Question

You are the manager of a medical/surgical unit. The unit has 32 beds and an occupancy rate of 75%. The desired staffing mix consists of four RNs, two LPNs/LVNs, and two nursing assistants on the 7 AM to 3 PM shift; three RNs, one LPN/LVN, and two nursing assistants on the 3 PM to 11 PM shift; and two RNs, one LPN/LVN, and one nursing assistant on the 11 PM to 7 AM shift. Using the formulas in Box 14-4, determine how many FTEs of each category of employees will be necessary to cover the staffing expectations. Remember, this division will operate 24 hours every day, including weekends and holidays.

Activity 14-1 (15 pts)
Using the 32-bed unit just described, determine (a = 5pts) to what average daily census (ADC) a 75% occupancy rate equates. Now assume that the actual number of patient days in the past month was 836. Using the formula in Box 14-4 of the text, (b= 5pts) calculate the real ADC. Finally, assume that during the past month, 102 discharges occurred. (c =pts) Determine the average length of stay.

Activity 14-2 (15 pts) PG. 263
You have called a staff meeting and have encouraged the staff to bring concerns regarding staff satisfaction. The focus of this meeting is to consider a new approach of self-scheduling. Before looking at how such an approach could actually be implemented, you want staff to consider the pros and cons of the current approach (a managerial function) versus the pros and cons of the potential approach (a self-scheduling approach). Complete the following chart to illustrate and clarify the dilemmas, benefits, issues, and problems associated with each.

Positives to Self-Scheduling (2.5pts)	Negatives to Self-Scheduling (2.5 pts)
1.	1.
2.	2.
3.	3.
4.	4.
5.	5.
Positives to Managerial Scheduling (2.5 pts)	Negatives to Managerial Scheduling (2.5 pts)
1.	1.
2.	2.
3.	3.
4.	4.
5.	5.

Now assume that you decide to initiate self-scheduling on a trial basis. Before initiating this new approach, you will need to write some guidelines for self-scheduling. Review the chart above for ideas.

Guidelines for Self-Staffing (Proposed) (5pts)

Box 14-4 Typical Unit Activities Productivity Report Indicators

• Volume statistic: number of units of service for the reporting period

• Capacity statistic: number of beds or blocks of time available for providing services

• Percentage of occupancy: number of occupied beds for the reporting period

• Average daily census (ADC): average number of patients cared for per day for the reporting period

• Average length of stay (ALOS): average number of days that a patient remained in an occupied bed

Formulas for Calculating Volume Statistics

Assume that a 20-bed medical-surgical unit (capacity statistic) accrued 566 patient days in June (volume statistic). Ninety-eight of these patients were discharged during the month.

Average Daily Census (ADC) on this unit is 18.9:

Formula: patient days for a given time period divided by the number of days in the time period

a.30 days in June

b.566 patient days/30 days=ADC of 18.9

Percentage of Occupancy for June is 95%:

Formula: daily patient census (rounded) divided by the number of beds in the unit

19 patients in a 20-bed unit =

19 patients/20 beds=95% occupancy

Average Length of Stay for June is 5.8

Formula: number of patient days divided by the number of discharges

566 patient days/98 patient discharges=5.8 (rounded)

Box 14-1 Other Indicators of Staffing Effectiveness

Clinical or Service Indicators

• Family complaints

• Patient complaints

• Adverse drug events

• Injuries to patients

• Postoperative infections

• Upper gastrointestinal bleeding

• Shock/cardiac arrest

• Length of stay

Human Resource Indicators

• Overtime

• Staff vacancy rate

• Staff turnover rate

• Understaffing as compared with the hospital’s staffing plan

• Nursing care hours per patient day

• Staff injuries on the job

• On-call or per diem use

• Sick time

Box 14-2 ANA Principles for Nurse Staffing

Principles

The nine principles identified by the expert panel for nurse staffing and adopted by the ANA Board of Directors on November 24, 1998, are listed below. A discussion of each of the three categories is available through ANA.

