Good Essay On Calculating Nursing Staff Requirements For An Orthopaedic Unit

Introduction

Nursing care is often measured by ‘hours per patient per day’, which does not include a measure of acuity, increased work by nurses because of complex transitions in admissions and discharges, or the expertise of care provider, quality of care that is provided (Connie Mullinix, 2011). Connie rightly points out that “nurses are the major care providers who make the observations that can quantify the cost of patient care.” Their direct contact with patients and continuous monitoring can prevent adverse events (which are not reimbursable by insurance companies). Nurses play a key role in the financial performance of healthcare organizations. According to Atencio, Cohen & Gorenberg (2007) the financial cost of losing a single nurse has been calculated to equal about twice the nurse’s annual salary. In current day -2015- figures, it could be much more. Acquiring relevant knowledge about budgeting and finance by the nursing community is very much essential, as they can closely monitor consequences of financial decisions on patient outcomes. The nursing leaders, with their knowledge in finance, can influence the decisions made in the board rooms about the need for: increasing levels of their nursing staff so as to prevent undesirable errors; reducing turnover of nurses and other cost-reducing measures.

Calculating nursing staff required for an Ortho unit

Nurse staffing can be measured by full-time equivalent (FTE) employment, nursing hours per patient day, share of registered nurses (RNs) in total nursing staff, nurse-to-patient ratios, or other metrics (Spetz, Donaldson, Aydin & Brown, 2008). The FTE method involves determining productive working hours of a nurse, who is assumed to work for 52 weeks per year at 40 hours per week, totalling to 2080 potential hours of work per year. In the assignment three categories of FTE are given: 1 FTE indicating 2080 hours of work load per year; while 0.9 FTE points to 1872 hours of work per year (36 hours of work per week; three 12-hour shifts); and 0.5 FTE indicating 1040 hours of work per year (part-time employees working five days in a two-week period, with 40 hours of work in a fortnight).

Calculations for determining Number of FTEs for the Ortho Unit with an average daily census (ADC) of 10 patients

Patient care days per year = ADC * 365 = 10*365 = 3650 patient care days
Care hours per patient care day = 7.5 hours
Work load on Ortho Unit, in hours = Patient care days * Care hours per patient day
= 3650*7.5 = 27375 hours
Assuming that nursing staff works for 365 days a year (without availing leave, vacation and other breaks), the FTEs required for the Ortho Unit are determined and presented in Table 1.
Just like any other employee, nurses apply for vacation, sick leave and attending training programs, which reduces the magnitude of 1 FTE to lower levels “between 75 and 86 per cent of potential hours which are considered to be productive” (Eldridge 2004). To take into account their absence, we calculate a coverage factor calculation of which is shown in Table 2.

Adjusting for the staff availing leave and other benefits the FTE per annum we get

Core level FTE (adjusted) = Unadjusted FTE * Coverage factor

Calculated FTEs (adjusted) for the three FTE levels are shown in Table 3.

Calculating non-productive hours
Pelletier & Duffield (2003) categorized potential activities for nursing staff into five groups: direct care, oral communication, documentation, indirect care and personal activities. It is given in the assignment that non-productive hours add up to 18.4 per cent. Non-productive time consists of: paid leave; break within the shift; paid time-off. The leave factor was taken care of while calculating ‘coverage factor’. Let us look at other factors, such as ‘break’, ‘paid-time off’ and ‘personal activities during shift’.
Breaks: For every four hours worked, a nurse is entitled to 15 minutes of break (0.25 hours). The average amount of break hours a nurse is entitled to take per day is 0.543 hours.
= 0.543*232 = 125.98 hours
Percentage of hours not worked in a year due to breaks = (125.98/2080)*100 = 6.05%

Paid time off: Every month a nurse is entitled to 16 hours of paid time off.

Total number of paid time off per year = 16 * 12 = 192 hours
Percentage of hours not worked in a year due to paid time off = (192/2080)*100 = 9.23%

In-transit activities: Time between tasks, such as visits to laboratory, record room and ward room

Personal activities: This include all activities unrelated to patient care, such as, personal errands, meal and coffee breaks, making telephone calls, informal chatting with colleagues.
Both personal and in-transit activities amount to 3.12% (this is usually established by observations in actual settings over a reasonable period of time).
Thus, total non-productive hours in percentage = 6.05 + 9.23 + 3.12 = 18.4%.
Taking the non-productive hours into account, for every FTE, actual hours worked in this case = 2080(1-0.184) = 1697.5 hours
Percentage of non-productive hours thus calculated, gives us another tool to adjust the FTEs, by considering utilization factor (1-0.184) = 0.816. Results of calculation yielding productive FTE, considering utilization factor, are given in Table 4.

Thus, we have three different estimates of FTE required for the Ortho Unit (indicated in Table 5).

In practice, among the three estimates, highest estimate (adjusted FTE) is usually selected. But in our Ortho Unit case, the estimate seems to be excessive, which could lead to higher salary bills. Hence, the productive FTE is chosen for further analysis. Calculating number of nurses and technicians required for the Ortho Unit
Taking the productive FTE estimates and considering the ratio of nurses to technicians (0.7:0.3), we get for different levels of FTE, number of technicians and nurses required (indicated in Table 6)

Conclusions

Measuring number of nurses required in health care departments does not boil down to simple numbers and revenue gain or losses. Over-staffing results in huge pay bills, while under-staffing results in low quality of patient care and patient dissatisfaction, further it could lead to turnover of nurses (which again translates into huge costs and time in recruiting and training new set of nurses). The concept of FTE though may seem simple, yields several alternatives for staffing Ortho Unit. The Ortho Unit has three alternatives to choose from:
I. The Unit can employ 11 nurses and 5 technicians (on a 5-day working week, 40 hours per week) scheduled over three shifts. Allocation for each shift should be based on percentage of workload in each shift.
II. If the workload is slack in one or two shifts, the Ortho Unit can think of employing 13 nurses and 5 technicians who work 36 hours (three 12 hour shifts) per week. The staff can be split into Team A and Team B and first team can be employed Mon-Wed days while second team can be assigned duties from Thurs-Sat days.
III. If the salary bill and benefits basket is cutting into the revenues of the Unit, it can think of employing 22 part-time nurses and 10 part-time technicians, who work five days in a two week period. They can be split into two teams, the first team coming for work in the first week, while the second one comes to work in the second week.

My learning

As a nursing student and future nursing-leader, it gave me perspectives about staffing requirements. Weighing pros and cons of having full-time employees or part-time employees (to cut down pay bill), but at the same time facing quality issues in patient care is a dilemma, which needs to be resolved. Health care, unlike other service sectors, has high level of human-interaction, uncertainty with respect to parameters like ADC, criticality of patients, and different levels of patient care. Further, I could understand that there are several methods to calculate nurse staffing and these methods yield different results for the same setting. I became aware of the differences in overall hospital staffing versus unit level staffing, data sets used in calculating nurse requirements.

References

Atencio, B., Cohen, J., and Gorenberg, B. (2007). Nurse retention: is it worth it? Nursing
Economics, 21.
Connie Mullinix, (2011). Making Nurses Full Partners in Redesigning Health Care in North
Carloina. North Carolina Medical Journal, 72(4): 314-316.
Eldridge, L.P. 2004. Hours measures for productivity measurement and National Accounting.
Paris: National Institute for Statistics and Economic Studies, Paris Group Meeting,
Lisbon. Retrieved February 19, 2015 http://www.insee.fr/en/nom_def_met/colloques/citygroup/pdf/US%203%20ParisGroup2004%20less%20AT.pdf
Pelletier D & Duffield C. (2003). Work sampling: valuable methodology to define nursing
practice patterns. Nursing and Health Sciences, 5, 31-38.
Spetz, Joanne., Donaldson, Nancy., Aydin, Carolyn., & Brown, Diane, S. (2008). How many
nurses per patient? Measurements of Nurse Staffing in Health Services Research
. HSR: Health Services Research 43:5, Part I. Retrieved February 19, 2015 http://www.blackwell-synergy.com/doi/abs/10.1111/j.1475-6773.2008.00850.x