Hours per patient day benchmarks

Staffing Assigment

Preliminary Data
Definition of Staffing Terms: To build a body of knowledge regarding the development of a staffing budget and later be able to create actual staffing plans, the registered nurse must first be familiar with the following terms and their definitions.

Nursing Hours Per Patient Day (NHPPD): A unit of measure that defines the average number of hours of nursing care delivered to each patient in a 24-hour period.

Hours Per Workload Unit (HPWU): A unit of measure that defines the average number of hours worked per workload unit. The workload unit can be number of visits, number of meals served, number of square feet cleaned, number of operating room minutes, and others, depending on the department worked.

There is a direct relationship between the workload and the amount of resources (RNs, LVNs, Aides, Dietary Aides, OR staff, etc.) needed.

Patient Day (PD): One patient occupying one bed for one day. Typically, counted at midnight. For example, a patient admitted to a nursing care unit at 11:50 p.m. will be counted in the midnight census for that unit; therefore will be counted as one patient day.

Average Daily Census: Patient days in a given time period (daily, weekly, monthly, or annual) divided by the number of days in the time period. It is also used to define the average number of total inpatients on any given day.

Variable Hours of Care: A component of NHPPD that measures the amount, in time, of care directly provided to the patient by a caregiver, e.g. RN, LVN, aide. It does not take into account fixed hours of care. Variable hours of care are also referred to as caregiver hours.

Fixed Hours of Care: A component of NHPPD that reflects the indirect care provided by nursing staff, e.g. unit secretary, nurse manager, clinical nurse specialist. This unit of measure is a constant, meaning that it is not dependent upon the acuity of the patient, or the volume of patients when calculating the staffing pattern.

Full-Time Equivalent (FTE): The equivalent of one full-time employee working for one year. It is calculated based upon 40 hours per week for 52 weeks, or 2080 hours. It includes both productive and nonproductive time. One employee, working full-time for one year (2080 hours) is one FTE. Two employees, each working 20 hours per week for one year (1040 hours each), are the equivalent of one FTE.

Replacement FTE: The number of FTEs required to replace non-worked hours.

Worked Hours: The actual number of hours worked, including both regular and overtime hours, orientation hours, on-call hours, callback hours, and training/education hours. Also known as productive hours.

Non-Worked Hours: The hours for which an employee is paid, but are not worked. Examples include vacation, sick, jury duty, holidays, funeral leave, paid time off, etc. The Fair Labor Standards Act dictates what an institution must include as non-worked hours. Also known as nonproductive hours.

Paid Hours: The total amount of worked and non-worked hours an employee is paid for.

Position: One person working one job, regardless of the number of hours that person works. A position is not the same as an FTE.

Shift: A designated number of hours that an employee works in a 24-hour period. A shift could be 4, 8, 10, 12, or even 16 hours in length. In this module, one shift will be considered as 8 hours.

Paid to Worked Ratio (PWR): Paid hours divided by the difference between paid and non-worked (nonproductive) hours. The PWR is calculated to determine the number of paid FTEs required. For example, one FTE is paid 2080 hours in one year. This FTE has 265 nonproductive hours (vacation, holiday, sick, etc.). PWR=2080/(2080-265)=1.15.

Worked FTE: The number of FTEs required to provide patient care on a daily, weekly, monthly, or annual basis.

Paid FTE: The actual number of worked FTEs plus the replacement FTEs needed during vacation, education, training, etc. to staff a cost center.

Cost Center: A unit or department in an organization.

Putting the Definitions to Use
Use the Excel™ Spreadsheet provided to document your answers. All calculations must be done using formulas in the spreadsheet, where applicable. Be sure to check your worksheet before submitting the assignment to ensure that when the reader clicks in a cell, the formula used to calculate the response is visible in the function bar.

