119 4M STAFFING
FUNCTIONAL NURSING OR FUNCTIONAL METHOD (Task-Oriented)
- is a nursing model that focuses on efficiency and getting as many tasks as possible done in the shortest time
Primary Care
A _ care doctor will refer a patient to a specialist if the patient has a health condition that requires specialized knowledge or expertise. While a patient is seeing a specialist, _ care doctors oversee their treatment.
a. The type, philosophy, objectives of the hospital and the nursing service. b. The number of patients and severity of their illness-knowledge and ability of nursing personnel are matched with the actual care needs of patients. c. Administrative policies such as rotation, weekends, and holiday off-duties. d. Layout of various nursing units and resources available within the department such as adequate equipment, supplies, and materials. e. Professional activities and priorities in non patient activities like involvement of professional organizations, formal education development, participation in research and staff development. f. The population served or kind of patients served whether pay or charity. g. Availability and characteristics of the nursing staff, including education, level preparation, mix of personnel, number and position. h. Standards of care desired which could be available and clearly spelled out. i. Budget including the amount alloyed to salaries, fringe benefits, supplies, materials and equipment. j. Teaching program of the extent of staff involvement in teaching activities. k. 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. l. Expected hours of work per annum of each employee. This is influenced by the 40 hour week law.
Affecting Factors of Staffing
staffing
All _ activities are designed to provide each nursing unit with an adequate and acceptable number of workers in each category to perform the nursing tasks that are required.
Patient Classification System
Also known as workload management, or patient acuity tools, it was developed in the 1960s because the formula in calculating nursing care hours per patient-day (NCH/PPD) may result in an incomplete or inaccurate picture of nursing care needs and may be too restrictive.
Emergency Care
Ambulances or other modes of transportation, hospital emergency rooms, or critical care units may be used to provide emergency treatment.
Primary Care
Another priority is to look after a patient's overall health by identifying and treating a wide range of diseases.
Checklist
Another subjective system, wherein the patient is assigned to a numerical value based on the level of activity in specific categories. The numerical value is added up to give the nurse an overall rating.
Skill Mix
Any strategy to evaluate optimum nurse staffing numbers must take into account the factors affecting care at the individual practice setting level.
Acuity of Client's Illness
As acuity rises, more time is needed to provide nursing care
Staffing
Before selecting employees, one must conduct an analysis of the specific job that is required in the organization, followed by personnel selection.
Category #1: Self-Care / Minimal Care Category #2: Moderate Care Category #3: Maximum Care Category #4: Intensive Care
Categories of the Patient Classification System
Primary
Clients usually seek medical help from _ care providers first. Patients may go to a doctor's office or a community health center for _care
Emergency Care
Diagnosing and treating life-threatening diseases or injuries that require rapid treatment is done
Regulatory Requirements
Evidence of compliance with applicable federal, state, and local regulations
Interruptions
Examples include: - intrusions - distractions - breaks
Urgent Care
Examples of _ ● Minor wounds or burns, ● stomachaches, ● sprains, ● ear or throat infections.
Specialists
Examples of _ include: ● cardiologists, ● gynecologists, ● physical therapists ● social workers
Emergency Care
Examples of emergencies: ● Chest discomfort, ● trouble breathing, ● a heart attack, ● a major injury, ● uncontrollable bleeding, ● a mental crisis
1. Acuity of Client's Illness 2. Degree of Dependence of Clients to Nurse 3. Need for Special Treatments and Procedures 4. Interruptions 5. Socializing
Factors Affecting Time Requirements of Nursing Care
Staff Support
Factors such as nurse satisfaction, burnout, turnover, retention, precepting students or new staff, acting as a mentor, care coordination, skill with technology, use of agency or contractual staff, competency requirements, and staff development should be monitored regularly to ensure that staffing outcomes are measured and adjusted
Acuity of Client's Illness
For example, a nurse may have to spend more time caring for a bed ridden client as the nurse has to provide additional care such as providing a bed bath and frequently changing positions to prevent bed sores.
Need for Special Treatments and Procedures
For example, a nurse taking care of a Diabetic client may need to take the blood glucose levels and monitor it regularly.
Degree of Dependence of Clients to Nurse
For example, critically ill patients admitted to intensive care units (ICUs) have a high level of dependency due to their severe illness and compromised body functions.
Category #4: Intensive Care
Frequent evaluation, observation, monitoring and adjustment of therapy is also required. Patients in these levels include those in critical conditions or in life and death situations
Patient Classification System acuity of illness
In nursing, patients are usually classified according to _
Category #4: Intensive Care 10 to 14 hours
Intensive care requiring _.
Category #3: Maximum Care 5 to 6
Intermediate care requiring _ hours.
