Fte Forecast Template - PowerPoint

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					Developing a Staffing Budget

   Nursing Resource Management
               Staffing
•   Overview
•   Budget
•   Schedule
•   Daily Staffing
•   Expected Fluctuation Plan
•   Peak Demand
•   Management Information
             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.
Staffing Overview
         • Overall staffing strategy
            – addresses volume
            – addresses staffing
              strategies
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.
  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.
    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.
            Budgeting Staff
      Required 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.
      Budgeting Staff
Required Patient Care Hours
  Budgeting for Staffing
Required Patient Care Hours
                Budgeting Staff

• Used for budgeting core staff to a unit


      Total FTE needed =

        Total Patient Care Hours
        #productive hrs./FTE
         Budget for Staffing
        Non Productive Time


Productive Hours/Paid Hours=% Productive



% Productive X 2080 = #Productive hr/FTE
                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
            Budgeting Staff

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

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

• Skill Mix
   –   Based on patient needs
   –   ICUs usually 90-100% RN
   –   General Care Units usually- > 60% RN
   –   Rehab/Psych Units usually- ~50%
  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.
  Budgeting Staff-Patient Outcomes

• Potter et al. (2003) Decreased RN hours> patient’s
  increased perception of pain & higher RN hours > 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 > higher probability of
  pressure ulcers
  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 >12 hours.
• Estabrooks et al. (2005) Decreased mortality with
  increased BSN & increased RN mix.
 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.
Budgeting Staff-Indirect Caregivers
   • Secretaries and non-nurses
   • Other Nurses
     – Managers
     – Education
     – CNS, NP, CNM,
            III. Scheduling Staff

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

 •   Internal Float Pools
 •   Floating
 •   PRN Staff
 •   Overtime
Expected Fluctuation Plan
VI. Peak Demand Management

 • Bonuses
 • Agencies
 • Use of other resources (Nurse Managers,
   Educators, CNS, other staff)
 • Diversion Plans
VII. Low Census Management

•   Policies & Procedures
•   Canceling most expensive staff first
•   Voluntary leaves
•   Hospital procedure for canceling shifts
•   Lay-offs
  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
Management Information Systems to
       Support Staffing

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

				
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