Calculating an FTE
Remember, an FTE is based upon the designated number of hours needed to cover a specified number of shifts during a specific time period. The time period may be per week, per pay period (usually two weeks) or per year. A shift is 8 hours of worked time. Below are some examples of how an FTE is calculated:

· FTE = Number of shifts assigned to work every pay period. A Full-time employee works 10 shifts every two weeks, and this equals 80 hours in a pay period. An employee who is full-time would not necessarily have to work 10 shifts as long as they worked 80 hours. However, for the purposes of this module, all shifts are to be considered 8 hours long, so the employee must work 10 shifts to be considered full-time.

· FTE = Worked hours hours per pay period for full-time employee

FTE = 40 worked hours 80 hours = 0.50 FTE

· Hours = FTE x Hours paid per pay period for full-time employee

· Hours = 0.50 FTE x 80 = 40 hours (number of hours that a 0.50 FTE would be scheduled to work in a pay period)

· Shifts = Hours per pay period Hours in a shift

Shifts = 80 hours per pay period 8 hours = 10 shifts per pay period

10 shifts = 80 hours per pay period = 1.00 FTE

9 shifts = 72 hours per pay period = 0.90 FTE

8 shifts = 64 hours per pay period = 0.80 FTE

7 shifts = 56 hours per pay period = 0.70 FTE

6 shifts = 48 hours per pay period = 0.60 FTE

5 shifts = 40 hours per pay period = 0.50 FTE

4 shifts = 32 hours per pay period = 0.40 FTE

3 shifts = 24 hours per pay period = 0.30 FTE

2 shifts = 16 hours per pay period = 0.20 FTE

1 shift = 8 hours per pay period = 0.10 FTE

For each of the following scenarios, complete your answers using your knowledge of Excel basic formulas on the Worksheet provided in the Assignment Drop Box:

FTEs

ONE WEEK

HOURS

ONE WEEK

SHIFTS

ONE PAY PERIOD HOURS

ONE PAY PERIOD SHIFTS

0.2

8

1

16

2

0.4

0.6

0.8

1.0

2.0

Great!!! You have now mastered being able to calculate the number of shifts and hours that a designated FTW works in one week and in one pay period. Using the same principles, you could also calculate the number of hours and shifts an FTE would work in a month, quarter, or year.

The next step is to be able to compute the number of FTEs needed to staff for one week based on the number of shifts required. To be able to calculate this number, you need to know the following:

· FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per week)

· FTEs = An RN works 5 shifts per week. How many FTEs are required?

FTE = 5 5 = 1.00 FTE

Now, it’s your turn again!!! Fill in the missing shifts and FTEs, using Excel formulas:

STAFF

S

M

T

W

T

F

S

SHIFTS

FTEs*

NM

0

1

1

1

1

1

0

5

1.0

RN

5

6

6

6

6

6

5

LVN

4

3

3

3

3

3

4

NA

4

4

4

4

4

4

4

US

1

1

1

1

1

1

1

TOTAL

14

15

15

15

15

15

14

*Format FTEs to 1 decimal place.

Calculating NHPPD
Were the previous calculation exercises easy for you to complete? Great!! The next few are just as easy, but they begin to combine the elements of required nursing hours per patient day and the unit’s FTE requirements. But, before we get to that, you need to know how to derive the NHPPD and its related components.

Let’s get started!

The numbers of FTEs allocated to a nursing unit are based upon the NHPPD for that particular unit’s patient population and acuity. A variety of sources are available to compare your unit’s NHPPD with other units. In many cases there are national nursing standards that can be used as comparative data (like units, with the same type of patient population, are compared to each other). These units with the same or similar patient types usually have common nursing care requirements. When this is true, those nursing unit’s NHPPD are averaged to create a standard NHPPD. This number can only be used as a guide to determine the NHPPD for your unit, because differences such as geography, nursing care delivery system, support services available, and other variables may not be accounted for.

Why is it important for RNs to understand the concept of NHPPD and know their unit’s hours? Simply put, NHPPD defines how much nursing care each patient on the unit requires in a 24-hour period. In a sense, it defines the level of care required. Without it, the staffing might be based upon volume, rather than patient needs, and nursing care in acute care units should be based upon the needs of the patient.

