Calculating Proper Staffing

Scenario – Staffing is an important part of nursing management as healthcare is very labor intensive. Since nursing is a major expense in any institution it is oftentimes the area where administrators will try to save money, sometimes forsaking quality and increasing the chances that there will be disgruntled nurses after a short time. The following scenarios are for two units in the same hospital so acuity levels will be the same. Acuity levels are as follows: #1=4.0; #2=3.2; #3=2.3; #4=1.4. The first unit is the ICU. The second is a Med-Surg floor.

ICU Unit

· 6 patients = #1 acuity

· 2 pts = #2 acuity

· 0 pts = #3 acuity

· 0 pts = #4 acuity

Med-Surg Unit

· 6 pts. = #1 acuity

· 2 pts. = #2 acuity

· 0 pts. = #3 acuity

· 0 pts. = #4 acuity

Below is information from study material

In addition to numbers of staff, the manager must be cognizant of the staffing mix. Staffing mix refers to the mix (percentages) of licensed (registered nurse [RN] and licensed vocational nurse [LVN]) and unlicensed assistive personnel (certified nursing assistant [CNA]/nursing assistive personnel) working at a given time. The manager must also be aware of the patient acuity so that the most economical level of nursing care that will meet patient needs can be provided.

Although Unit V discusses staffing, it is necessary to briefly discuss here how staffing needs are expressed in the personnel budget. Most staffing is based on a predetermined standard. This standard may be addressed in hours per patient-day (HPPD) (medical units), visits per month (home health agencies), or minutes per case (the operating room). Because the patient census, number of visits, or cases per day never remains constant, the manager must be ready to alter staffing when volume increases or decreases.

The standard formula for calculating nursing care hours per patient-day (NCH/PPD) is shown in Figure 10.1.

 FIGURE 10.1 Standard formula for calculating nursing care hours per patient-day (NCH/PPD). (Copyright © 2006 Lippincott Williams & Wilkins. Instructor’s Resource CR-ROM to Accompany Leadership Roles and Management Functions in Nursing, by Bessie L. Marquis and Carol J. Huston.)

A unit manager in an acute care facility might use this formula to calculate daily staffing needs. For example, assume that your budgeted NCH are 6 NCH/PPD. You are calculating the NCH/PPD for today, January 31; at midnight, it will be February 1. The patient census at midnight is 25 patients. In checking staffing, you find the following information:

Shift	Staff on Duty	Hours Worked
11:00 PM (1/30) to 7:00 AM (1/31)	2 RNs	8 h each
	1 LVN	8 h
	1 CNA	8 h
7:00 AM to 3:00 PM (1/31)	3 RNs	8 h each
	2 LVNs	8 h each
	1 CNA	8 h
	1 ward clerk	8 h
3:00 PM to 11:00 PM (1/31)	2 RNs	8 h each
	2 LVNs	8 h each
	1 CNA	8 h
	1 ward clerk	8 h
11:00 PM (1/31) to 7:00 AM (2/1)	2 RNs	8 h each
	2 LVNs	8 h each
	1 CNA	8 h

RNs, registered nurses; LVNs, licensed vocational nurses; CNA, certified nursing assistant.

Ideally, you would use 12 midnight to compute the NCH/PPD for January 31, but most staffing calculations based on traditional 8-hour shifts are made beginning at 11:00 PM and ending at 11:00 PM the following night. Therefore, in this case, it would be acceptable to figure the NCH/PPD for January 31 by using numerical data from the 11:00 PM to 7:00 AM shift last night and the 7:00 AM to 3:00 PM and 3:00 PM to 11:00 PM shifts today. The first step in this calculation requires a computation of total NCH worked in 24 hours (including the ward clerk’s hours). This can be calculated by multiplying the total number of staff on duty each shift by the hours each worked in their shift. Each shift total then is added together to get the total number of nursing hours worked in all three shifts or 24 hours: The nursing hours worked in 24 hours are 136 hours.

The second step in solving NCH/PPD requires that you divide the nursing hours worked in 24 hours by the patient census. The patient census in this case is 25. Therefore, 136 / 25 = 5.44.

The NCH/PPD for January 31 was 5.44, which is less than your budgeted NCH/PPD of 6.0. It would be possible to add up to 14 additional hours of nursing care in the next 24 hours and still maintain the budgeted NCH standard. However, the unit manager must remember that the standard is flexible and that patient acuity and staffing mix may suggest the need for even more staff for February 1 than the budgeted NCH/PPD.

The personnel budget includes actual worked time (also called productive time or salary expense) and time that the organization pays the employee for not working (nonproductive or benefit time). Nonproductive time includes the cost of benefits, new employee orientation, employee turnover, sick and holiday time, and education time. For example, the average 8.5-hour shift includes a 30-minute lunch break and two 15-minute breaks. Thus, this employee would work 7.5 productive hours and have 1.0 hours of nonproductive time.

 

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