A. Determining staffing mix

The same data used to determine FTSs are used to identify staffing mix. For example,

for patient care needs involving general hygiene care, feeding, transferring, or turning

patients, unlicensed assitive personnel (UAPs) can be used. For patient care needs

involving frequent assessments, patient education, or discharge planning, RNs will be

needed because of the skilla required. A high RN-skill mix allows for greater staffing

flexibility. Again , information on typical or usual patientneeds is obtained by using

trends from the patient classification system. For many patient care units, the

distribution of staff varies from shift to shift and by days of the week. Patient census

on a surgical unit will probably fluctuate throughout the week, with a higher census

Monday through Thursday and a lower census over the weekend. In addition, some

surgical units may have more complex cases earlier in the week and short-stay

surgical casses later in the week. Surgical patients may have a shorter length of stay

(LOS) than many medical patients. The patient census on a medical unit rarely

fluctuates Monday through Friday , but may be less on weekends, when diagnostic

tests are not done.

The workload on many units also varies within the 24-hour period. The care demands

on a surgical unit will be heavicst early in the morning hours prior to the start of the

surgical schedule; midmorning , when the unit receives patients from cretical care

unit(s); late in the afternoon, when patients return from the postanes-thesia recovery

unit; and in the evening hours, when same-day surgical patients are discharged.

Critical care units may have greater care needs in the mornings when transferring

patients to medical or surgical units and in the early afternoon hours when admitting

new surgical cases. Medical units usually have the heaviest care needs in the morning

hours, when patients’ daily care needs are being met and physicians are making

rounds. On skilled nursing and immediately after mealtimes and in the evening hours;

during other times of the day, patients are often away from the unit and involved in

various therapeutic activities. In contrast with the medical, surgical, critical care, and

rehabilitation units that have definite patterns of patient care needs, labor-and-delivery

and emergency department areas cannot predict when patient care needs will be most

intense. Thus, labor-and-delivery and emergency department areas must rely on block

staffing to ensure that adequate nursing staff are available at all times.

Block staffing involves scheduling a set staff mix for every shift. However, there may

be trends in peak workload hours in emergency departments, when additional staff

(RN, UAP, or secretary ) beyound the block staff are necessary. Examples of peak

workload hours within the emergency department may be from 6:00 p.m.TO 10.00

p.m to accommodate patient needs after physicians affices close or from 12:00 A.M.

to 3:00 A>M> to accommodate alcohol-related injuries. Ali these patienst of care

needs must be known when staffing, requirements and work scheduies are

established. Data reflecting peak workload times must be continously monitored to

maintain the appropriate levels and mix of staff.

Table 17-2 presents a staffing template for a 30-bed units with fluctuating needs. This

table illustrates numbers of staff and numbers of FTEs (the latter appear in brackets),

as well as the staffing mix required for every shift. The direct care totals include only

those nursing personnal providing direct patient care. Leadership and unit clerk

positions are excluded from the direct care numbers. The decisions to include or

exclude these two groups of staff is a very important decision that affects the units

productivity report. The total number of FTEs involved in direct care is based on the

average NHPPD of 6.15 hours and an average patient census of 26 patients (86.7%

occupancy). Average occupancy rates are determined by dividing the average patient

days (obtained by dividing total annual census by number of beds on unit) by number

of days in year.

Date

Annual census =9,490

Number of beds on unit =30

Formula

Average patient days ¿annual censusnumber of beds

Occupancy rate¿Average patient days

Days∈ year

Average patient days =9490

30 =316.33

Occupancy rate =316365

=86.7 %