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7 Management of Nursing Personnel The nursing care of patients in hospital fully depends upon the number and the quality of nursing personnel on duty at all times of the day and night. The following factors should be considered before planning the nursing manpower. 1) 2) 3) 4) 5) Number of beds in a hospital. The type of hospital and available services. The design and the layout of the hospital. Available/pattern of arrangement of nurses. The type and number of emergency cases coming to the hospital per day.

Staffing Norms For planning of nursing manpower we have to follow some norms. The nursing norms are recommended by various committees, such as; the nursing manpower committee, the high-power committee, doctor Bajaj committee, and the staff inspection committee, trained nurses association of India, and Indian nursing counseling (1985). All the above comities and the staff inspection unit recommended the norms for optimum nurse-patient ratio. Such as 1:3 for Non-teaching hospital and 1:5 for the teaching hospital. The staff inspection unit (S.I.U) is the unit which has recommended the nursing norms in the year 1991-1992 as per this S.I.U norm the present nurse-patient ratio is based and practiced in all central government hospitals. Most of the hospital today is following the S.I.U norms. In this the post of the nursing sisters and the staff nurses have been clubbed together and the work of the ward sister is remained same as staff nurse even after promotion. The assistant nursing superintendent and the deputy nursing superintendent have to do the duty of one category below of their rank. There will be: One nursing sister for 3.6 staff nurse (30% nursing sister) has been fixed by the government in settlement with the Delhi nurses union (DNU) in 1990. One ASN (assistant nursing superintendent) for every 4.5 nursing sisters The ANS will perform duty in shift as done by the present nursing sisters One DNS for 7.5 ANS. The DNS will perform the duty of the assistant nursing superintendent. One nursing superintendent for 200 beds in the hospital. One chief nursing officer for 500 to 750 beds.

There should be 45% post added for the area of 365 days working including 10% leave reserve ( maternity leave , earned leave , and the days off as nurse are entitled for 8 days off per month and 3 national holidays per year when doing 3 shift duties ). The Nurse-patient Ratio as per the S.I.U Norms General Ward Special Ward Nursery Labour Room I.C.U. O.T. Major O.T .Minor Casualty Burn O.P.D. Page no.8 The nurse patient ratio as per the norms of TNAI (trained nurses association of India) and INC (the Indian nursing council, 1985) The norms are based on hospital beds. 1) 2) 3) 4) 5) 6) chief nursing officer nursing superintendent D.N.S. A.N.S. Ward sister Staff nurse 1:6 1:4 1:2 1:1 per table 1:1(Nothing mentioned about the shifts) 1:2 per table 1:1 per table 1:35 1:2 1:40

7) Extra Nursing Staff to be provided for departmental research function. 8) For OPD and emergency 1 staff nurse for 100 patient (1:100) + 30% leave reserve. 9) For Intensive Care Unit (I.C.U) 1:1 or (1:3 for each shift) +30 % leave reserve. 10) It is suggested that for 250 bedded hospital there should be One Infection Control Nurse (ICN) For specialize department, such as Operation Theatre, Labour Room, etc. 1:25 + 30% leave reserve.

Norms are not based on Nursing Hours or Patients Need here. Following is another set of norms in practice based on the nature of illness of patients. These norms will be helpful to you in implementing progressive patients care concept in your hospital. Nursing Hours Required Nature of Illness Direct Nursing Hours Required 8-10 hours NursePatient Ratio 1:1 Remarks

Critically ill patient needing intensive care Moderately ill patients needing intermediate care

3-5 hours

1:3 1:5

(Teaching hours) (Non -teaching hours) (Teaching hours) (Non -teaching hours) (Teaching hours) (Non -teaching hours)

Mildly ill patients needing self care (Ambulatory)

1 -2 hours

1:6 1:10

Chronically ill patients requiring skilled prolonged medical and nursing care

30 minutes to 1 hour

1:12 1:18