In one example, a total of 103 shifts were worked by the distribution of staff given for one week. For a particular week, this unit experienced 85 patient days. From this data, one can calculate the NHPPD:

· NHPPD = Total shifts per week x 8 hours per shift

Number of Patient Days

NHPPD = 103 x 8 = 9.69

85

Now, here is one for you to figure out. Please calculate the NHPPD for the following unit, using Excel formulas to complete your calculations:

Unit 3A has had 61 patient days in the past week, with a total of 98 shifts staffed. What was 3A’s NHPPD for that time period?

NHPPD* = ___________________________________

*Format NHPPD to 2 decimal places.

As we said earlier, NHPPD is a compilation of different types of hours, one of which is Variable Hours of Care or Caregiver Hours. Remember, variable hours of care delineates those hours of care that are directly provided to the patient by a caregiver, defined as the RN, LVN, or nurse aide. Calculating Caregiver Hours gives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated:

· Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8 hours per shift

Patient Days

In one example, the total shifts calculated = 103. There were 12 non-caregiver shifts (NM and US), which leaves 91 Caregiver shifts. Assuming the same number of patient days (85) from above, calculate the Caregiver Hours:

Caregiver Hours = 91 x 8 = 8.56

85

Using the situation described previously for Unit 3A, calculate the Caregiver Hours where there were 54 RN shifts, 14 LVN shifts, and 13 NA shifts. Use formulas in Excel for your calculations.

Caregiver Hours* = __________________________

*Format the Variable Hours of Care (Caregiver Hours) calculation to 2 decimal places.

We hope that you noticed that your Variable Hours of Care did not equal the number you got for NHPPD. Great!! That is because we have not taken into account yet the Fixed Hours. Fixed Hours of Care are the hours required for indirect care for every patient on a unit. Fixed hours are comprised of the secretarial work, management of the unit, and non-direct patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume.

· Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours per shift

Patient Days

From our first example, calculate the number of shifts worked by the NM and US. Using the same patient days of 85, calculate Fixed Hours of Care for this unit:

Fixed Hours of Care = 12 x 8 = 1.13

85

Are you ready? Using the same situation for 3A and knowing that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit Secretary shifts, calculate the Fixed Hours of Care: Again, use formulas in Excel to complete your calculations.

Fixed Hours of Care* = ______________________

*Format calculation to 2 decimal places.

Hopefully, when you add your answers for the Caregiver Hours and Fixed Hours of Care, you came up with the answer you originally got for your NHPPD. Remember, this occurs because NHPPD is a combination of Variable (Caregiver) Hours and Fixed Hours of Care.

Calculating Paid FTEs and Positions
WOW!!! Your brain is probably already on overload, but the best is yet to come!!! Now, if you believe that, we have some beach front property in Arizona for sale… Interested?

Seriously, to complete the determination of staffing process, you must know how to figure paid FTEs and the number and type of positions needed. Paid FTEs differ from the FTEs you have previously figured because paid FTEs include both worked and non-worked hours. What you have done so far is to calculate worked FTEs.

· Non-worked Hours = Total shifts non-worked x 8 hours per shift

An example of calculating Non-worked Hours for a full-time employee is as follows:

Sick leave = 10 shifts per year

Vacation = 15 shifts per year

Holidays = 8 shifts per year

Training = 5 shifts per year

Misc. = 2 shifts per year

Total = 40 shifts per year

Non-worked Hours = 40 shifts x 8 hours = 320 hours per employee

Note: The number of non-worked hours for an employee is determined by the organization, which ensures consistent allocation of non-worked hours allocated. Although employees with seniority might have more vacation hours than new employees, for the purposes of this module, all employees have the same allocation of non-worked hours.

