UNIVERSITY OF REGINA CARMELI

City of Malolos
Graduate School Department

ACTION RESEARCH
“UNDERSTAFFING IN A SECONDARY
HOSPITAL”

Submitted to:
DR. AMELIA STA MARIA
Professor – Community Health Nursing, URC Malolos

Submitted by:
BENEDICTOS, Rinalyn
CACHO, Joana Marie
CANGCO, Paula
CASABUENA, Myra
De JESUS, Charish Rose
DELA CUEVA, Diana
GASPAR, Jaymilline
SANTIAGO, Polymar
Research Team
 I. INTRODUCTION
Staffing is the process of determining & providing the acceptable number & mix of
nursing personnel to produce a desired level of care to meet the patient’s demands.

The purpose of all staffing activities is to provide each nursing unit with an appropriate &
acceptable number of workers in each category to perform the nursing tasks required.
Too few or an improper mixture of nursing personnel will adversely affect the quality &
quantity of healthcare services delivered. This is attested by the previous studies done by
University of Pennsylvania, School of Nursing Study. It revealed that there is a clear link
between overworked nurses, staffing shortages & quality of patient care. According to the
study, approximately 20,000 people die each year because they checked into hospitals
with overworked nurses & understaffed hospitals. The study also found that people has a
31 percent risk of dying if they are admitted to a hospital with a severe shortage of
nurses.(http://www.afge.org
nurses.(http://www.afge.org))

Similar study had also showed same factual data regarding the relationship of
overworked nurses with direct patient care. According to the latest medical & nursing
research conducted by the Journal of the American Medical Association (JAMA), the
most important factor determining the safety of hospitalized patients is the ratio of
healthcare professionals attending to each patient (nurse to patient ratios). The study
found that each additional patient above four (4) that a nurse is caring for in a typical
ward produces a 7 percent increase in mortality. As to the cost of providing appropriate
staffing in hospitals, studies conducted in California and reported in the New England
Journal of Medicine, show that the average hospital will experience only a 1 percent
increase in operating costs if ratios are introduced. (http://www.capeannweb.com
(http://www.capeannweb.com))

Ideally, the Department of Health recommends a specific Hospital Staffing Formula to

calculate the manpower needed in a specific in- patient units of the hospital. It is
determined by the total number of bed capacity that can accommodate confined patients.
Indeed, putting up a new hospital is tedious & difficult because it entails a lot of
problems. One of which is staffing & manpower allocation. Kairos Maternity & General
Hospital, being a secondary hospital that is only in four (4) months of operation has also
its set of problems, among them is staffing. It has been noticed that there is only one
Registered Nurse that is assigned to a 12- hour shift in a ward, without the aid of any
nursing attendants & midwives. In contrast with the Department of Health Standards that
there should be atleast 2 nurses per 12- hour shift with 1 reliever & ancillary heathcare
personnel (nursing attendants or midwives) in a ward given the fact that they are
classified as a Secondary level hospital.

With these substantial data, the researchers consider that it would be very essential to
address this specific crisis so that future problems with regards to execution of healthcare
services maybe avoided.
 II. BACKGROUND/ OBJECTIVES OF THE STUDY