I. Patient Care Unit Related

a. Appropriate staffing levels for a patient care unit reflect analysis of individual and aggregate patient needs.

b. There is a critical need to either retire or seriously question the usefulness of the concept of nursing hours per patient day (HPPD).

c. Unit functions necessary to support delivery of quality patient care must also be considered in determining staffing levels.

II. Staff Related

a. The specific needs of various patient populations should determine the appropriate clinical competencies required of the nurse practicing in that area.

b. Registered nurses must have nursing management support and representation at both the operational level and the executive level.

c. Clinical support from experienced RNs should be readily available to those RNs with less proficiency.

III. Institution/Organization Related

a. Organizational policy should reflect an organizational climate that values registered nurses and other employees as strategic assets and exhibit a true commitment to filling budgeted positions in a timely manner.

b. All institutions should have documented competencies for nursing staff, including agency or supplemental and traveling RNs, for those activities that they have been authorized to perform.

c. Organizational policies should recognize the myriad needs of both patients and nursing staff.

Answer 1

Answer: The FTE of the employees are calculated as below:

The working hours of each employee per week = working hour per day multiplied by days in a week.

= 8 * 7 = 42 hours

In morning shift of 7 Am- 3Pm

• 4 RN works = 8*4= 32 . In a week it will be 32*7= 224 hrs.

FTE is calculated as Total Hours of work of all employees divided by total working hour of a week

FTE = 224/42 = 5.3

Similarly the FTE for other category of employess is calculated below per shift

• 2 LPN = 8*2 =16 *7 = 112/42 = 2.6
• 2 Nursing assistant = 8*2 = 16*7 = 112/42 = 2.6

In afternoon shift of 3Pm - 11Pm

• 3 RN = 8*3 = 24*7 = 168/42 = 4
• 1 LPN = 8*1 = 8*7 = 56/42 = 1.3
• 2 nursing assistant =  8*2 = 16*7 = 112/42 = 2.6

In night shift of 11Pm - 7Am

• 2 RN =  8*2 = 16*7 = 112/42 = 2.6
• 1 LPN = 8*1 = 8*7 = 56/42 = 1.3
• 1 nursing assistant = 8*1 = 8*7 = 56/42 = 1.3

Answer 1) Average daily census is equal to number of patient days divided by number of days in a month.

Lets assume a month of 30 days.

The total patient days =836

Average daily census = 836/30= 27.8 (which equals to 87.5% of occupancy rate)

The 75% occupancy rate will be equal to an average daily census of 24.

2)Average length of stay is equal to number of patient beds divided by number of discharges in a month.

Average length of stay = 836/102 = 8.19

Positives of Self Scheduling	Negatives of self scheduling
1) Employee satisfaction is increased.	1) Non compliance to the rules
2) Better management of time between life and work	2) Create a bias between emlpoyees
3) Quality of care is increased	3) Misuses of the facility
4) Helps in retention of staff	4)Tension and anxiety to the nurse manager due to the non adherence of the staff to its rules.
5)Less involvement of manager	5) Miscommunication can occur.
Positives of Managerial Scheduling	Negatives of Managerial scheduling
1) The compliance by staff is adequate.	1) Its time comsuming.
2) Non violation of rules and regulations.	2) Imbalance of work and life schedule among nurses
3) Increased chances of overtime cost	3) Decreases staff commitment to work
4) Makes equal decision for each employee	4) Individual staff requirements are not considered.
5) Its unbiased.	5) Reduces staff satisfaction effects the quality of care.

Guidelines for self scheduling program:

1. Readiness of the staff towards adherence of the program must be checked.
2. The staff should be competent in the place of work and should be helped by their senoir colleagues.
3. Staff should strictly follow the rules and timing schedules.
4. Avoid miscommunications while scheduling.
5. Though its a self scheduling, equality among the employees is important while work and hours allotment.
6. Individual needs and differences should be considered.