Ayder referral hospital is one of the most advanced medical facilities in the Northern part of Ethiopia. Have a total of 500 beds and serve more than 8 million people of Tigray and nearest zones of Amhara and Afar. The hospital has Inpatient, outpatient and emergency services with advanced technologies of diagnostic aids and have a total staff of 1162.

Nurses are the cornerstone of hospital care delivery and the hospitals most costly and valuable resource.Their efficiency and effectiveness are central to any effort to maximize patient safety or minimize costs. So Ayder referral hospital nursing service have a total of 677 staff and 500 of them are nurses.


  • To provide patient centered high quality health care service.
  • To produce qualified health science graduates.
  • To integrate health care service with clinical teaching and research to satisfy the health care and education needs of the society


Shortages of appropriate nursing staff or inappropriate distribution of available staff adversely affects the quality of patient care. Inappropriate workforce planning has been shown to increase staff dissatisfaction and nurse turnover, increase patient mortality, increase hospital-acquired infections, and increase the risk of needle-stick injuries18.

The hospital established a nursing workforce plan that:
  • establishes minimum nurse to patient ratios for each inpatient ward/service, taking the skill mix of staff into consideration,
  • identifies priority areas where the nurse count must at all times meet the minimum ratio requirements (for example intensive care/high dependency units, postoperative recovery, emergency department, labor and delivery etc.), and
  • Establishes procedures for transferring nurses across clinical settings, or calling in extra nurses from home in order to maintain minimum nurse to patient ratios, especially in the priority areas.

Determining the minimum nurse staffing level is a complex process. Factors that considered to staffing nurses includes:

  • The severity of the clinical condition of patients,
  • The intensity of nursing care needed, for example the frequency of nursing interventions such as observations, medication administration, wound care, stoma care, bathing etc.,
  • The number of admissions and discharges,
  • The availability of technology (patient monitors, etc.),
  • The skill mix of staff, and
  • The availability of and responsibilities of patient care givers.

There should be a minimum of a registered professional nurse in-charge of each ward/unit who has a diploma or bachelor degree education and relevant knowledge, skills and experience to manage a ward/unit and the nursing staff therein. The nurse-in charge, together with hospital management should determine the minimum nurse to patient ratio for the unit. The ratio should be kept under review and amended as necessary.

The nursing workforce plan also considered the role of nurses in outpatient and specialist clinics and the nursing contribution to hospital management and governance structures (such as quality committees, infection prevention committees etc.).

Our nursing task force is different in different departments and at different shift. In big wards those have 45 up to 54 beds it is one to six at AM and PM up to 11:30 and in PM from 11:30 up to whole night is one to 18. In ICUs, recovery one to two patients and in OPDs one nurse to each room. Despite the arrangement it is open to move or shift staff from department to others in case of accident and busy schedule.  

 Based on the above factors in each in patient ward we have 12 up to 35 nurses and four porters. And in outpatient we have one nurse per one examination room.

When we see the managerial structure of Ayder referral hospital nursing service we have Chief nursing Office under this position we have six cluster lead by nurse directors it categorized based on the working area.

In each ward we have four to five networks which have two, three, four and five those nurses working in one shift.   

Ayder Referral Hospital Nursing Service managerial structure      Nusing service


     CNO- Chief Nursing Officer

     NICU- Neonatal Intensive Care Unit

     PICU- pediatric Intensive care unit

     AICU- Adult Intensive Care Unit

     OR- Operation Unit

     Focal person represents outpatient units

Ayder Referral Hospital Nursing Service Wards Managerial Structure

head Nurse 

NB.      NW- Network leader

            NA- Nurse A, NB- Nurse B, NC- Nurse C, ND- Nurse D    

Sr. Hareya Gebremedhin Teka

Back ground: BSC Nurse from Gonder University and MHA from Jimma University

Academic Position: Chief Nursing Officer, lecturer