How to calculate nursing staffing needs

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: