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N5341 Staffing Module Assignment
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
FTEsrequired. 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:
· FTE = Number of shifts assigned to work every pay period. A
Full-time employee works 10 shifts every two weeks, and this
equals 80 hours in a pay period. An employee who is full-time
would not necessarily have to work 10 shifts as long as they
worked 80 hours. However, for the purposes of this module, all
shifts are to be considered 8 hours long, so the employee must
work 10 shifts to be considered full-time.
· FTE = Worked hours hours per pay period for full-time
employee
FTE = 40 worked hours 80 hours = 0.50 FTE
· Hours = FTE x Hours paid per pay period for full-time
employee
· Hours = 0.50 FTE x 80 = 40 hours (number of hours that a
0.50 FTE would be scheduled to work in a pay period)
· Shifts = Hours per pay period Hours in a shift
Shifts = 80 hours per pay period 8 hours = 10 shifts per pay
period
10 shifts = 80 hours per pay period = 1.00 FTE
9 shifts = 72 hours per pay period = 0.90 FTE
8 shifts = 64 hours per pay period = 0.80 FTE
7 shifts = 56 hours per pay period = 0.70 FTE
6 shifts = 48 hours per pay period = 0.60 FTE
5 shifts = 40 hours per pay period = 0.50 FTE
4 shifts = 32 hours per pay period = 0.40 FTE
3 shifts = 24 hours per pay period = 0.30 FTE
2 shifts = 16 hours per pay period = 0.20 FTE
1 shift = 8 hours per pay period = 0.10 FTE
For each of the following scenarios, complete your answers
using your knowledge of Excel basic formulas on the Worksheet
provided in the Assignment Drop Box:
FTEs
ONE WEEK
HOURS
ONE WEEK
SHIFTS
ONE PAY PERIOD HOURS
ONE PAY PERIOD SHIFTS
0.2
8
1
16
2
0.4
0.6
0.8
1.0
2.0
Great!!! You have now mastered being able to calculate the
number of shifts and hours that a designated FTW works in one
week and in one pay period. Using the same principles, you
could also calculate the number of hours and shifts an FTE
would work in a month, quarter, or year.
The next step is to be able to compute the number of FTEs
needed to staff for one week based on the number of shifts
required. To be able to calculate this number, you need to know
the following:
· FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per
week)
· FTEs = An RN works 5 shifts per week. How many FTEs are
required?
FTE = 5 5 = 1.00 FTE
Now, it’s your turn again!!! Fill in the missing shifts and FTEs,
using Excel formulas:
STAFF
S
M
T
W
T
F
S
SHIFTS
FTEs*
NM
0
1
1
1
1
1
0
5
1.0
RN
5
6
6
6
6
6
5
LVN
4
3
3
3
3
3
4
NA
4
4
4
4
4
4
4
US
1
1
1
1
1
1
1
TOTAL
14
15
15
15
15
15
14
*Format FTEs to 1 decimal place.
Calculating NHPPD
Were the previous calculation exercises easy for you to
complete? Great!! The next few are just as easy, but they begin
to combine the elements of required nursing hours per patient
day and the unit’s FTE requirements. But, before we get to that,
you need to know how to derive the NHPPD and its related
components.
Let’s get started!
The numbers of FTEs allocated to a nursing unit are based
upon the NHPPD for that particular unit’s patient population
and acuity. A variety of sources are available to compare your
unit’s NHPPD with other units. In many cases there are national
nursing standards that can be used as comparative data (like
units, with the same type of patient population, are compared to
each other). These units with the same or similar patient types
usually have common nursing care requirements. When this is
true, those nursing unit’s NHPPD are averaged to create a
standard NHPPD. This number can only be used as a guide to
determine the NHPPD for your unit, because differences such as
geography, nursing care delivery system, support services
available, and other variables may not be accounted for.
Why is it important for RNs to understand the concept of
NHPPD and know their unit’s hours? Simply put, NHPPD
defines how much nursing care each patient on the unit requires
in a 24-hour period. In a sense, it defines the level of care
required. Without it, the staffing might be based upon volume,
rather than patient needs, and nursing care in acute care units
should be based upon the needs of the patient.