KAIROS MATERNITY AND GENERAL HOSPITAL is a secondary general hospital

located in Muzon, San Jose Del Monte City, Bulacan. KAIROS was a named suggested
by Rev. Fr. Emmanuel I. Curz. It is a Greek word which means”God’s gift in Gods time”
it started a small family clinic on July 25, 1999 about 25 meters away from its present
location. It has a branch in Poblacion, Meycauyan, Bulacan which started its operation on
May 8, 2000. The hospitals construction started on January 15, 2006 and was finally
patient-focused health care that is accessible and affordable medical care to the patients
of San Jose Del Monte City and its neighboring towns. The vision of this institution is
“To be a provider of high quality patient-focused health care that is dedicated to the
administration of excellent, affordable and cost effective, and meets the needs of the
people and communities we serve.” Considering its vision, the institution aims to be:
First, to be the best place for the patients to receive efficient, excellent and affordable
medical care; second, to be the best place for the doctors to practice medicine and share
their expertise; and third, to be the place for its entire staff to work and serve the
community. The institution is guided by its core values such a KNOWLEDGE- staff shall
provide the best skills and standards of care set by our profession, irrespective of our
patient’s race, religion and beliefs; AFFORDABILITY/ ACCESSIBILITY- staff shall
strive to provide affordable and accessible health care to everyone in the community
while preserving our commitment of giving quality service; INTEGRITY- staff shall
communicate openly and honestly, maintain our loyalty in this institution and build trust
and conduct ourselves in accordance with the highest ethical standards of our profession;
RESPECT- staff shall respect each individual, those we work with the highest
professionalism and dignity; OBLIGATION- staff has our obligation to do our best in all
endeavors, to God who guide us in our tasks and to our patients who expect the best in us
for their health care; and SERVICE- staff shall strive to anticipate and meet the needs of
our patients, physicians, and co-workers.

KAIROS MATERNITY AND GENERAL HOSPITAL is a 36 bed capacity secondary

hospital. It caters to private patients in the following departments and respective units:
GROUND FLOOR- Emergency Room, Pharmacy, Business Office, Laboratory,
Radiology (X-ray and mammography), Ultrasound, Out-patient Department, and Chapel;
SECOND FLOOR- Operating room, Delivery Room, Nursery, Central Supply Room,
Suite and Private Rooms, Pediatric Ward; THIRD FLOOR- Obstetrics and Gynecology
Ward, Female and Male Ward, Suite and Private Rooms; and BASEMENT- Office of the
Chief Nurse, Electrical Room, Doctor’s Quarters, Male and Female Dorms, Guest Room,
Dietary Department and Canteen. Presently, the hospital has 12 hours duty for nurses.

The EMERGENCY ROOM is the front liner of the hospital where the acutely ill and
emergency cases are treated and admitted. OPD cases also are catered in ER as long as
they have no Attending Physician to attend for their needs. It is well-equipped and
manned by the Resident-on-duty Doctors, 24 hrs a day. As of now, the hospital has six
ROD. There are six staff nurses in ER; two nurses every 12 hour shift. An ambulance
with MOA from the Barangay is always on standby to transport to other health facilities
if necessary.

The OUTPATIENT DEPARTMENT is where patients are seen and attended to by

consultants in Pediatrics, Internal Medicine, Surgery, Ophthalmology, ENT, Obstetrics
and Gynecology. There are 2 personnel, midwives or nursing graduate assign everyday
from7am to 5pm, Mondays to Sundays.

The RADIOLOGICAL DEPARTMENT operates diagnostic radiology units,

mammography, ultrasound and 2D echo. The department has two radiologists with a 24
hours duty.

The CLINICAL LABORATORY is equipped with modern laboratory diagnostic

facilities capable of performing routine laboratory and blood chemistries. The Laboratory
consists of 4 Medical technologies, with 12 hours duty.
The OR-DR COMPLEX has two operating rooms, one delivery room and recovery room.
Each operating room is complete with anesthesia and suction machines. An
electrosurgical unit is also available. There are male and female dressing rooms and one
doctor’s lounge. There are three fix staff nurses assigned in DR and one nurse and two
midwives in OR. One staff in every 12 hour shift.

The NURSERY has a Pathological area with two incubators, a breastfeeding area and a
well-baby area with 8 bassinets. The nurse assigned in this area is also the DR Nurse.

The NURSES STATION I compose of 12 Bed Capacity which caters pediatric ward with
8 beds, then 3 private ward and 1 suit room. It is manned by one nurse in a 12 hour shift.
There are three nurses that rotate in its station.

The NURSES STATION II is composed of 24 bed capacity. These include: Male ward (3
beds), Female ward (4 beds), OB ward (6 bed), 1 suite room and 10 private rooms. There
are also two fix staff nurse and a reliever being rotated in this ward, one nurse per shift.
 III. PROCEDURE / METHODOLOGY

The researchers studied Understaffing in a Secondary Hospital. The total no. of

respondents among staff nurses in the said institution is three while among admitted
patients is also three. In staff nurses, two came from Nurse’s Station II & the other one is
a reliever. The participants varied in terms of Gender, Civil Status, Religion, Affiliation,
Highest Educational Attainment and Length of Hospital Service.

