2. Acuteness of Illness:
The degree of illness affects the amount of nursing care needed. In some studies, acutely ill and therefore completely dependent patients have been known to require 430 minutes in the first (morning), 186 in the second (afternoon), and 124 during the night shift.
3. Experience of Nurses:
Graduate nurses are usually more mature in judgement, more skilled and able to work more rapidly (efficiently). Student nurses in upper classes are more experienced and skilled than younger students.
4. Amount and Quality of Supervision:
Nurses who are well-supervised learn to use their time more efficiently.
5. Availability of Nursing Aides:
Nursing aides (variously called nursing assistants, nursing orderlies, etc.) can play an important role in saving time of nurses if properly trained. Nursing assistants/medical assistants, who are nursing aides, take on many nursing tasks in military hospitals, thereby significantly reducing the nurse to patient ratio in military hospitals.
6. Teaching Function:
Inexperienced medical students often need assistance and supervision from nurses. There are more treatments and tests performed on patients in a teaching hospital. More nursing staff is needed to meet these demands in teaching hospitals.
7. Plan of Nursing Units (Wards):
In an open type of ward, the patients are in full view of nurse, and it is easier to see what is happening. Therefore, supervision of the patients is easier. In wards where patients are housed in small units (Rig’s pattern), more number of nursing staff are required.
8. Physical Facilities:
Good functional planning of physical facilities minimises avoidable walking and waste of time of nurses.
9. Location of Equipment and Supplies:
Time-saving equipments and their availability at nursing units save nurses’ time. A central supply department and flash sterilisers are two examples.
10. Working Hours and Shifts:
When the staff is able to work only certain fixed hours and days, the result is inflexibility, and more nurses are needed to adequately cover all parts of the day.
11. Hospital Routine:
Although reports and record keeping are essential, more complex the system of record keeping and reporting, the more nursing time is consumed in clerical work. Availability of a less technical person to handle telephone communications, direct visitors, assemble charts and papers, and check supplies, etc. enhances nurses’ time available for nursing.
12. Assignment Method:
Other things apart, the functional method of assignment of work is more efficient than case or team method.
The team method where the assignment of duties is based upon analysis of functions to be performed, competencies available and supervision required is a popular method and is quite effective if properly organised and supervised.
13. Standard of Care Desired:
The attention given to comfort and safety measures and the emphasis on personalized rather than routine care (e.g. in private rooms) influence the number “of nursing staff required.
Barrett has suggested that in determining the staffing pattern of a patient care division, the factors which should be considered are as follows.
1. The mean daily patient census
2. Daily patient turnover rate
3. Illness acuity of majority of the patients
4. Types of therapies and surgical procedures usually performed on patients and special nursing requirements of such procedures.
5. Proportion of time required per shift per patient for both indirect and direct nursing care activities.
Whereas in a new hospital the staffing plan must be based on a mix of the experience of other similar hospitals, current staffing levels in a existing hospital can be studied for their adequacy by the method described below
To be practicable, the study must not club all the wards and different types of service (medical, surgical, obstetrical, etc.) together, as the intensity and level of nursing care in each must differ.
A National Institute of Health and Family Welfare (NIHFW) study revealed that the minimum actual time needed for direct nursing care in four different types of wards was as follows.
1. Surgical ward 192 min
2. Medical wards 236 min
3. Paediatric wards 308 min
4. Maternity ward 158 min Limitations of such studies are obvious as their findings do not fit in other situations. However, they act as starting points for further studies.
Limitations of such studies are obvious as their findings do not fit in other situations. However, they act as the starting points for further studies.