Gusrina K.p. , Msn

GUSRINA K.P. , MSN

METHOD OF ASSIGNMENT 1. 2. 3. 4.

5.

Total patient care nursing / case method Functional nursing Team and modular nursing Primary nursing Case management

TOTAL PATIENT CARE Charge nurse Nursing staff

Patients

Patients

Nursing staff

Patients

Patients

Patients

Patients

FUNCTIONAL NURSING Charge nurse

RN medication nurse

RN treatment nurse

Nursing assistants

PATIENTS

Clerical

TEAM NURSING

Charge nurse

Team leader

RN, LPN, PCA

Patients

Team leader

RN, LPN, PCA

Patients

PRIMARY NURSING Physician

Charge nurse

Healthcare org. resources

Primary Nurse patients

Associate nurse (am)

Associate nurse (pm)

Associate nurse (as needed)

CENTRALIZED STAFFING DECENTRALIZED

TERMINOLOGY Staffing distribution

• Determination of number of personnel allocated per shift (ex: 45% days, 35% evenings, 20% nights).

Staffing mix

• Ration of RNs to other personnel (ex: a shift on 1 unit might have 40% RNs, 40% LPN/LVN and 20% other)

FULL TIME EQUIVALENT (FTE) Number of hours work for which a full time employee is scheduled for a weekly period. Ex : 1 FTE = 8 Hr in per day in a week = 40 hr in a week 1 FTE = 2 part timer (@ 20 hours a week) 56 hours  1.4 FTE  more than one person

WORKLOAD MEASUREMENT TOOLS 1. Nursing Care Hours (NCH) per patient-day (PPD)

NCH / PPD = Nursing hours worked in 24 hrs patient census

NCH/PPD NCH / PPD = Nursing hours worked in 24 hrs patient census Case : There are 15 staffs that work on 12 hours shift. The patient census is 30. Calculate the NCH/PPD NCH / PPD = (15 X 12 ) / 30 = 6 NCH/PPD

NCH/PPD to project daily staffing 6 NCH / PPD = Nursing hours worked in 24 hrs patient census  30

pt x 6 hrs/pt = 180 hours of care /day  180/12 hr shift = 15 nurses needed  If same census and acuity of patient ??

2. Patient Classification Systems (PCS) Grouping of patients according to specific characteristics that measure acuity of illness, because using the numbers of patients alone has proved to be an inaccurate method for determining nursing care assignments

Sample of PCS Area of Care

Category I

Category II

Category III

Category IV

Eating

Feeds self or needs little food

Needs some help in preparing; may need encouragement

Cannot feed self Cannot feed self but is able to and may have chew and swallow difficult swallowing

Grooming

Almost entirely self-sufficient

Needs some help in bathing, oral hygiene, hair combing, and so forth

Unable to do much for self

Excretion

Up and to bathroom alone or almost alone

Needs some help in getting up to bathroom or using urinal

In bed, needs Completely bedpan placed or dependent urinal place; may be able to partially turn or lift self

Completely dependent

Calculating staffing needs Category I acuity level 3.2 NCH/PD Category II acuity level 5.6 NCH/PD Category III acuity level 7.0 NCH/PD Category IV acuity level 10.0 NCH/PD

for 7a - 7p : 172.8 hrs. X 60% (days) = 103.68 NCH 103.68/12 = 8.64 nurses needed on day shift

*How many NCH are needed for the next 24 hours? 

  

Category I 3.2 NCH/PD X 3 pts. Category II 5.6 NCH/PD X 7 pts. Category III 7.0 NCH/PD X 12 pts. Category IV 10.0 NCH/PD X 4 pts.

Answers:    

Category I 3.2 NCH/PD X 3 pts. = 9.6 NCH Category II 5.6 NCH/PD X 7 pts. = 39.2 NCH Category III 7.0 NCH/PD X 12 pts.= 84.0 NCH Category IV 10.0 NCH/PD X 4 pts. = 40.0 NCH

172.8 NCH

for 7p-7a:

172.8 hrs X 40% (evenings) = 69.12 NCH 69.2/12= 5.77 nurses needed on evening shift

The Relationship between Staff Mix, Assignment Methods, and Staffing Must examine the staff mix and patient care assessments to ensure that appropriate changes are made in staffing and scheduling policies  E.g.

Decreasing licensed staff, increasing numbers of unlicensed assistive staff, and developing new practice models have a tremendous impact on patient care assignment methods

Recruitment The process of or actively seeking out or attracting applicants for existing positions. -

Retention  organization stable Turnover ratio : rate at which employees leave their jobs for reasons other than death or retirement. The rate is calculated by dividing the number of employed in the unit during the year and then multiplying by 100.

Interviewing A verbal interaction between individual for a particular purposes Limitations of Interviews  validity and reliability of interview are inconsistent

Overcoming interview limitations Use a team approach

Developed a structured interview format for each job classification

Conduct multiple interviews

Use scenarios to determine decision making ability

Provide training in effective interviewing techniques

Seleksi Adequate applicant pool

Pre employment screening

Completion of application

Reference checks ; pre employment testing; physical examination; employment interview

Employer decision

Notification of applicants

Placement / Penempatan  Appropriate

placement  important for org. function & new employee success.  Faulty placement  reduced org, efficiency, increased attrition, threats to org. integrity and frustration of personal and professional ambitions.

Induksi / Indoctrination Planned, guided adjustment of an employee to the organization and the work environment. Purpose: 1. Establish favorable employee attitudes toward organization, unit & department 2. Provide info & edu for the position 3. Feeling of belonging & acceptance

Phases of Indoctrination Induction

Orientation

•Take place after the employee has been selected but before performing the job role •General information about org.

•Activities more specific for the position

Socialization

Performance appraisal

An appraisal of how well employees perform the duties of their job as delineated by the job description Factors for effective performance appraisal

Appraisal should be based on standard • Employee should have input into development of standard

Employee must know standard in advance • Employee must know sources of data gathered for the appraisal

Appraiser should be someone who has observed employee’s work • Appraiser should be someone the employee trusts and respects

Performance appraisal tools Trait rating scales Job dimension scales

•Rates an individual against some standard

•Rates the performance on job requirements

Behaviorally anchored rating scales (BARS)

•Rates desired job expectations on a scale of importance to the position

Checklists

•Rates the performance against a set list of desirable job behaviors

Essay

Self-appraisals Management by objectives Peer review

•A narrative appraisal of job performance

•An appraisal by performance by the employee •Employee and management agree upon goals of performance to be reached •Assessment of work performance carried out by peers