In one example, a total of 103 shifts were worked by the
distribution of staff given for one week. For a particular week,
this unit experienced 85 patient days. From this data, one can
calculate the NHPPD:
· NHPPD = Total shifts per week x 8 hours per shift
Number of Patient Days
NHPPD = 103 x 8 = 9.69
85
Now, here is one for you to figure out. Please calculate the
NHPPD for the following unit, using Excel formulas to
complete your calculations:
Unit 3A has had 61 patient days in the past week, with a total of
98 shifts staffed. What was 3A’s NHPPD for that time period?
NHPPD* = ___________________________________
*Format NHPPD to 2 decimal places.
As we said earlier, NHPPD is a compilation of different types
of hours, one of which is Variable Hours of Care or Caregiver
Hours. Remember, variable hours of care delineates those hours
of care that are directly provided to the patient by a caregiver,
defined as the RN, LVN, or nurse aide. Calculating Caregiver
Hours gives us how many hours within the NHPPD are spent
providing direct nursing care. It is calculated:
· Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8
hours per shift
Patient Days
In one example, the total shifts calculated = 103. There
were 12 non-caregiver shifts (NM and US), which leaves 91
Caregiver shifts. Assuming the same number of patient days
(85) from above, calculate the Caregiver Hours:
Caregiver Hours = 91 x 8 = 8.56
85
Using the situation described previously for Unit 3A, calculate
the Caregiver Hours where there were 54 RN shifts, 14 LVN
shifts, and 13 NA shifts. Use formulas in Excel for your
calculations.
Caregiver Hours* = __________________________
*Format the Variable Hours of Care (Caregiver Hours)
calculation to 2 decimal places.
We hope that you noticed that your Variable Hours of Care did
not equal the number you got for NHPPD. Great!! That is
because we have not taken into account yet the Fixed Hours.
Fixed Hours of Care are the hours required for indirect care for
every patient on a unit. Fixed hours are comprised of the
secretarial work, management of the unit, and non-direct patient
care (e.g. patient teaching done by a CNS). Remember, this
number is constant, since it is not affected by acuity or volume.
· Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours
per shift
Patient Days
From our first example, calculate the number of shifts
worked by the NM and US. Using the same patient days of 85,
calculate Fixed Hours of Care for this unit:
Fixed Hours of Care = 12 x 8 = 1.13
85
Are you ready? Using the same situation for 3A and knowing
that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit
Secretary shifts, calculate the Fixed Hours of Care: Again, use
formulas in Excel to complete your calculations.
Fixed Hours of Care* = ______________________
*Format calculation to 2 decimal places.
Hopefully, when you add your answers for the Caregiver Hours
and Fixed Hours of Care, you came up with the answer you
originally got for your NHPPD. Remember, this occurs because
NHPPD is a combination of Variable (Caregiver) Hours and
Fixed Hours of Care.
Calculating Paid FTEs and Positions
WOW!!! Your brain is probably already on overload, but the
best is yet to come!!! Now, if you believe that, we have some
beach front property in Arizona for sale… Interested?
Seriously, to complete the determination of staffing process,
you must know how to figure paid FTEs and the number and
type of positions needed. Paid FTEs differ from the FTEs you
have previously figured because paid FTEs include both worked
and non-worked hours. What you have done so far is to
calculate worked FTEs.
· Non-worked Hours = Total shifts non-worked x 8 hours per
shift
An example of calculating Non-worked Hours for a full-time
employee is as follows:
Sick leave = 10 shifts per year
Vacation = 15 shifts per year
Holidays = 8 shifts per year
Training = 5 shifts per year
Misc. = 2 shifts per year
Total = 40 shifts per year
Non-worked Hours = 40 shifts x 8 hours = 320 hours per
employee
Note: The number of non-worked hours for an employee is
determined by the organization, which ensures consistent
allocation of non-worked hours allocated. Although employees
with seniority might have more vacation hours than new
employees, for the purposes of this module, all employees have
the same allocation of non-worked hours.
