Nursing

Case scenario: Justification for an increase in staff

Staff Development Weekly: Insight on Evidence-Based Practice in Education, September 16, 2005

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New nurse manager, Carey Carrington, runs a busy telemetry unit. The unit is particularly difficult to manage because it has 85 staff members and an average daily census (ADC) of 26 patients.

Patients are constantly transferring in and out of the unit. Each week, Carey's productivity report reflects a large variance toward the beginning of the week, but her unit's midnight census has remained consistent. When reviewing the previous month's staffing reports and admission/discharge/transfer data, Carey found that an average of 20 new patients flowed through the unit during the same 12-hour period every Tuesday. She discovered that the patients were not captured in the midnight census.

Carey is scheduled to meet with her supervisor in the morning. What should she say?

Always support your requests with information. The best approach is: "After collecting data and observing the unit for the past 90 days, I have found that as a result of the cardiac catheterization lab scheduling, we take on an average of five extra cases each Tuesday. Along with the added cases, the intensive care unit census is running to capacity. Therefore, we have turned over an average of 20 patients every Tuesday for the past three months. And although our productivity reports show an ADC of 26, we are actually caring for 46 patients over the course of the day."

"I would like approval to increase staffing on Tuesdays, and I will modify the schedule accordingly. Currently, we are reducing staff on Fridays because of the lowered census, which will help maintain the overall budgeted HPPD. I will explain the variances each month on the variance report. I anticipate the overall CPUOS to remain the same."

Editor's note: The above excerpt is from the new online course, "Nursing CE Series: Finance and Budgeting for Nurse Managers." For more information on this and other courses in our library, go to www.hcprofessor.com and click on Nursing CE.



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