, appropriate, sensible and useful.

72. Cont..  Rules should vary with changes in
the working conditions of
employees.
 Rules should be uniformly enforced
if they are to be effective.
 Penalties for any violation of any
rules should be clearly stated in
advance.
 A disciplinary policy should have as
its objectives the prevention of any
infringement rather than the simple
administration of penalties; however
it should be preventive rather than
punitive.

73.  Extreme caution should be exercised to
ensure that infringements are not
encouraged.
 If violations of a particular rule are fairly
frequent, the circumstances surrounding
them should be carefully investigated
and studied in order to discover the
cause or causes of such violations.
 Recidivism must be expected. Some
offenders would almost certainly violate
rules more often than others. These
cases should be carefully considered so
that their causes may be discovered.
 Definite and precise provisions for
appeal and review of all disciplinary
actions should be expressly mentioned in
the employees’ handbook or collective
agreements.

74. ASPECTS OF DISCIPLINE:-
Positive aspect: Employees believe in and support
discipline and adhere to the rules, regulations and
desired standards of behaviour. Discipline takes the
form of positive support and reinforcement for
approved actions and its aim is to help the individual in
moulding his behaviour and developing him in a
corrective and supportive manner. This type of
approach is called positive approach or constructive
discipline or self-discipline.

75. Positive discipline takes place
whenever the organizational climate is marked
by aspect such as payment of adequate
remuneration and incentives, appreciation of
performance and reinforcement of approved
personnel behaviour or actions etc.
which will motivate employees to adhere to
certain rules and regulations or exercise self-
control and work to the maximum possible
extent.

76. Negative aspect: Employees sometimes do not
believe in and support discipline. As such, they do not
adhere to rules, regulations and desired standards of
behaviour. As such, disciplinary programme forces and
constraints the employees to obey orders and function
in accordance with set rules and regulations through
warnings, penalties and other forms of punishment.
This approach to discipline is called negative
approach or corrective approach or punitive
approach.

77. • This approach is also called autocratic
approach as the subordinates are
given no role in formulating the rules
and they are not told why they are
punished. Punishment, penalties,
demotions and transfers provide or
establish a climate which demotivate
and delead the employees.

78. The highest level
and most effective
form of discipline
is self-discipline.
Ideally, all
employees should
have adequate
self-control and
should be self-
directed in their
pursuit of
organizational
goals.

79. Definition:
Self discipline is best defined
as the ability to regulate
ones conduct by principle
and sound judgment, rather
than by impulse, desire, or
social custom.
Self discipline can be
considered a type of
selective training, creating
new habits of thought,
action, and speech toward
improving yourself and
reaching goals.

80. The Five Pillars of self
discipline
Acceptance
Willpower
Hard work
Industry
Persistence.
If you take the first letters of each word
you get the acronym “A WHIP”- since
many people associate self discipline
with whipping themselves into shape.

81. To be self disciplined:
• Get yourself organized
• Don’t constantly seek to be entertained
• Be on time
• Keep your word
• Do the most difficult tasks first
• Finish what you start
• Accept correction
• Practice self denial
• Welcome responsibility

82. Health Care Education Associates (1987) identified
four factors that must be present to foster a climate
of self-discipline.
• Employee awareness and understanding of rules
and regulations that govern behaviour- The rules
and regulation must be clearly written and
communicated. Young and Hayne (1988) stated that
the most common reason for unsatisfactory work
performance is that the employee thinks they are
performing satisfactorily. In other words the employee
does not know there is a problem.

83. • There must exist an atmosphere of mutual trust-
Manager must believe that employees are capable of and
actively seeking self-discipline. Likewise employees must
perceive the manager as honest and trustworthy.
Employees lack the security for self-discipline if they do not
trust their manager’s motives.
• Formal authority must be used judiciously-
Approximately one-half of grievance cases appealed before
an arbitrator by labour unions involved disciplinary action. In
about one-half of those cases, management either reversed
or modified its decision when the individual’s appeal was
upheld.
• Employees should identify with the goals of the
organization- When the employees accept the goals and
objectives of an organization, they are more likely to accept
the standards of conduct deemed acceptable by the
organization.

84. DICIPLINARY PROCEDURE:-
The following steps should be taken into consideration:
• Accurate statement of the problem- The first step is
to ascertain the problem by seeking answer to the
following questions:
– Does this case call for a disciplinary action?
– What exactly is the nature of the violation or offence?
– Under what condition did it occur?
– Which individual or individuals were involved in it?
– When or how often, did the violation occur?
• Collecting facts bearing on the case- Before any action is
taken in a case, it is essential to gather all the facts about it.
A thorough examination of the case should be made within
the stipulated time limit.

85. • Selection of tentative penalties- The kind of penalty to be
imposed for an offence should be determined beforehand.
• Choice of Penalty- When a decision has been taken to
impose a penalty, the punishment to be awarded should be
such as would prevent a recurrence of the offence.
• Application of the Penalty- The application of the penalty
involves a positive and assured attitude on the part of the
management. If the disciplinary action is a simple
reprimand, the executive should calmly and quickly
dispose of the matter.
• Follow-up on disciplinary action- The ultimate purpose
of disciplinary action is to maintain discipline, to ensure
productivity, and avoid a repetition of the offence. A
disciplinary action should, therefore, be evaluated in terms
of its effectiveness after it has been taken.

86. BASIC INGREDIENT FOR A DISCIPLINARY
ACTION:-
The principle ingredients of a sound
disciplinary system are:
Location of responsibility
Proper formulation and communication of rules
Rules and regulations should be reasonable
Equal treatment
Disciplinary action should be taken in Private
Importance of promptness in taking
Disciplinary action

87. Innocence is presumed
Get the facts
Action should be taken in cool
atmosphere:
Natural justice
After a disciplinary action has been taken
the Supervisor should treat his
subordinate in a normal manner
Don’t back down when you are right
Negative Motivation should be handled in
a positive manner

88. TYPES OF PUNISHMENT:-
When the delinquent employee is going to be
punished, the type of punishment should be a
commensurate with the severity of the omission or
misconduct.
Different types of punishment resulting from various
types of omission or misconduct are as follows:
– Oral warnings
– Written warnings
– Loss of privileges and fines
– Punitive suspension
– Withholding of increments
– Demotion
– Termination

89. THANK YOU.....