Here goes! Is your computer smoking yet??? Calculate the
number of Non-worked Hours for any employee of 3A, using
formulas in Excel, based upon the following data:
Sick leave = 12 shifts per year
Vacation = 10 shifts per year
Holidays = 6 shifts per year
Training = 3 shifts per year
Misc. = 3 shifts per year
Total = 34 shifts per year
Non-worked Hours = _________________
Calculating the non-worked hours is essential prior to figuring
the Paid-to-Worked Ratio (PWR) for an organization. The PWR
allows you to determine the total number of paid FTEs required
to staff your nursing unit. As explained earlier, paid FTEs is a
combination of worked FTEs and the replacement FTEs needed
when, for example, someone is on vacation, ill, or at an
education seminar. Replacement FTEs are necessary in order to
maintain established staffing patterns by replacing an employee
(who is calculated in Caregiver Hours) who is off, on vacation,
etc. with a person of equal skill classification (RN for RN, LVN
for LVN, etc.). Replacement FTEs need to be budgeted when the
staffing pattern is established so that you are not using overtime
to staff the unit, or staffing at levels below requirements. Paid
FTEs is a requirement for being able to put a dollar figure to a
staffing plan.
· PWR = Annual Paid Hours for a full-time employee
(Annual Paid Hours) – (Non-worked Hours)
Using an example of 320 non-worked hours per employee,
PWR = __2080___ = 2080
2080-320 1760
PWR = 1.18
To calculate paid FTEs required, multiply the worked FTEs for
each classification of employee times the PWR.
· Paid FTEs = Worked FTEs x PWR
Using an example of having 6.6 worked FTEs of NA, and the
PWR calculated above, calculate the number of Paid FTEs
required:
Paid FTEs = 6.6 x 1.18 = 7.79
*Format Paid FTEs to 2 decimal places
Remember that when an employee who is off is not replaced
with another comparable employee, such as the nurse manager
or clinical specialist, the Paid FTEs are equal to Worked FTEs.
Calculate the Paid FTEs (Worked FTEs plus replacement) in the
following staffing plan, using PWR = 1.18. Put your formula in
the appropriate cells in Excel.
STAFF
S
M
T
W
T
F
S
SHIFTS
WORKED FTEs
PAID FTEs*
NM
0
1
1
1
1
1
0
5
1.0
RN
5
6
6
6
6
6
5
40
8.0
LVN
4
3
3
3
3
3
4
23
4.6
NA
4
4
4
4
4
4
4
28
5.6
US
1
1
1
1
1
1
1
7
1.4
TOTAL
14
15
15
15
15
15
14
103
20.6
*Format Paid FTEs to 2 decimal places.
Easy, isn’t it? Well, you are almost done with this section.
Close your eyes, take a deep breath, and forge onward! Now we
are going to learn how to assign positions to a staffing pattern.
Positions do not designate time: they designate space or the
number of employees needed for a specific skill type, e.g. RN.
A positionis not the same thing as a FTE! As obvious as it may
seem, let us say that it is important to have the correct number
of positions so that you will have the correct number of staff to
implement the staffing pattern.
In a staffing pattern that gives every other weekend off, the
number of positions required is equal to the total number of
shifts worked on weekends. As before, assume each shift
worked is an 8-hour shift. Let’s say that on a typical nursing
unit at your facility the number of RN shifts worked every
Saturday and Sunday are five, and six RN shifts are worked
Monday through Friday. The number of RN positions required
would be 10. For positions that are not replaced by another
comparable employee (e.g. Nurse managers), the number of
positions needed for that skill classification is equal to the
actual number of employees in that classification. For example,
if you have one Nurse Manager, you only need one position of
NM.
