Developing a Staffing Budget Nursing Resource Management

Why is staffing so important? Nursing Salary & wages are 68% of the Nursing direct expense budget. Nursing Salary & Wages are 15% of the hospital direct expense budget. Scheduling is a major reason nurses change jobs Nurse Managers spend a lot of their time with staffing issues. Overall staffing strategy addresses volume addresses staffing strategies Certain census levels, up to the ADC require a core unit staff . Probable census levels rely on internal staff Possible census levels utilize internal staff and increased compensation Peak census may require outside staff, expensive compensation and limitation of benefits.

Budgeting Staff-Direct Caregivers Volume X HPPD or HPV = Required Patient Care Hours Volume determination 1

The cornerstone in calculating staffing needs The unit of service for most hospitals is patient days Some departments may use visits or procedures for their unit of service Volume projections are not usually controlled totally by the Nurse Manager ADC is calculated by dividing total volume by 365.

Volume Volume must be forecast for the entire year The forecast must also include the distribution of volume, by month, day of the week, etc. Forecasts are usually based on past history and adjusted by the Nurse Manager. The Nurse Manager must add her expertise and add or subtract volume based on her knowledge of the patient population and programs being offered.

Budgeting Staff Required Patient Care Hours Determine the total number of patient days (visits). Determine from your patient classification system the number of days (visits) in each classification. Multiply the HPPD per classification, times the number of days budgeted (or HPV times visits). Total the number of patient care hours needed Budgeting Staff Required Patient Care Hours

Required Patient Care Hours Patient Classification 1 2 3 4 5 Total Number of Patient Days 1500 3700 2400 900 500 9000 HPPD 2.5 4.7 8.0 12.2 19.0 Total Hours 3750 17,390 19,200 10,980 9500 60,820

Used for budgeting core staff to a unit

Total FTE needed = Total Patient Care Hours #productive hrs./FTE

Budget for Staffing Non Productive Time Productive Hours/Paid Hours=% Productive % Productive X 2080 = #Productive hr/FTE

Daily FTE required-used to plan daily staffing

Total Patient Care Hours = Daily Hours of Care 365 For 8 hour shifts Daily Hours/8 For 12 hour shifts Daily Hours/12

Total FTE Budget Used to allocate core staff to units Allocates staff to cover 24/7, vacation, sick, FMLA Daily FTE Needs Used to develop basic staffing pattern Divided by shifts Divided by skill mix Equals core staffing pattern Shift-to Shift Breakdown Based on patient needs at different times of the day Start by identifying census on the different shifts ICUs usually D/E/N-.33/.33/.33 More units are moving to ICU-type breakdown due to shorter LOS, increased acuity Skill Mix Based on patient needs ICUs usually 90-100% RN General Care Units usually- > 60% RN Rehab/Psych Units usually- ~50% Secretaries and non-nurses Other Nurses 3

Managers Education CNS, NP, CNM,

. Scheduling Staff Pattern of Core staff Patient flow, placement guidelines Unit Activity Monitors -ADT Factors Vacation/FMLA Policies & Procedures to support Staffing . Daily Staffing 24 hour plan Consistent and continuous patient care Ensure availability of competent staff High value on cross training Have employees work in primary unit, as much as possible Reduce unfair competition between units Deal with special resource requirements Fine-tuning to cover volume changes acuity changes, call offs Floating plan, plan to replace deficits Meeting increased/peak demand Low census management plans cancellation procedure, increased cost out first Plan for 7-10 days ahead

Expected Fluctuation Plan Internal Float Pools Floating PRN Staff Overtime

2001 Agency Overtime Travelers Total

5.4% 1.9% 1.4% 8.7%

2002
5.4% 5.6% 4.2% 15.2%

2003
2.4% 4.6% 1.2% 8.2%

2004
5.3% 4.4% 3.5% 13.2%

2005
4.4% 9.5% 7.6% 21.5%

2006
5.1% 5.3% 5.6% 16.0%

Peak Demand Management Bonuses Agencies Use of other resources (Nurse Managers, Educators, CNS, other staff) Diversion Plans

Low Census Management Policies & Procedures Canceling most expensive staff first Voluntary leaves Hospital procedure for canceling shifts Lay-offs

Management Information Systems to Support Staffing Prospective data-operations budget Current data-daily management reports Actual versus required staff variance Actual versus budgeted census Retrospective-Productivity Analysis Benchmarking Quality data Budgeted versus actual Retrospective Analysis, cont Audits of schedules % unfilled holes OT % agency # requests granted/denied