In understaffing in a secondary hospital in Bulacan, the researchers made used of a

questionnaire as an instrument. All throughout the study, the said tool will be employed.
The questionnaire is divided into two parts. The first part contains the demographic
profile of the respondents. The second part deters the perceived lack of manpower to staff
nurses in a secondary hospital and its effect in terms of psychological, social and physical
aspects. The respondents were asked to rate its level in accordance to the situations they
are experiencing brought about by lack of manpower.

The data gathered for the action research were tallied, tabulated, and treated statistically.
The frequency of respondents who checked off particular items wee computed. In
treating the data, the following formulas were used:

Frequency and Percentage Distribution. The formula is:

P= n X 100
N
Where:
P = Percentage (%)
n = Number of responses
N = Number of respondents
100 = Constant
Mean. The formula is:

X=∑x
N
Where:
X = Mean
∑ = Summation
X = Number of respondents
N = Total number of respondents
Average Weighted Mean. The formula is:

AWM = f1w1 + f2w2 + f3w3 + f4w4

Tf
Where:
AWM = Average Weighted Mean
fw = Weighted frequency
Tf = Total frequency

The most common scaling technique is the Likert scale, which consists of several
declarative statements (or items) that express a viewpoint on a topic. Respondents are
asked to indicate how much they agree or disagree with the statement.
 IV FINDINGS / ANALYSIS / INTERPRETATION

Table 1: Number of Patients Admitted in Nurse Station 2 (NS2)

No. of
Month Patients

March 40

April 72

May 75

June 78

Number of Patients Admitted in Nurse

Station 2 (NS2)

100
No. Of Patients

80
Admitted

60
Series1
40
20
0
March April May June
Month

Based on the line graph above, there is consistent increase in the number of
admitted patients each month, once it started. Some prominent cases noted were the
following: dengue hemorrhagic fever, common flu, cardiac related diseases, and other
Obstetric cases since the institution is a maternity hospital.
With the onset of the rainy season, the Department of Health (DOH) pushed a
campaign against dengue. Health Secretary Francisco Duque III said the number of
dengue cases is increasing but this should not lead the public into concern. Dengue
belongs to the so-called W.I.L.D. (Water-borne, Infectious, Leptospirosis, Dengue)
diseases that the DOH wants the public to be concerned about. Duque added the WILD
diseases are “easily preventable if only people will follow the advisories of the DOH
issued on television, radio, newspaper and Internet via the DOH website.” The DOH is
primarily advocating proper hand washing with soap and water. It also urged the public
to wear protective gear when it is raining and avoid wading in floodwaters. “The most
important key to preventing and controlling diseases is empowering our people with
correct information so that they can take steps to stop their transmission and limit the
harm they bring through proper and timely health-seeking behavior,” he maintained. Flu
cases were also noted that were increased because of seasonal environment. Cardiac
related diseases are the number one mortality and morbidity cases in the Philippines
recorded by the Department of Health.
PROFILE OF 3 STAFF NURSES IN THE FOLLOWING CATEGORY
Table 2.1 Ages of Staff Nurses
No. of Staff
Age Range Nurses
20-30y/o 3
31-40y/o 0
41-50y/o 0

The table shows that all staff nurses are in the range of 20-31 years old. It is because the
hospital is newly established and the management believes that newly registered nurses
are more competent one.

Table 2.2 Gender of Staff Nurses

Gender No. of Staff
Nurses
Male 1
Female 2

The table shows that the majority of staff nurses are female in gender. Ward nurses
mainly compose of female staffs while male staffs are in the special area like Emergency
room and Intensive Care Units.