Determine the number positions required for each skill
classification in the staffing pattern below. Watch out!! If you
determine the total number of positions needed by adding the
total shifts for Saturday and Sunday you will be WRONG
because the NM doesn’t work on those days; you will not have
counted that “position!” To get the accurate number of total
positions, add the column of positions for each skill
classification:
STAFF
S
M
T
W
T
F
S
SHIFTS
WORKED
FTEs
PAID FTEs
POSITIONS
NM
0
1
1
1
1
1
0
5
1.0
1.0
1
CNS
0
1
1
1
1
1
0
5
1.0
1.0
1
RN
2
3
3
3
3
3
2
19
3.8
4.48
4
LVN
3
3
3
3
3
3
3
21
4.2
4.96
NA
2
4
4
4
4
4
2
24
4.8
5.66
US
3
3
3
3
3
3
3
21
4.2
4.96
TOTAL
10
15
15
15
15
15
10
95
19.0
22.06
PWR = 1.18
Putting it all Together
Okay. Now it’s time to give you a real brain teaser. Let’s see if
you can put it all together.
Complete the information for the following staffing pattern.
Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a
one-week period:
STAFF
S
M
T
W
T
F
S
SHIFTS
WORKED
FTEs
PAID FTEs
POSITIONS
NM
0
1
1
1
1
1
0
CNS
0
1
1
1
1
1
0
RN
6
6
6
6
6
6
6
LVN
2
3
3
3
3
3
2
NA
6
8
8
8
8
8
6
US
2
2
2
2
2
2
2
TOTAL
Inserting the appropriate data from above, calculate the
following using formulas in Excel:
Calculate NHPPD: _____________________
Calculate Variable Hours: _________________
Calculate Fixed Hours: ____________________
Determining Paid NHPPD
Up to this point, you have been learning how to determine
Worked NHPPD and its components. Below are formulas for
calculating the Paid NHPPD. For each question below, use
formulas in the Excel answer sheet to display your answer.
· Paid NHPPD = Worked NHPPD x PWR
Using an example where a unit had a NHPPD of 9.69, and the
allocated PWR of 1.12, calculate the Paid NHPPD:
Paid NHPPD = 9.69 x 1.12 = 10.85
What is the Paid NHPPD with a Worked NHPPD of 15?
· Paid Caregiver Hours = Worked Caregiver Hours x PWR
The Variable Hours for that unit was 8.56. With a PWR of 1.12,
calculate the Paid Caregiver Hours:
Paid Caregiver Hours = 8.56 x 1.12 = 9.59
What are the Paid Caregiver Hours with Worked Caregiver
Hours of 7.25?
· Paid Fixed Hours = Worked Fixed Hours x PWR
The Fixed Hours for our earlier example was 1.13. With a PWR
of 1.12, calculate the Paid Fixed Hours:
Paid Fixed Hours = 1.13 x 1.12 = 1.26
What are the Paid Fixed Hours with Worked Fixed Hours of
1.6?
Note that you can calculate the Worked elements of NHPPD by
dividing the paid NHPPD by the PWR. For example, if you
know the Paid NHPPD is 10.85 and the PWR is 1.12, then the
Worked NHPPD is 10.85 1.12 = 9.69.
Acuity and its Influence
Just knowing your average daily census (ADC) and NHPPD may
not be enough to create an accurate staffing pattern because
these elements do not take into account the actual severity of
the patients. If you are currently using an acuity system that
assigns a numerical score to the severity level of the patients on
your unit, you can adjust your staffing pattern to take into
account the influence of patient severity.
· Acuity = Average Acuity Score x Patient Volume for a
Specified Time
The Specified Time Period
You have calculated 12.85 NHPPD for a unit that has 61
patient days in one week (ADC=8.7). Assume an acuity on that
unit of 2 (on average, each patient requires 2 RVUs); calculate
Adjusted Daily Census (reflects acuity):
Acuity = 2 x 3176 Annual Patient Days
365 Days
Acuity = 6352 Adjusted Patient Days
365 Days
Acuity = 17.4 Adjusted Daily Census
This value equals an adjusted average daily census that reflects
the acuity of that patient population. The staffing pattern is then
configured based on this adjusted average daily census. For
example, with an ADC of 8.7 and NHPPD of 12.85, you would
need 13.97 FTE. Factoring in the acuity value would indicate
that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8
hour shifts) to care for those 8.7 patients because of the acuity
level.
