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Module 3

Elements of a Staffing PatternPart 1

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Staffing PatternsStaffing Patterns are the foundation of the salary budgetIndicate the number and type of staff needed to care for a specific number and type of patient populationBased on the Unit of Service (UOS) which was identified during the volume projection and the activity of that unit

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Staffing Pattern

The activity on a unit can be defined in a variety of ways

Beds = the number of beds available for occupancy

Census = number of patients on the unit at a specific time of day (most hospitals use a midnight census, but some desire a more frequent count to identify transfers into and out of a unit)

Percent Occupancy = Census of a unit ÷ beds available x 100. Ex: a unit with a Midnight census of 22 and a bed count of 26, 22 ÷ 26 = .846 x 100 or an occupancy of 84.6 %

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Staffing Pattern

Activity Definition continued

Patient Day = a single patient in a bed for one complete day.

Average Daily Census = number of patient days in a given period ÷ number of days in that period Ex: 765 patient days in March ÷ 31 days in month = ADC of 24.67

Average Length of Stay = number of patient days in a given period ÷ number of discharges or admission in that time period Ex: 765 patient days in March ÷75 discharges in march = 10.2 as the average of stay for the patients.

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Each unit/department is assigned a specific unit of service

Nursing units – patient days OR - # of Cases performed Labor & Delivery - # of Deliveries Pharmacy - # of doses dispensed Emergency Department - # of Visits

To determine the volume of patients projected a conversion of the available data to the unit of service might be necessary

Ex: An increase in OR orthopedic volume by 5% due to a new surgeon. Current Orthopedic volume is 10 cases per week = 520 cases per year and increase of 5% would mean 52 additional cases or 1 per week in the coming year.

Staffing Pattern

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Staffing Pattern Now that the volume of a department/ unit has been projected the next step is to identify if there are varying Levels of Care Volume does not tell the entire needs

of the patient. Some type of measurement of the

acuity of the patient should be considered

Patient classification systems allow for the categorization of patients based upon the level of nursing care needed.

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Staffing PatternsTypes of Patient Classification Systems Subjective method – a description is developed

for each category/level of care requirements. Time requirements are then associated with each level based on the description. Patients are then matched up to the best descriptor of the patient.

Factor isolation method – forms are designed to include all the necessary care factors which the patient might require. The forms are uniquely designed for a specific clinical specialty. Each element has an associated time factor. The total time requirement is determined by the number of elements selected.

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Either of these methods calculate the appropriate hours of careAdvantage is that the information is “unbiased” based on mathematical formulas. But staff over time learn what to check to increase requirements. Only true unbiased system is to link system to a documentation system where the elements documented as delivered are recorded and time elements are calculatedDisadvantage of most of the systems is the maintenance of the categories and the underlying hours of care. As new methods and equipment change how care is delivered the underlying hours of care an time allocation must be maintained.

Staffing Pattern

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Staffing Pattern

Many states are reviewing a “standard” hours per patient day or nurse to patient ratios that should be delivered to identified patient populationsCalifornia was one of the first states to mandate patient ratios. The ratios are to be maintained 24 hours a day, including breaks and meals.

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Staffing PatternsCalifornia Ratios by specialty

Critical Care – no less than 1:2 OR – 1RN circulator, 1 scrub (RN or other) ED – no less than 1:4 when patient, 2 nurses at all

times Post Anesthesia Care – 1:2 regardless of type of

anesthesia Pediatrics – 1:4 Step Down – 1:3 Telemetry – 1:5 Psychiatry – 1:6 Med/Surg – 1:5 Labor & Delivery – 1:2 in labor, 1:4 Antepartum, 1:4

Postpartum with Mother/Baby couplets, 1:6 Postpartum Mothers only

Staffing PatternsHouse Bill 2273 – Submitted 5/6/09 To establish direct care registered nurse

to patient staffing ratio requirement in hospitals

Rationale Higher acuity of patients increase need Inadequate and poorly monitored registered

nurse staffing practices that result in too few registered nurses providing direct care

Required staffing ratios help nursing shortage by aiding in recruitment and improve retention

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Staffing PatternsHouse Bill 2273 The staffing plan needs to provide for each

shift on every unit a direct care registered nurse may not be assigned to more than: 1 patient in OR and Trauma ED 2 patients in Critical Care Units, L & D Units, and

Post Anesthesia Units 3 patients in Antepartum units, Emergency Room,

Pediatric, Step Down and Telemetry Units 4 patients in Intermediate Care Nursery, Med/Surg

Units, Acute Care Psychiatry Unit 5 patients in rehabilitation units 6 patients in Postpartum (6 couplets) and well baby

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Staffing PatternsPublic Act No. 08-79 (State of Connecticut) – Effective October 1, 2008 On or after July 1, 2009 each hospital licensed

by the Department of Public Health shall make available a prospective nurse staffing plan with a written certification that the nurse staffing plan is sufficient to provide adequate delivery of care

Each hospital shall establish a hospital staffing committee to assist in the preparation of the nurse staffing plan. The committee membership shall be made up of not less than fifty (50) per cent direct patient care givers.

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Staffing PatternsPublic Act No.08-79 (continued) Each hospital, in collaboration with its staff

committee, shall develop and implement to the best of its ability the prospective nurse staffing plan.

The plan shall include: Minimum skill mix for each patient care unit in the

hospital Identify the hospital’s employment practices

concerning the use of temporary and traveling nurses

Set the level of administrative staffing in each patient care unit

Set the hospital’s process for internal review of the nurse staffing plan