Developing a Staffing Budget

Nursing Resource Management

Staffing
Overview Budget Schedule Daily Staffing Expected Fluctuation Plan Peak Demand Management nformation

I. Staffing Overview
!hy i" "taffing "o important#
$ %ur"ing Salary & wage" are '() of the %ur"ing direct expen"e *udget+ $ %ur"ing Salary & !age" are ,-) of the ho"pital direct expen"e *udget+ $ Scheduling i" a ma.or rea"on nur"e" change .o*" $ %ur"e Manager" "pend a lot of their time with "taffing i""ue"+

Staffing Overview
Overall "taffing "trategy
$ addre""e" volume $ addre""e" "taffing "trategie"

Staffing Overview
/ertain cen"u" level"0 up to the 1D/ re2uire a core unit "taff + Pro*a*le cen"u" level" rely on internal "taff Po""i*le cen"u" level" utili3e internal "taff and increa"ed compen"ation Peak cen"u" may re2uire out"ide "taff0 expen"ive compen"ation and limitation of *enefit"+

Budgeting Staff-Direct Caregivers

4olume 5 6PPD or 6P4 7 8e2uired Patient /are 6our" 4olume determination
$ 9he corner"tone in calculating "taffing need" $ 9he unit of "ervice for mo"t ho"pital" i" patient day" $ Some department" may u"e vi"it" or procedure" for their unit of "ervice $ 4olume pro.ection" are not u"ually controlled totally *y the %ur"e Manager $ 1D/ i" calculated *y dividing total volume *y :'-+

Budget Staff-Direct Caregivers

4olume
$ 4olume mu"t *e foreca"t for the entire year $ 9he foreca"t mu"t al"o include the di"tri*ution of volume0 *y month0 day of the week0 etc+ $ Foreca"t" are u"ually *a"ed on pa"t hi"tory and ad.u"ted *y the %ur"e Manager+ $ 9he %ur"e Manager mu"t add her experti"e and add or "u*tract volume *a"ed on her knowledge of the patient population and program" *eing offered+

Budgeting Staff Required atient Care !ours

Determine the total num*er of patient day" ;vi"it"<+ Determine from your patient cla""ification "y"tem the num*er of day" ;vi"it"< in each cla""ification+ Multiply the 6PPD per cla""ification0 time" the num*er of day" *udgeted ;or 6P4 time" vi"it"<+ 9otal the num*er of patient care hour" needed+

Budgeting Staff Required atient Care !ours

R e q u ir e d P a t ie n t C a r e H o u r s P a tie n t C la s s if i c a t io n 1 2 3 ! 5 T o ta l N u m b e r o f P a t ie n t D a y s 1500 3 00 2!00 #00 500 #000 H PPD 2 .5 !. $ .0 1 2 .2 1 # .0 T o ta l H o u rs 3 50 1 "3 # 0 1 # "2 0 0 1 0 "# $ 0 #500 % 0 "$ 2 0

Budgeting for Staffing Required atient Care !ours

2 0 0 R e q u ir e d P a tie n t C a r e H o u r s P a tie n t C la s s if i c a t io n 1 2 &1 '3 ( 3 &1 '2 ( ! &1 '1 ( 5 &2 '1 ( T o ta l N u m b e r o f P a tie n t D a y s %3 0 0 1#0 # 1 0 %5 0 0 % ! "3 % % H PPD #. 2 # .$ 1 3 .$ 2 5 .$ T o ta l H o u rs % 1 "2 3 % 1 $%2 1 2!2 2 5 .$

Budgeting Staff
="ed for *udgeting core "taff to a unit

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

Budget for Staffing Non roductive "ime

Productive Hours/Paid Hours=% Productive

% Productive X 2080 = #Productive hr/FTE

Budgeting Staff

Daily F9E re2uired>u"ed to plan daily "taffing

Total Patient Care Hours #$%
For 8 hour shi"ts For &2 hour shi"ts

= ail! Hours o" Care

ail! Hours/8 ail! Hours/&2

Budgeting Staff
9otal F9E Budget
$ ="ed to allocate core "taff to unit" $ 1llocate" "taff to cover ?@AB0 vacation0 "ick0 FMC1

Budgeting Staff
Daily F9E %eed"
$ $ $ $ ="ed to develop *a"ic "taffing pattern Divided *y "hift" Divided *y "kill mix E2ual" core "taffing pattern

Budgeting Staff
Shift>to Shift Breakdown
$ $ $ $ Ba"ed on patient need" at different time" of the day Start *y identifying cen"u" on the different "hift" /=" u"ually DAEA%>+::A+::A+:: More unit" are moving to /=>type *reakdown due to "horter COS0 increa"ed acuity

Budgeted Staffing
Skill Mix
$ $ $ $ Ba"ed on patient need" /=" u"ually DE>,EE) 8% Feneral /are =nit" u"ually> G 'E) 8% 8eha*AP"ych =nit" u"ually> H-E)

Budgeting Staff- atient Outcomes

%eedleman & Buerhau" et al+ ;?EE,< Strong con"i"tent relation"hip" *etween nur"e "taffing and =9 0 pneumonia0 COS0 =F *leed" and "hock+ n ma.or "urgical patient" failure to re"cue wa" al"o related to nur"e "taffing+ Blegan et al+ ;?EE,< Decrea"ed med error" with ) 8% up to (B)0 no relation"hip to BS%0 exp+ Sa"ichay>1kkadechanunt et al+ ;?EE:< 9otal nur"e "taffing wa" related to inpatient mortality+ %o relation"hip of mortality to )8%0 8% experience or ) BS%+

Budgeting Staff- atient Outcomes

Potter et al+ ;?EE:< Decrea"ed 8% hour"G patientI" increa"ed perception of pain & higher 8% hour" G higher perception of "ati"faction *y patient"+ /ho et al+ ;?EE:< 1n increa"e of , 6PPD a""ociated with (+D) decrea"e in odd" of pneumonia0 ,E) increa"e in )8% a""ociated with D+-) decrea"e in odd" of pneumonia0 increa"ed 6PPD G higher pro*a*ility of pre""ure ulcer"

Budgeting Staff- atient Outcomes

1iken et al+ ;?EE?< Each additional patient cared for *y a nur"e wa" a""ociated with a B) increa"e likelihood of dying within :E day" of admi""ion0 and odd" of failure to re"cue0 a ?:) increa"e in nur"e *urnout and a ,-) increa"e in .o* di""ati"faction+ 8oger" et al+ ;?EE@< Error" and near error" more likely to occur when nur"e" work G,? hour"+ E"ta*rook" et al+ ;?EE-< Decrea"ed mortality with increa"ed BS% & increa"ed 8% mix+

Budgeting Staff- atient Outcomes

%eedleman et al+ ;?EE'< ncrea"ed "kill mix to B-) re"ult" in *etter patient care ;decrea"ed COS0 death"< and co"t "aving"+ ncrea"ing care hour" and increa"ing care hour" and 8% ) wa" not+

Budgeting Staff-Indirect Caregivers

Secretarie" and non>nur"e" Other %ur"e"
$ Manager" $ Education $ /%S0 %P0 /%M0

III. Sc#eduling Staff

Pattern of /ore "taff Patient flow0 placement guideline" =nit 1ctivity Monitor" >1D9 Factor" 4acationAFMC1 Policie" & Procedure" to "upport Staffing Plan

I$. Dail% Staffing

?@ hour plan /on"i"tent and continuou" patient care En"ure availa*ility of competent "taff 6igh value on cro"" training 6ave employee" work in primary unit0 a" much a" po""i*le 8educe unfair competition *etween unit" Deal with "pecial re"ource re2uirement"

Dail% Staffing
Fine>tuning to cover volume change" acuity change"0 call off" Floating plan0 plan to replace deficit" Meeting increa"edApeak demand Cow cen"u" management plan"
$ cancellation procedure0 increa"ed co"t out fir"t

Plan for B>,E day" ahead

I$. &'pected (luctuation lan

nternal Float Pool" Floating P8% Staff Overtime

&'pected (luctuation lan

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%

$I.

ea) Demand Management

Bonu"e" 1gencie" ="e of other re"ource" ;%ur"e Manager"0 Educator"0 /%S0 other "taff< Diver"ion Plan"

$II. *ow Census Management

Policie" & Procedure" /anceling mo"t expen"ive "taff fir"t 4oluntary leave" 6o"pital procedure for canceling "hift" Cay>off"

$II. Management Information S%stems to Support Staffing

Pro"pective data>operation" *udget /urrent data>daily management report"
$ 1ctual ver"u" re2uired "taff variance $ 1ctual ver"u" *udgeted cen"u"

8etro"pective>Productivity 1naly"i"
Benchmarking Juality data Budgeted ver"u" actual

Management Information S%stems to Support Staffing

8etro"pective 1naly"i"0 cont
$ 1udit" of "chedule"
) unfilled hole" O9 ) agency K re2ue"t" grantedAdenied