Nurses are the constant in healthcare organizations. They are on the front-line and at the point of care, 24 hours a day, 7 days a week. They are the most visible faces in these highly complex organizations, nurses provide a critical surveillance function in healthcare organizations, particularly in hospitals, by monitoring care and safeguarding patients; thus, the availability and work of nurses affect the quality of care and patient safety (Aiken et al. 2003). Nurses are a primary determinant of patient satisfaction ( Abramowitz., Cote, and Berry 1987; Vahey et al. 2004).
Understanding how best to deploy nurses while balancing quality and costs is an important ongoing function for healthcare administrators that may be especially challenging during periods of nursing shortage when adequate numbers and types of nurses needed to ensure the delivery of safe, high-quality care may be in short supply.
Types of Nursing Personnel
Licensed and unlicensed nursing personnel differs in terms of education; knowledge, skills, and abilities; and patient care responsibilities. These differences must be considered when planning nurse workloads and staffing. Licensed nursing personnel include those who work under a specific scope of practice set by regulatory requirements.
There are two types of licensed nurses: registered nurses (RNs) and licensed practical nurses (LPNs); the educational, licensure, and practice requirements for one group differ from those of the other.
Unlicensed nursing personnel, such as nursing assistants, provide support services to licensed nurses and other healthcare professionals.
Nurse Workload and Staffing
Nurse workload means (1) the number of patients or patient days for which nursing care is required on a unit or within a department or organization or (2) the number of patients cared for by an individual nurse (often referred to as the patient-to-nurse ratio).
Nurse staffing means (1) the number of nurses deployed (also called staffing level) or (2) the process by which the appropriate number and type of nursing personnel are deployed to satisfy nurse workload requirements.
Nurse workload thus refers to a number of nursing services, while nurse staffing comprises the planning, budgeting, and costing aspects of providing nursing services.
Nurse workload is measured for three primary reasons: (1) to inform the budgeting process; (2) to meet regulatory and accreditation standards; and (3) to inform the development, implementation, and evaluation of staffing plans. The budgeting process necessitates the calculation of nurse workload to prepare an organization’s operating budget and, specifically to determine nursing personnel requirements and costs (Finkler, Kovner, and Jones 2007).
The budgeting process involves decision making about the level and mix of nurse staffing, the workload that nurses will assume, and the allocation of resources.
Nurse staffing plans, on the other hand, are a blueprint for meeting specific patient care and regulatory requirements and for deploying nursing personnel efficiently and effectively.
Staffing plans also enable managers to develop policies for reasonable work schedules, which promote a positive work environment, and for accommodating operational uncertainties and contingencies.
Measurement of Nurse Staffing
Nurse staffing involves determining the numbers and types of nursing personnel employed on a patient care unit in a hospital. Decisions about the numbers and types of nurses employed on a patient care unit are based on (1) the patient population, (2) the nurses’ education and skills, and (3) the organization’s philosophy about nursing and patient care delivery.
The metric for determining the number and types of nurses is the full-time equivalent or FTE. Nursing FTE calculations are used to determine unit and departmental staffing needs and are the key input to the budgeting process. An FTE is based on the concept of one individual working full time for a year or 40 hours a week, 2,080 hours for a 52-week period (Finkler, Kovner, and Jones 2007). FTE calculations include both productive and nonproductive time. Productive time is the time spent on providing care to patients and nonproductive time is time spent not giving care (Strasen 1987). Nonproductive time includes sick, vacation, holiday, and professional development days, as well as other paid time off that, is part of the employment benefit. Although the amount of nonproductive time
paid varies by organization, only productive time is used in calculating the amount of nurse workload available to deliver care to patients.
For more illustration, consider this example: A patient care unit that averages 25 patients per day during a 30-day month pays for 6,000 RN hours. Of these 6,000 RN hours, 90 percent are considered productive. What are the paid nursing hours per day and per patient day? How many are nursing care hours per patient day involved? Here are the calculations:
Paid nursing hours
6,000 nursing hours paid per month/30 days in the month = 200 paid nursing hours
per day 200 hours of nursing care per day/25 patients per day = 8.0 nursing hours paid per patient per day
Nursing care hours
6,000 nursing hours paid per month × 90 percent productive = 5,400 nursing care hours per month 5,400 nursing care hours per month / 30 days in the month = 180 nursing care hours per day
180 nursing care hours per day / 25 patients per day = 7.2 nursing care hours per patient per day
Key Issues in Managing Nurse Workload and Staffing
Healthcare managers should consider several issues as they reconcile budgetary and staffing issues such as:
Workload stress and staff burnout
Staff turnover, recruitment, and retention
Aging of the nursing workforce
The nature of nursing work
Balancing quality and costs of care Healthcare administrators especially first-line patient care unit or nurse managers, should be aware of such issues and the impact of staffing decisions on nurses and nurse perceptions as well as on patients, care delivery, and overall organizational performance