To further see how FTEs change in relation to the addition of
acuity, please follow this example:
A nursing unit has been told that they must maintain a worked
NHPPD of 6.62 hours. The baseline workload unit volume is
12,500 patient days, requiring 39.78 worked FTEs. Remember
how to calculate that? 6.62 NHPPD x 12,500 patient days =
82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) =
39.78 worked FTEs. The workload unit volume, with an acuity
of 1.08 factored, is now 13,500 patient days. The worked FTEs
that would be required to care for this adjusted patient day
volume would be:
FTEs = NHPPD x Adjusted Workload Volume
2080 hours
FTEs = 6.62 x 13,500 = 42.97
2080
An additional 3.19 FTEs are needed to account for the acuity of
the patient population and to maintain a worked NHPPD of
6.62.
How many more FTEs would be needed with an acuity level of
3.0 for this same volume of patients and 6.62 NHPPD? Use
formulas in Excel to calculate your answer.
Sheet1Assignment 1AvailableActualStudent Answer Sheet:
Complete each section as indicated. PointsPointsWhen creating
formulae, feel free to place "constant" numbers in separate cells
(e.g. in the first section, you may wish to put 8, 40, and 80 in
H7, H8, H9 to use the cell identifier in your
formulae.)Calculating Hours and Shifts: 10 pointsInsert
formulae to calculate appropriate hours and shiftsFTEsONE
WEEK HOURSONE WEEK SHIFTSONE PAY PERIOD
HOURSONE PAY PERIOD
SHIFTS0.2811620.420.620.821222Calculating Worked FTEs: 5
pointsInsert formulae to calculate missing shifts and FTEs.
Format FTE to 1 decimalSTAFF S M T W T F
SSHIFTSFTEsNM011111051.0RN56666651LVN43333341NA44
444441US11111111TOTAL141515151515141Calculating
NHPPD: 2.5 points:Insert formula in C29 to calculate NHPPD;
format to 2 decimal placesUnit 3A# 8 hr. shifts98# Pt.
Days61NHPPD:2.5Calculating Caregiver (Variable) Hours: 2.5
pointsInsert formula in C38 to calculate caregiver hours; format
to 2 decimal placesUnit 3A Caregiver hoursRN Shifts54LVN
Shifts14NA Shifts13Pt. Days61Caregiver Hours:2.5Calculating
Fixed Hours: 2.5 pointsInsert formula in C47 to calculate fixed
hours; format to 2 decimal places3A: # of shifts for Nurse
Manager, Clin. Spec., & Unit SecretariesNM5CNS5US7Pt.
Days61Fixed Hours:2.5Calculating Non-worked Hours: 5
pointsInsert formula in B58 to calculate the sum of non-worked
shifts;Then, insert a formula in B59 to calculate the number of
non-worked hours; format with 0 decimalsNumber of non-
worked 8-hour shifts per year:Sick leave = 12 shifts per
year12Vacation10Holiday6Training3Misc.3TotalShifts2.5Total
Non-worked Hours2.5Calculating Paid FTEs: 7.5 pointsInsert
formulae to calculate Paid FTEs using PWR of :1.18where
appropriate; format for 1
decimalSTAFFSMTWTFSSHIFTSWORKED FTEsPAID
FTEs*NM011111051.002RN5666665408.000.75LVN433333423
4.600.75NA4444444285.600.75US111111171.400.75TOTAL141
5151515151410320.602.5Calculating the number of required
positions: 4 pointsInsert formulae to calculate the number of
required positions (whole numbers)STAFF S M TW T F
SSHIFTSWORKED FTEsPAID FTEsPOSITIONS (given: NM,
CNS,
RN)NM01111105111CNS01111105111RN2333332193.84.484L
VN3333333214.24.961NA2444442244.85.661US3333333214.24
.961TOTAL10151515151510951922.061Putting it all
TogetherStaffing Pattern: 21 pointsComplete the information for
the following staffing pattern, by inserting formulae in
appropriate cells. Assume:Hours/shift:8PWR:1.15Pt.