Centralized Staffing
It allows for staffing decisions to be made based on a comprehensive, enterprise-wide view of patient needs and available staff, which leads to balanced, data-driven decisions for the entire organization
Patient Classification System
It groups patients according to specific characteristics that measure acuity of illness in an effort to determine both the number and mix of the staff needed to adequately care for those patients
Historical Information
Keep intact the effective ways of doing tasks
Historical Information
Knowledgeable of the presence or absence of supplies or equipment
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Look Table 17.1 page 16 of their report
Benchmarking
Management tool for seeking out the best practice in one's industry so as to improve one's performance.
Regulatory Requirements
Mandated by RA 5901; should consider in making a staffing pattern because regular office hours for eight hours a day, for five days a week, or a total of forty hours a week
Category #2: Moderate Care 3 to 4
Minimal care requiring _ hours of care.
Skill Mix
No single approach, model, or evaluation tool [e.g., nursing hours per patient day (NHPPD), case mix index (CMI), nursing intensity weights, or required nurse-to-patient ratios] has been shown to be appropriate in all contexts and circumstances.
Socializing
Nurses have to interact with the client, their significant others, and other health-care team members. This allows for collaboration and networking. Although, this can take up time and delay the work of the nurse.
Patient Classification System
Once an appropriate PCS is adopted, hours of nursing care must be assigned for each patient classification. Although an appropriate number of hours of care for each classification is generally suggested by companies marketing PCSs, each institution is unique and must determine to what degree that classification system must be adapted for that institution.
Patient Classification System
Other variables within the system have an impact on nursing care hours (NCH), it is usually not possible to transfer a PCS from one facility to another. Instead, each basic classification system must be modified to fit a specific institution.
Degree of Dependence of Clients to Nurse
Patient dependency refers to the amount of support needed by a patient whose self-care abilities have decreased and whose care demands make him/her to a certain degree dependent.
Category #3: Maximum Care
Patient needs close attention and complete care all through the shift. The nurses initiate, supervise and perform most of the patient's activities.
Skill Mix
Percentage or ratio of professionals to non-professional
Benchmarking
Process of measuring products, practices and services against best performing organization as a tool for identifying desired standards of organizational performance.
● To delegate the work to be done to the nursing personnel. ● To gain the cooperation of nursing personnel by knowing and accepting of the work to be done. ● To prepare work systematically ● To shoulder accountability.
Purpose of Patient Classification System:
Acuity of Client's Illness
Refers to the complexity and severity of the client's health condition.
Critical Indicator PCS
Refers to those activities on the patient classification instrument that have the greatest impact on direct care time
Regulatory Requirements
Regulations govern how organizations manage their business and employees and how they interact with clients, among many other areas
Benchmarking
Seeking out the best practices in ones institution to improve performance
Category #1: Self-Care / Minimal Care 1-2
Self-care requiring from _ hours per day
Staff Support
Staffing plans should accommodate experienced registered nurses who can offer clinical support to other staff.
1. Determine the number and types of personnel required to carry out the philosophy, meet fiscal planning responsibilities, and carry out the patient care management organization of choice. 2. Recruit, interview, choose, and assign personnel in accordance with job description performance standards. 3. Use organizational resources for orientation and induction. 4. Ensure that each employee has received adequate socialization to organizational values and unit norms. 5. Increase productivity and retention by using creative and flexible scheduling based on patient care needs. 6. Create a staff education program to assist employees in meeting the organization's goals.
Steps on Staffing
Category #1: Self-Care / Minimal Care
The first classification of patients who are recovering and normally requires only diagnostic studies, minimal therapy, less frequent observations, and daily care for minor conditions and are awaiting elective surgery.
Degree of Dependence of Clients to Nurse
The higher the degree of dependence, the more time needed to provide nursing care.
Need for Special Treatments and Procedures
The more special treatments and procedures needed to be done, the more time needed to provide nursing care.
Category #2: Moderate Care
The patient in this category is moderately ill or under the recovery stage from a serious illness or operation. They require nursing supervision or assistance that is related to ambulating and caring for their own hygiene.
Decentralized Staffing
The unit manager is often responsible for covering all scheduled staff absences, reducing staff during periods of decreased patient census, preparing monthly schedules, and preparing holiday schedules.
Summative Task Type PCS
These measures are task and frequency-based and assume that patient care requirements are best expressed as the sum of a series of observable tasks and activities.
Descriptive
This is a purely subjective system wherein the nurse selects which category the patient is best suited.
Time Standards
This is another method where the nurse assigns a time value based on the various activities needed to be completed for the patient. This time value is sum up and converted to an acuity level.
Summative Task Type PCS
This requires the nurse to check off the activities, treatments, and procedures according to the frequency of occurrence for each patient in her care. Such as the frequency of occurrence of specific activities, treatments, and procedures for each patient.
1. Descriptive 2. Checklist 3. Time Standards
Three most commonly used PCS
high absenteeism or staff turnover
Too few or an ineffective mix of nursing personnel will have a negative impact on the quality and quantity of work performed. A situation like this can result in _ and _, resulting in low morale and dissatisfaction.