Table 2.3 Marital Status of Staff Nurses

Marital Status No. of Staff
Nurses
Single 3
Married 0
Live in 0
Widowed 0

The table shows that all staff nurses are single. It is because they are most likely at early
age of their profession.
Table 2.4 Employment History of Staff Nurses
 Employment No. of Staff
History Nurses
> 3 months 0
3-6 months 0
6-9 months 1
9-12 months 2

The table shows that two staff nurses have 9-12 months experience and one has 6-9
months experience. The experienced they had usually a volunteer or trainee nurse.

Table 2.5 Length of Stay of Staff Nurses

Length of Stay No. of Staff
Nurses
1 month 0
2 months 0
3 months 2
4 months 1
5 months 0

The table shows that two staff nurses have a length of 3 months and one has 4 months.
The staff nurses serves as the pioneer in the hospital since the hospital starts its serve on
the month of March.

Table 2.6 Number of Patients in NS2 mostly handle by the Staff Nurses
Patient Number No. of Staff
Nurses
1-3 0
4-6 0
7-9 2
10-12 1
13-15 0
16-18 0
 19-21 0
22-24 0

The table shows that two staffs mostly handle 7-9 patients per shift while one staff
handles 10-12. Having 22 bed capacities Hospital, recommended nurses should be 5 plus
1 reliever. The hospital is understaffed.

Table 3 Educational Attainment of Staff Nurses

Educational No. of Staff
Attainment Nurses
RN 2
MAN/MSN 1

The table shows that two nurses are registered nurse while one nurse taking up the master
degree. To be more competent nurse registered nurses engaged themselves in continuing
education which are masters degree other certification like midwife and renal specialist.

ANCILLARY HEALTH WORKERS

There are no ancillary health care workers in the institute. Ancillary health care workers
refer to the other allied health workers that is knowledgeable and skillful to the hospital
setting which helps nurses and doctors maintain and restore patient’s health. They are
midwives, nursing assistants and student nurses.

Table 4 Response of the Staff Nurses in the Questionnaire

NO. 5 4 3 2 1 ΣFX MEAN INTERPRETION
1 1 1 1 6 2
2 3 3 1
2.1 3 3 1
2.2 3 3 1
3 2 1 14 4.666667
4 1 2 7 2.333333
5 3 6 2
6 3 9 3
7 3 12 4
Total 2.23 Fair
1 3 12 4
2 2 1 14 4.666667
3 1 2 13 4.333333
4 3 12 4
4.1 1 2 10 3.333333
4.2 3 12 4
4.3 1 2 10 3.333333
5 1 2 13 4.333333
6 3 9 3
7 3 3 1
7.1 3 3 1
7.2 3 6 2
Total 2.64 Fair
1 1 2 10 3.333333
2 3 12 4
3 2 1 11 3.666667
4 2 1 11 3.666667
5 3 9 3
6 3 9 3
7 1 2 10 3.333333
8 3 9 3
9 2 1 11 3.666667
total 3 Fair
Overall
total 272 2.62 Fair
As shown on the table, the overall weighted mean reveals that 3 respondents (staff nurses
in nurse station 2) have fair response to the job satisfaction rating.
Shaver and Lacey (2003) found that when RNs feel short staffing interfered with their
ability to meet patients' needs; they were also less satisfied with their job. Kalliath and
Morris (2002) determined that job satisfaction was a significant predictor of burnout and
suggested that improving job satisfaction may be an antidote to burnout. Most recently,
Aiken, Clarke, and Sloane (2002) reported that nurse staffing patterns affect not only
patient mortality but also burnout and job dissatisfaction.

Patient’s Response to the Services of the Staff Nurses

1. Bakit ninyo naisipan Magpaospital dito?

Figure 1
 2.5 As shown on Figure 1 Two among 3 respondents
2
No. of Patients chose the institution based on recommendation of
1.5