Here goes! Is your computer smoking yet??? Calculate the number of Non-worked Hours for any employee of 3A, using formulas in Excel, based upon the following data:

Sick leave = 12 shifts per year

Vacation = 10 shifts per year

Holidays = 6 shifts per year

Training = 3 shifts per year

Misc. = 3 shifts per year

Total = 34 shifts per year

Non-worked Hours = _________________

Calculating the non-worked hours is essential prior to figuring the Paid-to-Worked Ratio (PWR) for an organization. The PWR allows you to determine the total number of paid FTEs required to staff your nursing unit. As explained earlier, paid FTEs is a combination of worked FTEs and the replacement FTEs needed when, for example, someone is on vacation, ill, or at an education seminar. Replacement FTEs are necessary in order to maintain established staffing patterns by replacing an employee (who is calculated in Caregiver Hours) who is off, on vacation, etc. with a person of equal skill classification (RN for RN, LVN for LVN, etc.). Replacement FTEs need to be budgeted when the staffing pattern is established so that you are not using overtime to staff the unit, or staffing at levels below requirements. Paid FTEs is a requirement for being able to put a dollar figure to a staffing plan.

· PWR = Annual Paid Hours for a full-time employee

(Annual Paid Hours) – (Non-worked Hours)

Using an example of 320 non-worked hours per employee,

PWR = __2080___ = 2080

2080-320 1760

PWR = 1.18

To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the PWR.

· Paid FTEs = Worked FTEs x PWR

Using an example of having 6.6 worked FTEs of NA, and the PWR calculated above, calculate the number of Paid FTEs required:

Paid FTEs = 6.6 x 1.18 = 7.79

*Format Paid FTEs to 2 decimal places

Remember that when an employee who is off is not replaced with another comparable employee, such as the nurse manager or clinical specialist, the Paid FTEs are equal to Worked FTEs.

Calculate the Paid FTEs (Worked FTEs plus replacement) in the following staffing plan, using PWR = 1.18. Put your formula in the appropriate cells in Excel.

STAFF

S

M

T

W

T

F

S

SHIFTS

WORKED FTEs

PAID FTEs*

NM

0

1

1

1

1

1

0

5

1.0

RN

5

6

6

6

6

6

5

40

8.0

LVN

4

3

3

3

3

3

4

23

4.6

NA

4

4

4

4

4

4

4

28

5.6

US

1

1

1

1

1

1

1

7

1.4

TOTAL

14

15

15

15

15

15

14

103

20.6

*Format Paid FTEs to 2 decimal places.

Easy, isn’t it? Well, you are almost done with this section. Close your eyes, take a deep breath, and forge onward! Now we are going to learn how to assign positions to a staffing pattern.

Positions do not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A position is not the same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positions so that you will have the correct number of staff to implement the staffing pattern.

In a staffing pattern that gives every other weekend off, the number of positions required is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8-hour shift. Let’s say that on a typical nursing unit at your facility the number of RN shifts worked every Saturday and Sunday are five, and six RN shifts are worked Monday through Friday. The number of RN positions required would be 10. For positions that are not replaced by another comparable employee (e.g. Nurse managers), the number of positions needed for that skill classification is equal to the actual number of employees in that classification. For example, if you have one Nurse Manager, you only need one position of NM.

Determine the number positions required for each skill classification in the staffing pattern below. Watch out!! If you determine the total number of positions needed by adding the total shifts for Saturday and Sunday you will be WRONG because the NM doesn’t work on those days; you will not have counted that “position!” To get the accurate number of total positions, add the column of positions for each skill classification:

STAFF

S

M

T

W

T

F

S

SHIFTS

WORKED

FTEs

PAID FTEs

POSITIONS

NM

0

1

1

1

1

1

0

5

1.0

1.0

1

CNS

0

1

1

1

1

1

0

5

1.0

1.0

1

RN

2

3

3

3

3

3

2

19

3.8

4.48

4

LVN

3

3

3

3

3

3

3

21

4.2

4.96

NA

2

4

4

4

4

4

2

24

4.8

5.66

US

3

3

3

3

3

3

3

21

4.2

4.96

TOTAL

10

15

15

15

15

15

10

95

19.0

22.06

PWR = 1.18

Putting it all Together
Okay. Now it’s time to give you a real brain teaser. Let’s see if you can put it all together.

