The problem common to all hospitals is the development of a method to determine the nursing effort by categories of nursing staff to meet the nursing needs of the patients in an effective manner.
Empirically there are three methods of determining the number and types of nurses.
1. Calculating staff needs based on the number of beds in the hospitals. The inadequacy of this method is that it takes no account of the patient’s requirements or of the fact that nurses are also required in OPDs, OTs and other departments.
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Using this system it is possible to develop formulae to calculate the number of staff required only in a given clinical specialty, say surgical department.
2. Estimating the number of staff according to the degree of dependency of the patients as determined on a scale. The advantage of this method is that it gives an estimate of the minimum level of staff necessary to provide safe care.
The disadvantage lies in its emphasis on physical dependency as compared with the need for psychological, emotional, social and clinical support. This method can be enlarged to determine different levels of staff to meet the patient’s needs.
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3. The third method relies on observations of nursing activity. The correct nursing practices in different hospitals are observed and recorded and staff requirements are determined accordingly.
This system is also not satisfactory since it assumes that current practices are meeting patient’s needs without validating the assumption.
Calculating the staff requirement on the basis of patients’ need, there has been a move towards considering potential ability rather than inability of the patient in relation to health functions in determining nursing effort.
However, the actual requirement of clinical nursing is dependent on the method of nursing that is practised in a hospital. Five methods have been in vogue, although in many situations a combination of one with the other will generally be observed.