Understanding the Central Responsibilities of the Nurse Manager

One of the central responsibilities of the nurse manager on a clinical unit is to provide the appropriate number and mix of nursing staff (nursing care hours [NCH]) to match actual or projected patient care needs (patient care hours) that will result in safe, effective, quality care for the patients on the unit. While the nurse manager may plan, organize, staff, direct, and controldoing a multitude of things simultaneously all day longthe purpose of a great deal of this activity is to ensure that this responsibility will be carried out. Appropriate staffing has become even more critical as the focus on quality care at a reasonable cost has become paramount. To develop a master staffing pattern, a nurse manager must determine how many hours of nursing care are required, based upon available patient classification system information. Once the hours of required nursing care are determined, the number of full-time equivalents (FTEs) can be calculated. One full-time equivalent is equal to 40 hours per week, 80 hours per two-week pay period, or 2,080 hours per year. There are several methods to determine required FTEs once a desirable staffing pattern has been established. Activity 1:

The Situation In the unit where you are planning the budget, it has been determined that patients need 4 hours of RN nursing care hours per day (NHPD), 2 hours of LPN nursing care/day and six hours of unlicensed assistive personnel (UAP) care/day. This information is based on data from last year, and assumes no change in patient census or acuity for the upcoming year. The average daily census is 32 patients. Figure 17-1: The Staffing Plan Instructions 1. Using the information from the Situation above, determine the nursing care hours (NCHs) for each category of staff per pay period and enter it into the middle column in the table below. Number of RNs: _________ Number of LPNs: _________ Number of UAPs: __________ 2. Using the figures above, determine how many FTEs in each category of staff will be needed to staff this unit per pay period and enter it into the table. 3. How might the number of nursing care hours needed in each category of care in the staffing pattern have been determined?

Category of Staff RNs LPNs UAPs Total nursing staff

Nursing Care Hours per Pay Period

Number of FTEs Required in Each Category

4. Figure 17-2: Total Required Nursing Care Hours Activity 2:

Another method for determining FTEs is to calculate a fraction that can be used as a constant to determine replacement hours needed to cover non-productive hours for each position. Non-productive hours include vacations, holidays, personal days, and so on. Non-productive hours are paid out of the unit budget but not worked. Since a hospital is open for business 24 hours a day and seven days a week (24/7), the non-worked "benefit" hours must be covered by replacements, and must be planned for in the budgeting process. The replacement factor can be calculated by determining the average number of vacation days, paid holidays, personal days, bereavement days, and other paid days off that an organization provides, and the average number of sick days per employee as experienced by the unit or cost center. Example: To determine replacement time at Hospital X:*

Benefit time 15 vacation days 8 holidays 4 personal days 5 sick days

Hours/shift x 8 hours/day x 8 hours/day x 8 hours/day x 8 hours/day Total

Replacement hours/year = 120 hours = 64 hours = 32 hours = 40 hours = 256 hours to replace/year

To determine the FTE replacement requirement, divide the replacement time by the annual FTE hours paid: 256 benefit hours paid --------------------------------------2080 total hours paid = 0.12 This means that for each position on a unit, an additional 0.12 FTE must be included in the budget as a replacement for the non-worked hours. *See Sullivan and Decker textbook, Chapter 12, Budgeting and Managing Resources, for more. This formula accounts for the non-productive time that must be covered. However, it does not include the coverage needed for a seven-day workweek. Each position, or FTE, works 40 hours a week (or 36 hours a week in a 12-hour shift pattern). The additional hours needed to cover the extra two days per week also must be included in budget planning. A second method often used to calculate needed nursing hours for budgeting purposes is to calculate the needed hours as a fraction, as above. Below is a representation of how that is done. The factor used to represent the extra two days per week that must be covered is 0.4. (Let's call this relief time for the purposes of this activity.) Combined with the factor for benefit time, the manager now has a constant that can be used to calculate needed nursing care positions for budgeting purposes. Example: Determining Total FTEs for Budget Planning

1 FTE + 0.12 (benefit replacement time) + 0.4 (additional shifts/wk) = 1.52 FTE (factor used in calculating budget
Figure 17-3: Understanding 24/7 coverage (Relief time)

One full-time person working eight-hour shifts works 40 hours a week, or 80 hours per pay period. Each eight-hour workday of a full-time employee's workweek is considered to be 20%, or 0.2 FTE (5 x 0.2 = 1 FTE). This is one way to visualize the personnel it takes to cover a unit seven days a week, 24 hours a day. (24/7 is shortcut jargon you'll hear in the workplace.) We'll call this relief time. M = 20% or 0.2 T = 20% or 0.2 W = 20% or 0.2 5 workdays = 1.0 FTE Th = 20% or 0.2 F = 20% or 0.2 100%= 1.0 FTE What about Saturday and Sunday? Sat = 20% or 0.2 Sun = 20% or 0.2 2 workdays = 0.4 FTE (to cover the weekend) So, you see, it takes 1.0 FTE plus 0.4 FTE (let's switch to talking about positions, not people) to cover "relief" for the full-time equivalent position to have two days off per week so that seven days per week are staffed. This also must be calculated when determining a staffing budget for the next year. So we will use the factor 1.4 FTEs to account for seven-days-per-week coverage.

Instructions 1. Complete the equation below to determine how many hours of non-productive time each staff member is entitled to per year. Hint: see Chapter 12 in S&D textbook On your unit, all employees receive the following benefit package: 7 holidays/year x _____ = _____ 10 sick days/year x _____ = _____ 14 vacation days/year x _____ = _____ 3 personal days/year x _____ = _____ ---------------Total per year _____ 2. Using the formula in the example above, Determining FTE Replacement Time, calculate the replacement factor for this hospital unit. 1 FTE + ______ (benefit replacement factor) = _____ FTEs 3. Now add the relief time factor from Figure 17-3 to obtain a constant factor that you can used to determine the total FTEs in each skill category for your budget. 1 FTE + _____ (benefit replacement factor) + _____ (relief time factor) = _____ FTE 4. Finally, apply this constant factor to calculate the number of FTEs for the unit described in below.

Shift Day Shift 4

RNs 2

LPNs 2

UAPs

Evening Shift Night Shift

Number of RNs: _________ Number of LPNs: _________ Number of UAPs: __________

4 2

1 2

2 1

Number of Staff from Activity 1 RNs LPNs UAPs Total nursing staff

Factor from #3, Activity 2 applied

Number of FTEs Required in Each Category

Figure 17-4: Total Required Nursing Care Hours FYI: The figure below demonstrates a comparison of eight-hour shifts and 12-hour shifts in terms of obtaining a constant calculation factor for budgeting purposes.

For Your Information: Are More Nurses Needed for 12-hour Shifts?

For eight-hour shifts: 1.4 x 3 shifts/day = 4.2 FTEs for 24-hour day x seven days per week similar formula can be used to come up with a coverage factor for a unit using a 12-hour pattern: three shifts/week x 12 hours/shift = 36 hours per week; 36/40 = 0.9 (Each full-time employee covers 0.9 FTE with this schedule.) Therefore, it takes 2.1 FTEs to staff one 12-hour shift each day, seven days a weekthat is, two people working three 12-hour shifts and one person working one 12-hour shift (0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs for seven days per week). 2.1 x 2 shifts/day = 4.2 FTEs to cover 24-hour day x seven days per week