1
their immediate friends and relatives.
relatives
0.5

0
maganda malinis nairekominda
Dahil ng pagpili sa Ospital

2. Base sa inyong pamamalagi sa Ospital na ito, nagustuhan niyo po ba ang serbisyo

ng mga Nars?
Figure 2
2.5
This figure revealed that most of the respondents
2

1.5
were unsatisfied with their confinement at the said
1 institution.
0.5

0
OO HINDI

3. Kung hind, ano ang mga karanasang hindi nagustuhan?

Figure 3
1.2 In connection with the data on Fig. 2 and Fig. 3,
1
0.8 revealed that most of the negative comments by
0.6
0.4 the respondents were poor health education and
0.2
0
slow execution of health care needs.
Mabagal na

pangangailangan

impormasyon sa

Hindi maayos na
Hindi pagtugon

Kakulangan ng

pakikitungo ng
serbisyo

ng pasyente

pasyente

Nars
sa

Computation of Staffing in Nurse

Station 2 with 22 bed capacity
1. Secondary Hospital
22 x .65 = 14.3
22 x .30 = 6.6
22 x .05 = 1.1
_______
22
 2. 14.3 x 1.5 = 21.45
6.6 x 3 = 19.8
1.1 x 4.5 = 4.95
______
46.2
3. 46.2 x 365 days = 16863 hrs/yr

4. 12 hrs x 265 = 3180

5. 16863/ 3180 = 5.30 staff nurses/day

6. 5.30 x .12 = 0.64 / 1 reliever

5 staff nurses + 1 reliever

6 staff needed
In a secondary hospital, with 22 bed capacity nurse station 2, the recommended
staff nurses are 5 with 1 reliever. Currently, the hospital has 2 staff nurses and 1 reliever
in the area.
Unfortunately, on a low level, insufficient staffing is causing a decrease in the
quality of health care. Because of under-staffing, nurses are unable to spend adequate
time with each patient, which reduces attention to detail. This causes stress, which
decreases levels of job satisfaction. Unhappiness is driving nurses out of a profession that
is already experiencing a huge discrepancy in hiring. A study in the Journal of the
American Medical Association's October 2002 issue has stated that the nursing shortage
is causing "avoidable patient deaths." With the reduction in nursing hires, there is
lowered access to effective health care. Hospitals experience frequent nurse turnover,
which lowers the consistency of care. The nursing shortage has allegedly caused
problems in complication detection and communication between nurses.
 V. RECOMMENDATIONS / RESOLUTIONS OF THE
PROBLEM

The researchers had arrived at the conclusion that there is profound lack of manpower in
Kairos Maternity & General Hospital. Pertinent data had been collected showing that
there is a need for additional healthcare workers to suffice the fast- growing number of
patients that they are handling (as seen on the line graph in chapter 4). Enumerated below
are some of the projected solutions that may help the institution in dealing with the
presently diagnosed problem.

1. Accommodation of Student nurses for affiliation. The institution will

explicitly benefit with this strategy because part of the workload shouldered by
staff nurses, specifically those who are assigned in the ward, will be lessened.
With the aid of student nurses, problems regarding manpower maybe solved.
Also, it will help the institution to collect substantial revenue that is very
beneficial in a newly built hospital like Kairos Maternity & General Hospital.

2. Hiring of other ancillary health workers like midwives, nursing

attendants & caregivers. The researchers perceived that the root cause why ward
nurses consider themselves overworked & exhausted is due to the fact that they
shoulder all of the nursing activities alone from the simple obtaining of patient’s
vital signs & requisition of medicines to the more complex nursing activities like
drug administration. The hiring of ancillary health worker may help the ward
nurses by delegating basic healthcare activities to them, thus reducing the nurses’
workload. Although this strategy demands additional charge in the hospital’s
operating expenses, the salary of ancillary health worker is still cheaper if
compared to the basic salary of a regular nurse.

3. Accommodation of Volunteer Registered Nurses. Given the fact that

Kairos Maternity & General Hospital is a newly built structure, The researchers
know that the cost of hiring a regular staff nurse will be in question. We perceived
that since there are many unemployed registered nurses nowadays who seek
hospital experiences, the institution may take advantage on that part so that
manpower problem maybe resolved accordingly.

4. The combination of the abovementioned strategies. Truly, if the

circumstances may allow, the combination of the abovementioned strategies will
be advantageous to the institution. The accommodation of Volunteer Registered
Nurses & the affiliation of student nurses can already satisfy the manpower
deficiency.
VI. APPENDICES