Developing a Staffing Budget Nursing Resource Management

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Developing a Staffing BudgetNursing Resource
Management

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Staffing

• Overview
• Budget
• Schedule
• Daily Staffing
• Expected Fluctuation Plan
• Peak Demand
• Management Information

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I. Staffing Overview

• 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.

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Staffing Overview

• Overall staffing strategy
• addresses volume
• addresses staffing strategies

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Staffing Overview

• 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.

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Budgeting Staff-Direct Caregivers

• Volume X HPPD or HPV Required Patient Care
  Hours
• Volume determination
• 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.

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Budget Staff-Direct Caregivers

• 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.

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Budgeting StaffRequired 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.

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Budgeting StaffRequired Patient Care Hours
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Budgeting for StaffingRequired Patient Care Hours
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Budgeting Staff

• Used for budgeting core staff to a unit

Total FTE needed Total Patient Care
Hours productive hrs./FTE
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Budget for StaffingNon Productive Time

Productive Hours/Paid Hours Productive
Productive X 2080 Productive hr/FTE
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Budgeting Staff

• 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
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Budgeting Staff

• Total FTE Budget
• Used to allocate core staff to units
• Allocates staff to cover 24/7, vacation, sick,
  FMLA

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Budgeting Staff

• Daily FTE Needs
• Used to develop basic staffing pattern
• Divided by shifts
• Divided by skill mix
• Equals core staffing pattern

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Budgeting Staff

• 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

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Budgeted Staffing

• Skill Mix
• Based on patient needs
• ICUs usually 90-100 RN
• General Care Units usually- gt 60 RN
• Rehab/Psych Units usually- 50

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Budgeting Staff-Patient Outcomes

• Needleman Buerhaus et al. (2001) Strong
  consistent relationships between nurse staffing
  and UTI, pneumonia, LOS, UGI bleeds and shock.
  In major surgical patients failure to rescue was
  also related to nurse staffing.
• Blegan et al. (2001) Decreased med errors with
  RN up to 87, no relationship to BSN, exp.
• Sasichay-Akkadechanunt et al. (2003) Total nurse
  staffing was related to inpatient mortality. No
  relationship of mortality to RN, RN experience
  or BSN.

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Budgeting Staff-Patient Outcomes

• Potter et al. (2003) Decreased RN hoursgt
  patients increased perception of pain higher
  RN hours gt higher perception of satisfaction by
  patients.
• Cho et al. (2003) An increase of 1 HPPD
  associated with 8.9 decrease in odds of
  pneumonia, 10 increase in RN associated with
  9.5 decrease in odds of pneumonia, increased
  HPPD gt higher probability of pressure ulcers

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Budgeting Staff-Patient Outcomes

• Aiken et al. (2002) Each additional patient
  cared for by a nurse was associated with a 7
  increase likelihood of dying within 30 days of
  admission, and odds of failure to rescue, a 23
  increase in nurse burnout and a 15 increase in
  job dissatisfaction.
• Rogers et al. (2004) Errors and near errors more
  likely to occur when nurses work gt12 hours.
• Estabrooks et al. (2005) Decreased mortality with
  increased BSN increased RN mix.

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Budgeting Staff-Patient Outcomes

• Needleman et al. (2006) Increased skill mix to
  75 results in better patient care (decreased
  LOS, deaths) and cost savings. Increasing care
  hours and increasing care hours and RN was not.

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Budgeting Staff-Indirect Caregivers

• Secretaries and non-nurses
• Other Nurses
• Managers
• Education
• CNS, NP, CNM,

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III. Scheduling Staff

• Pattern of Core staff
• Patient flow, placement guidelines
• Unit Activity Monitors -ADT Factors
• Vacation/FMLA
• Policies Procedures to support Staffing Plan

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IV. 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

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Daily Staffing

• 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

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IV. Expected Fluctuation Plan

• Internal Float Pools
• Floating
• PRN Staff
• Overtime

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Expected Fluctuation Plan
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VI. Peak Demand Management

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

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VII. Low Census Management

• Policies Procedures
• Canceling most expensive staff first
• Voluntary leaves
• Hospital procedure for canceling shifts
• Lay-offs

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VII. 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

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Management Information Systems to Support Staffing

• Retrospective Analysis, cont
• Audits of schedules
• unfilled
• holes
• OT
• agency
• requests granted/denied