1. Critical Indicator PCS 2. Summative Task Type PCS
Types of Patient Classification System Measurement Tools
Each type of tool is designed to connect staffing and scheduling in various ways, with the goal of assuring the right number and type of staff needed to care for any given patient group.
Types of Patient Classification System Measurement Tools
Critical Indicator PCS
Uses broad indicators to categorize patient care activities. Such as bathing, diet, intravenous fluids and medications, and positioning to categorize patient care activities.
Long-term Care
When a person is unable to carry out everyday tasks because of an injury, disability, chronic illness, or dementia
Specialists
_ are experts in a certain illness or organ system of the human body
Specialty
_ care can be continuous or preventive, and it revolves around a certain bodily system.
Primary Care
_ care focuses on illness prevention via frequent physical exams and health screenings.
Specialty
_ care is provided to patients who have a health issue or condition that necessitates expertise in a certain medical field
Specialists
_ must undergo _ training and get certification or licensure in their field of expertise. They might be physicians, nurses, or other members of the healthcare team.
Primary
_ team members include: ● doctors or family doctors, ● pediatricians, ● nurses, ● physician assistants, ● nurse practitioners.
Centralized Staffing
a holistic, enterprise-wide approach to staffing
Regulatory Requirements
a rule that a government entity imposes on an organization.
Historical Information
amination of any data pertaining to the quality or opinion of workers regarding the success of the prior staffing pattern
Hospice care
based on providing physical, emotional, spiritual, and social assistance to patients and their families. It can be given at a patient's home or in a hospice center.
Interruptions
can delay care delivery and may prevent the nurse from successfully finishing tasks, and may potentially lead to errors.
Urgent Care
care for an illness or injury that requires urgent attention but is not life threatening.
1. Primary Care 2. Specialty Care 3. Emergency Care 4. Urgent Care 5. Long-term Care 6. Hospice Care 7. Mental Healthcare
categories of patient care
1. Benchmarking 2. Regulatory Requirements 3. Skill Mix 4. Staff Support 5. Historical Information
considerations in developing staffing patterns
Hospice care
focuses on "palliative" treatment, which aims to relieve symptoms rather than cure an illness as a person nears death
Centralized Staffing
focuses on ensuring proper staffing levels and the decisions are made at the top levels (single office or staffing center).
Long-term Care
includes medical, nursing, and social services. It can be done at a person's home, at a long-term care facility, or in an assisted living facility.
Patient Classification System
institution specific and must be modified to reflect the unique staff and patient population of each health-care organization.
FUNCTIONAL NURSING OR FUNCTIONAL METHOD (Task-Oriented)
it involves giving a particular nursing function to each worker. It's often a helpful model in hospitals with a deficiency of registered nurses.
Patient Classification System
method of classifying patients. Different criteria are used for different systems.
Interruptions
occur when the main task is suspended so that a secondary activity receives attention
Breaks
planned or spontaneous pauses in a task
Distractions
psychological responses triggered by external or environmental stimuli, or by secondary activities that break one's concentration on the primary task
Skill Mix
refers to the mix of licensed and unlicensed staff working at a given time.
Staffing
s the process of determining and providing an acceptable number and mix of nursing personnel in order to provide the desired level of care to the patient.
Staffing
the process of selecting, training, motivating, and retaining employees in an organization.
Intrusions
unexpected encounters with someone who temporarily interrupts the main activity
Category #4: Intensive Care
wherein the patients are acutely ill and high level of nurse dependency is required s needed because of the unstable condition of the patient
Centralized Staffing
● It benefits individual units as it relieves some of the management load for unit leaders. ● Managers spend less time on staffing, which reduces frustrations and gives more time to focus on their staff and patient care. ● Frees the middle-level manager to complete other management functions ● Worked hours are distributed more equitably across a large group of people. ● Units leaders can move from administrative tasks to have a more patient-centered focus. ● Better coordination of resources across facilities, resulting in patients receiving their specific care needs.
Decentralized Staffing
● Managers retains greater control over unit staffing ● Provides greater autonomy and flexibility for individual staff members ● Staff are able to take requests directly to their manager ● Staffing is easier and less complicated
FUNCTIONAL NURSING OR FUNCTIONAL METHOD (Task-Oriented)
● Nurses complete work within the shortest time possible ● Nurses gain career skills faster ● Cost-Efficient ● Promotes teamwork
Centralized Staffing
● Provides less flexibility for the worker and may not account for a specific worker's desires ● Managers may be less responsive to personnel budget control in scheduling and staffing matters
Decentralized Staffing
● Result in more special pleading and arbitrary treatment ● May not be cost-effective for organization because staffing needs are not viewed holistically ● More time consuming for unit manager ● Inefficient use of resources and poor implementation of technology solutions due to irregular use
