Evidence Based Nursing: Nursing Management, 14 February 2016

Evidence Based Nursing14 February 2016 Nursing Management Wwwnur

Obtaining resources for quality patient care is a major responsibility of nurse managers. Historically, nursing department labor budgets comprise the largest percentage of hospital employees and expense; therefore, careful management is essential to maintain a balance between patient care and cost-effective budgeting. Patient classification systems (PCSs) were adopted in the mid-1970s to understand the utilization of nursing resources and provide an objective measure of full-time equivalent (FTE) requirements, supporting staffing budgets. The National Institutes of Health Clinical Center uses data from PCS to quantify workload measures like acuity, hours per patient day (HPPD), and length of stay adjusted census (LOSAC), which are vital for budgeting direct care staff. These systems also enable nurse managers to monitor variances to meet budget goals, reinforcing credible leadership and resource advocacy.

The budget process begins with clear, written hospital and departmental goals, translated into a formal management plan encompassing expected patient activity, salary, nonsalary, and operational expenses. Data forecasts incorporate inpatient admissions, outpatient visits, length of stay, and census data, derived from retrospective historical financial data and PCS metrics. The Clinical Center employs an executive information system (EIS) for trending patient activity, including patients on temporary absences (PASS), which are factored into census but not staffed directly. To accurately project staffing needs, PCS metrics like LOSAC are combined with acuity workload measures and professional judgment, ensuring reliable FTE allocations.

Budgeing also accounts for fixed and variable costs. Variable costs fluctuate with patient census and acuity, including staff such as nurses, patient care technicians, and behavioral health technicians, with staffing skill mixes tailored to patient needs. Fixed costs include support staff like secretaries and clinical managers, which remain constant regardless of census fluctuations. The distinction between position and FTE is crucial: a position refers to a job classification, while FTE represents the hours an employee works routinely, with 1.0 FTE equating to 2,080 hours annually (40 hours/week over 52 weeks).

In practice, the direct care FTE requirements are calculated using LOSAC, HPPD, and replacement coverage for benefit time and weekends. For example, a 32-bed oncology unit may require approximately 54.1 direct care providers, with additional FTEs for complex research duties, totaling around 54.6 FTEs. Fixed FTEs, such as administrative support, are added to these variable needs to arrive at a total staffing requirement. Understanding and applying these calculations allows nurse managers to develop accurate staffing budgets that reflect actual patient activity, thereby optimizing resource utilization and maintaining quality care.

Furthermore, nurse managers must familiarize themselves with financial concepts, as such knowledge enhances resource allocation and budget monitoring. Variance analysis comparing actual hours per patient day with budgeted values offers insights into productivity trends and forecasting, leading to more effective staffing decisions over time. The integration of evidence-based planning tools like PCS, paired with continuous monitoring and professional judgment, equips nurse leaders to adapt staffing efficiently to fluctuating demands, ensuring sustainable, high-quality patient care.

Paper For Above instruction

Efficient staffing and resource management are pivotal to delivering high-quality patient care in nursing. Central to this management is the use of patient classification systems (PCS), which facilitate objective measurement of nursing workload and inform staffing budgets. The evolution of PCS from its inception in the 1970s marked a significant advancement in aligning resource allocation with patient acuity and care needs, ultimately supporting effective workforce planning within hospital settings (Finkler, 1985; Harper & McCully, 2007).

At the core of staffing management is accurate data collection, which encompasses metrics such as length of stay (LOS), hours per patient day (HPPD), and census figures. The Clinical Center, for instance, utilizes an electronic information system that captures midnight census data, including patients temporarily absent for nonmedical reasons (PASS). Despite these patients contributing to census counts, they do not require direct staffing, posing unique challenges in accurate workload estimation. To address this, the concept of LOSAC incorporates all classified patients' lengths of stay, providing a comprehensive measure that aids in workload forecasting (Ghosh & Cruz, 2005).

The use of acuity workload measures further refines staffing plans. These measures classify patients based on their care needs, ensuring that staffing ratios and skill mixes are appropriate for unit-specific demands. When combined with professional judgment and historical performance data, acuity measures enable nurse managers to determine the optimal number of direct care FTEs (Lim & Noh, 2015). This data-driven approach improves staffing efficiency by aligning nurse staffing levels with actual patient care requirements, which is essential in controlling costs while maintaining care quality (Rundio & Wilson, 2013).

Financial aspects of staffing include understanding fixed and variable costs. Variable costs such as nursing staff fluctuate with patient volume and acuity, whereas fixed costs—including administrative and support personnel—remain constant. Recognizing this distinction helps managers allocate resources more precisely and develop flexible staffing models that can adapt to changing demands (O’Byrne, 1984). The calculation of FTEs involves converting hours worked into full-time units, with one FTE equaling 2,080 hours annually for full-time staff working eight-hour shifts (Beglinger, 2007).

Replenishment coverage for time off and weekend shifts is integral to maintaining continuous staffing. Typically, an additional 0.4 to 0.6 FTE per staff member is budgeted to account for benefits, holidays, and coverage needs. For example, budgeting for a 7-day operation may require incorporating this additional FTE to ensure adequate staffing levels during absences. Such calculations safeguard against understaffing and support optimal patient outcomes (Lim & Noh, 2015).

Practical case studies highlight the application of these principles. In a 32-bed oncology unit, staffing calculations might involve LOSAC, HPPD, and a 1.4-weekend replacement factor, leading to an estimate of approximately 54.6 direct care FTEs. Fixed FTE requirements, such as managerial and administrative personnel, are added to determine the total staffing need. This thorough, data-informed approach ensures that scheduling aligns with patient activity, enhancing both efficiency and quality of care (Ghosh & Cruz, 2005).

For nurse managers, mastering financial concepts and variance analysis is crucial. Regular comparison of actual HPPD against budgeted values identifies productivity trends and guides future staffing adjustments. Such analyses facilitate proactive resource management, reduce wastage, and promote high standards of patient safety and satisfaction. Furthermore, fostering competencies in financial management enhances leadership credibility and supports evidence-based decision-making (Harper & McCully, 2007).

In conclusion, resource management in nursing, underpinned by tools like PCS and robust financial understanding, is vital for delivering safe, effective, and economical patient care. Continuous monitoring, professional judgment, and data-driven strategies empower nurse managers to navigate complex staffing landscapes, ultimately ensuring optimal patient outcomes in an ever-evolving healthcare environment (Finkler, 1985; Rundio & Wilson, 2013).

References

• Beglinger, J. E. (2007). A critical competency: determining and communicating the number of nurses you must hire. Nursing Economics, 25(3), 174, 177.
• Finkler, S. A. (1985). Flexible budget variance analysis extended to patient acuity and DRGs. Health Care Management Review, 10(4), 21-34.
• Ghosh, B., & Cruz, G. (2005). Nurse requirement planning: a computer-based model. Journal of Nursing Management, 13(4), 409–417.
• Harper, K., & McCully, C. (2007). Acuity systems dialogue and patient classification system essentials. Nursing Administration Quarterly, 31(4), 341-351.
• Lim, J. Y., & Noh, W. (2015). Key components of financial-analysis education for clinical nurses. Nursing & Health Sciences, 17(3), 297–303.
• O’Byrne, A. (1984). Budget monitoring: understanding the concepts. Top Hospital Pharmacy Management, 3(4), 33-41.
• Rundio, A., & Wilson, V. (2013). Nurse executive resource manual. American Nurses Credentialing Center.
• Rundio, A., & Wilson, V. (2013). Nurse executive resource manual. American Nurses Credentialing Center.
• Additional references can be added based on specific institutional data and reports.