Days:220for one-week periodSTAFF S M TW T F
SSHIFTSWORKEDPAID FTEsPOSITIONS
FTEs*NM01111101.5CNS01111101.5RN66666663.5LVN23333
323.5NA68888863.5US22222223.5TOTAL4Calculation of
NHPPD, Variable, and Fixed hours for staffing pattern above:
12 pointsInsert formulae in D105, D107, and D109 to:Calculate
NHPPD: 4Calculate Variable Hours: 4Calculate Fixed Hours:
4Determining Paid NHPPD: 12 pointsGiven the following data,
insert formulae in cells I114, I115, and I116 PWR=1.12What is
the Paid NHPPD with a Worked NHPPD of:154What are the
Paid Caregiver Hours with Worked Caregiver Hours
of:7.254What are the Paid Fixed Hours* with Worked Fixed
Hours of: 1.64*These fixed hours are for staff who are
replacedEffect of Acuity: Part A=5 points; Part B=11
pointsInsert formulae into cells J125 and J126 to answer the
questions below:StandardAdj. AcuityPatient
Volume1250012500NHPPD6.626.62Acuity Level (in RVU)03A.
How many FTEs are needed to care for this patient volume (in
column labeled Standard)?5B. What is the difference between
the number of FTE needed for the actual volume, when acuity is
taken into consideration?11Total Points1000
&P
Sheet2
Sheet3

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N5341 Staffing Module AssignmentPreliminary DataDefiniti.docx

  • 1. N5341 Staffing Module Assignment 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.
  • 2. 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.
  • 3. 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 FTEsrequired. 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.
  • 4. 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: · FTE = Number of shifts assigned to work every pay period. A Full-time employee works 10 shifts every two weeks, and this equals 80 hours in a pay period. An employee who is full-time would not necessarily have to work 10 shifts as long as they worked 80 hours. However, for the purposes of this module, all shifts are to be considered 8 hours long, so the employee must work 10 shifts to be considered full-time. · FTE = Worked hours hours per pay period for full-time employee FTE = 40 worked hours 80 hours = 0.50 FTE · Hours = FTE x Hours paid per pay period for full-time employee · Hours = 0.50 FTE x 80 = 40 hours (number of hours that a 0.50 FTE would be scheduled to work in a pay period) · Shifts = Hours per pay period Hours in a shift Shifts = 80 hours per pay period 8 hours = 10 shifts per pay period 10 shifts = 80 hours per pay period = 1.00 FTE 9 shifts = 72 hours per pay period = 0.90 FTE 8 shifts = 64 hours per pay period = 0.80 FTE 7 shifts = 56 hours per pay period = 0.70 FTE 6 shifts = 48 hours per pay period = 0.60 FTE 5 shifts = 40 hours per pay period = 0.50 FTE 4 shifts = 32 hours per pay period = 0.40 FTE 3 shifts = 24 hours per pay period = 0.30 FTE 2 shifts = 16 hours per pay period = 0.20 FTE 1 shift = 8 hours per pay period = 0.10 FTE For each of the following scenarios, complete your answers using your knowledge of Excel basic formulas on the Worksheet
  • 5. provided in the Assignment Drop Box: FTEs ONE WEEK HOURS ONE WEEK SHIFTS ONE PAY PERIOD HOURS ONE PAY PERIOD SHIFTS 0.2 8 1 16 2 0.4 0.6 0.8 1.0 2.0
  • 6. Great!!! You have now mastered being able to calculate the number of shifts and hours that a designated FTW works in one week and in one pay period. Using the same principles, you could also calculate the number of hours and shifts an FTE would work in a month, quarter, or year. The next step is to be able to compute the number of FTEs needed to staff for one week based on the number of shifts required. To be able to calculate this number, you need to know the following: · FTEs = Total Shifts 5 shifts (shifts worked by 1 FTE per week) · FTEs = An RN works 5 shifts per week. How many FTEs are required? FTE = 5 5 = 1.00 FTE Now, it’s your turn again!!! Fill in the missing shifts and FTEs, using Excel formulas: STAFF S M T W T F S SHIFTS FTEs* NM 0 1 1 1
