Nursing

From the staff development bookshelf: Analyzing nurse staffing: Calculating FTEs

Staff Development Weekly: Insight on Evidence-Based Practice in Education, October 28, 2011

The million-dollar question most nurse leaders struggle with is, "How many FTEs do I need on my position control (staffing roster) to cover my average daily census?" This question leads us into the complicated discussion of units of service and what drives the intensity of need for staffing. Here's a case study of how an inaccurate measurement of work can cause plenty of problems.

A hospital-based department of surgery cared for both inpatients and outpatients and was the only surgical service in the city. Historically, the department had measured its work in total number of cases. Soon, an ambulatory surgery center was being built across town. It was predicted that 80% of all outpatient cases would be moved to the surgery center. The staff in the department was downsized to account for this 80% reduction in outpatient volume. When the surgery center opened, the hospital could not provide enough staff to handle the number of cases that remained in the hospital surgery department. They had indeed lost the number of cases predicted; however, they were working late, did not have enough staff to start the day, and cases were being delayed. What had gone wrong?

The majority of the outpatient cases that had been moved to the surgery center were short cases that required only two staff members in the operating room. The inpatient and complicated outpatient cases that remained at the hospital were cases that were longer in duration and often required more than two staff members in the room. The realization was evident: when it comes to measurement of work, a case is not a case. The nurse leader had to ask, "What is the true measurement of work?"

The nurse leader decided to look at the time between when the patient was brought into the operating room (OR) and the time the patient was taken out of the OR (demonstrated in OR minutes). This measurement of patient in to patient out would more accurately reflect the measurement of work. When the nurse leader did a retrospective review of the six months prior to the surgery center opening and compared it with the six months after the surgery center opening, the department had actually lost only 11% of the previous six months' OR minutes. This demonstrates the need to evaluate and believe that the measurement of work or unit of service that is being used for calculating your department's volume really does reflect the workload in your department.

In addition to the demonstration above, the nurse leader also compared the average number of staff needed per OR prior to the surgery center opening and the average number of staff needed after the surgery center opening. This number went from an average of 3.0 staff per room to 3.5 staff per room. This information was also useful in justification for additional staffing need.

Source: Book excerpt adapted from The Nurse Leader's Guide to Business Skills: Strategies for Optimizing Financial Performance by Pamela Hunt, BS, MSN, RN, and Deborah Laughon, RN, BSN, MS, DBA, CCRN.

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