• Nurse to patient ratio: Number of patients
cared for by one nurse typically specified by
job category. This varies by shift and nursing
unit; some researchers use
• Total nursing staff or hours per patient
day: All staff or all hours of care including
RN, LVN, aides counted per patient day.
• (Patient day ):is the number of days any one
patient stays in the hospital.
• Nursing skill (or staff) mix:The proportion
or percentage of hours of care provided by
one category of caregiver divided by the
total hours of care .
(A 60% RN skill mix indicates that RNs
provide 60% of the total hours of care)
Determination Of Staffing Needs
DIRECT CARE: is the time spent providing
hands on care to patients.
INDIRECT CARE: is the time spent on activities
that are patient-related but are not done directly to
Nursing Hour Per Patient Per Day: is a standard
measure that quantifies the nursing time available
to each patient by available staff.
NHPPD reflects only productive nursing time
Models of nursing care delivery
• take one patient and care for all of their
• The consequences of teaching nursing this
way was that reality shock hit upon
graduation when the new graduate critical
care areas, labor and delivery, or any area
where one nurse cares for one patient’s total
• RNS were self-employed
Patient needs were quickly met
Close relationship between the RN and the
• Disadvantages: Cost! RNs are expensive! :-)
• This model is that one nurse cares for one group of
patients with 24 hour accountability for planning
• This is a decentralized delivery model: more
responsibility and authority is placed with each
staff nurse. It has been debated whether PN is a
• Primary Nurse (PN) cares for her primary patients
every time she works and for as long as the patient
remains on her unit.
• Increased satisfaction for patients and nurses.
• More professional system: RN plans and
communicates with all disciplines as more
knowledgeable and responsible.
• RNs more satisfied because they continue to learn
as a function of the in-depth care they are required
• Intimidating for new graduates who are less
skilled and knowledgeable.
• The goal of the Team method is for a team to
• In the ideal team, an RN is assigned as a Team
Leader for a group of patients. The Team Leader
has a cadre of staff reporting to her and together
they work to disseminate the care activities. The
team member possessing the skill needed by the
individual patient is assigned to that patient, but
the Team Leader still has accountability for all of
• Team Leader must be both a skilled clinician and
an effective group leader.
• Each member’s capabilities are maximized so job
satisfaction should be high.
• Patients have one nurse (the Team Leader) with
access to other providers
• Requires a team spirit and commitment to
• RN may be the Team Leader one day and a team
member the next, thus continuity of patient care
• Care is still fragmented with only 8 or 12 hour
• Modular nursing effectively combines many
models of nursing care, enabling
comprehensive care of individual clients. It
promotes professional practice, high levels of
autonomy and accountability.
• Combination between team and primary
• It ensures that nurses are able to work at
their level of skill and competence in
providing care to meet the varied needs of
Description of Modular Nursing
• All clients are assigned within a module and
to a particular nurse when they are admitted.
• Each module is made up of a group of nurses
and their allocated clients.
• The number of clients per module and the
number of modules are determined by the
overall ward occupancy at any given time.
• Team or Functional Nursing Care: A model
using the RN as a team leader and LVNs/UAPs to
perform activities such as bathing, feeding.
• Magnet Hospital Environment: Shared
governance, Characterized as "good places for
nurses to work" and includes a high degree of RN
autonomy, MD-RN collaboration, and RN control
of practice; allows for shared decision making by
RNs and managers.
• the Task Method .
• nursing was essentially divided into tasks, a
model that proved very beneficial when
staffing was poor.
• A very efficient way to delivery care. Could
accomplish a lot of tasks in a small amount of time
Staff did what only they were capable to do: no
extraneous work was added that could be done by
• Care of persons became fragmented.
• Patients did not have one identifiable nurse and
the nurse had no accountability.
• Very narrow scope of practice for RNS.
• Lead to patient and nurse dissatisfaction
Nursing Case Management
• are Case Managers or are members of Care
Management Teams – interdisciplinary groups
that meet regularly to monitor patient’s progress
through the health care system.
• Nursing case managers are
empowered to identify the best
patient outcomes and for mobilizing
the resources to achieve those
outcomes in a preset time frame.
Evidence that relates patient outcomes
1)specific numbers, proportions, or ratios of
nurses to patients (nurse staffing);
The number of hours nurses spend with patients.
Census of nurses to patients at a particular point
2) specific organization of nursing care delivery,
nursing models of care, or organizational
Nursing care delivery models.
Hospital culture and governance structures.
autonomy and communication
Evidence that relates patient outcomes
3)specific nursing interventions.
4) education, training, or retraining of nurses,
providing audit data to nurses, and
5) assessment of patient outcomes.
Patient classification system
• Patient classification system :Measurement
tool used to determine the nursing workload
for a specific patient or group of patients
over a specific period of time.
• Patient acuity: is the measure of nursing
workload that is generated for each patient
APPROACHES TO NURSE
ASPECTS OF NURSING
• Facilitation of high-quality nursing care.
• Facilitation of efficient nursing care.
• Facilitation of job satisfaction .
• Supporting multiple views on nursing
schedule quality .
Nurse scheduling problem
• The Nurse scheduling problem (NSP) is
the problem of determining a work schedule
for nurses that is both reasonable (or fair)
• Hard constraints: if this constraint fails then
the entire schedule is invalid.
• Soft constraints: it is desirable that these
constraints are met but not meeting them
doesn't make the schedule invalid.
What is self scheduling in
• “A process in which staff on a unit
collectively develop and implement the
Goals of self scheduling
1)Self scheduling increases staff autonomy
through control over their own schedules.
2) Self scheduling promotes staff retention by
3) Self scheduling decreases staff absenteeism.
4) Self scheduling also supports team development
through a heightened
sense of accountability to one another as
negotiations amongst staff takes place.
• Productivity in economics refers to
measures of output from production
processes, per unit of input. Labor
productivity, for example, is typically
measured as a ratio of output per labor-
hour, an input.