Complete the information for the following staffing pattern. Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a one-week period:

STAFF

S

M

T

W

T

F

S

SHIFTS

WORKED

FTEs

PAID FTEs

POSITIONS

NM

0

1

1

1

1

1

0

CNS

0

1

1

1

1

1

0

RN

6

6

6

6

6

6

6

LVN

2

3

3

3

3

3

2

NA

6

8

8

8

8

8

6

US

2

2

2

2

2

2

2

TOTAL

Inserting the appropriate data from above, calculate the following using formulas in Excel:

Calculate NHPPD: _____________________

Calculate Variable Hours: _________________

Calculate Fixed Hours: ____________________

Determining Paid NHPPD
Up to this point, you have been learning how to determine Worked NHPPD and its components. Below are formulas for calculating the Paid NHPPD. For each question below, use formulas in the Excel answer sheet to display your answer.

· Paid NHPPD = Worked NHPPD x PWR

Using an example where a unit had a NHPPD of 9.69, and the allocated PWR of 1.12, calculate the Paid NHPPD:

Paid NHPPD = 9.69 x 1.12 = 10.85

What is the Paid NHPPD with a Worked NHPPD of 15?

· Paid Caregiver Hours = Worked Caregiver Hours x PWR

The Variable Hours for that unit was 8.56. With a PWR of 1.12, calculate the Paid Caregiver Hours:

Paid Caregiver Hours = 8.56 x 1.12 = 9.59

What are the Paid Caregiver Hours with Worked Caregiver Hours of 7.25?

· Paid Fixed Hours = Worked Fixed Hours x PWR

The Fixed Hours for our earlier example was 1.13. With a PWR of 1.12, calculate the Paid Fixed Hours:

Paid Fixed Hours = 1.13 x 1.12 = 1.26

What are the Paid Fixed Hours with Worked Fixed Hours of 1.6?

Note that you can calculate the Worked elements of NHPPD by dividing the paid NHPPD by the PWR. For example, if you know the Paid NHPPD is 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 1.12 = 9.69.

Acuity and its Influence
Just knowing your average daily census (ADC) and NHPPD may not be enough to create an accurate staffing pattern because these elements do not take into account the actual severity of the patients. If you are currently using an acuity system that assigns a numerical score to the severity level of the patients on your unit, you can adjust your staffing pattern to take into account the influence of patient severity.

· Acuity = Average Acuity Score x Patient Volume for a Specified Time

The Specified Time Period

You have calculated 12.85 NHPPD for a unit that has 61 patient days in one week (ADC=8.7). Assume an acuity on that unit of 2 (on average, each patient requires 2 RVUs); calculate Adjusted Daily Census (reflects acuity):

Acuity = 2 x 3176 Annual Patient Days

365 Days

Acuity = 6352 Adjusted Patient Days

365 Days

Acuity = 17.4 Adjusted Daily Census

This value equals an adjusted average daily census that reflects the acuity of that patient population. The staffing pattern is then configured based on this adjusted average daily census. For example, with an ADC of 8.7 and NHPPD of 12.85, you would need 13.97 FTE. Factoring in the acuity value would indicate that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8 hour shifts) to care for those 8.7 patients because of the acuity level.

To further see how FTEs change in relation to the addition of acuity, please follow this example:

A nursing unit has been told that they must maintain a worked NHPPD of 6.62 hours. The baseline workload unit volume is 12,500 patient days, requiring 39.78 worked FTEs. Remember how to calculate that? 6.62 NHPPD x 12,500 patient days = 82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) = 39.78 worked FTEs. The workload unit volume, with an acuity of 1.08 factored, is now 13,500 patient days. The worked FTEs that would be required to care for this adjusted patient day volume would be:

FTEs = NHPPD x Adjusted Workload Volume

2080 hours

FTEs = 6.62 x 13,500 = 42.97

2080

An additional 3.19 FTEs are needed to account for the acuity of the patient population and to maintain a worked NHPPD of 6.62.

How many more FTEs would be needed with an acuity level of 3.0 for this same volume of patients and 6.62 NHPPD? Use formulas in Excel to calculate your answer.