  • 8. 1 1 1 1 1 1 1 TOTAL 14 15 15 15 15 15 14 *Format FTEs to 1 decimal place. Calculating NHPPD Were the previous calculation exercises easy for you to complete? Great!! The next few are just as easy, but they begin to combine the elements of required nursing hours per patient day and the unit’s FTE requirements. But, before we get to that, you need to know how to derive the NHPPD and its related components. Let’s get started! The numbers of FTEs allocated to a nursing unit are based upon the NHPPD for that particular unit’s patient population and acuity. A variety of sources are available to compare your unit’s NHPPD with other units. In many cases there are national nursing standards that can be used as comparative data (like units, with the same type of patient population, are compared to each other). These units with the same or similar patient types
  • 9. usually have common nursing care requirements. When this is true, those nursing unit’s NHPPD are averaged to create a standard NHPPD. This number can only be used as a guide to determine the NHPPD for your unit, because differences such as geography, nursing care delivery system, support services available, and other variables may not be accounted for. Why is it important for RNs to understand the concept of NHPPD and know their unit’s hours? Simply put, NHPPD defines how much nursing care each patient on the unit requires in a 24-hour period. In a sense, it defines the level of care required. Without it, the staffing might be based upon volume, rather than patient needs, and nursing care in acute care units should be based upon the needs of the patient. In one example, a total of 103 shifts were worked by the distribution of staff given for one week. For a particular week, this unit experienced 85 patient days. From this data, one can calculate the NHPPD: · NHPPD = Total shifts per week x 8 hours per shift Number of Patient Days NHPPD = 103 x 8 = 9.69 85 Now, here is one for you to figure out. Please calculate the NHPPD for the following unit, using Excel formulas to complete your calculations: Unit 3A has had 61 patient days in the past week, with a total of 98 shifts staffed. What was 3A’s NHPPD for that time period? NHPPD* = ___________________________________ *Format NHPPD to 2 decimal places. As we said earlier, NHPPD is a compilation of different types of hours, one of which is Variable Hours of Care or Caregiver Hours. Remember, variable hours of care delineates those hours of care that are directly provided to the patient by a caregiver, defined as the RN, LVN, or nurse aide. Calculating Caregiver
  • 10. Hours gives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated: · Caregiver Hours = Total shifts of RNs, LVNs, & NAs x 8 hours per shift Patient Days In one example, the total shifts calculated = 103. There were 12 non-caregiver shifts (NM and US), which leaves 91 Caregiver shifts. Assuming the same number of patient days (85) from above, calculate the Caregiver Hours: Caregiver Hours = 91 x 8 = 8.56 85 Using the situation described previously for Unit 3A, calculate the Caregiver Hours where there were 54 RN shifts, 14 LVN shifts, and 13 NA shifts. Use formulas in Excel for your calculations. Caregiver Hours* = __________________________ *Format the Variable Hours of Care (Caregiver Hours) calculation to 2 decimal places. We hope that you noticed that your Variable Hours of Care did not equal the number you got for NHPPD. Great!! That is because we have not taken into account yet the Fixed Hours. Fixed Hours of Care are the hours required for indirect care for every patient on a unit. Fixed hours are comprised of the secretarial work, management of the unit, and non-direct patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume. · Fixed Hours of Care = Total shifts of NM, US, etc x 8 hours per shift Patient Days
  • 11. From our first example, calculate the number of shifts worked by the NM and US. Using the same patient days of 85, calculate Fixed Hours of Care for this unit: Fixed Hours of Care = 12 x 8 = 1.13 85 Are you ready? Using the same situation for 3A and knowing that there are 5 Nurse Manager shifts, 5 CNS shifts, and 7 Unit Secretary shifts, calculate the Fixed Hours of Care: Again, use formulas in Excel to complete your calculations. Fixed Hours of Care* = ______________________ *Format calculation to 2 decimal places. Hopefully, when you add your answers for the Caregiver Hours and Fixed Hours of Care, you came up with the answer you originally got for your NHPPD. Remember, this occurs because NHPPD is a combination of Variable (Caregiver) Hours and Fixed Hours of Care. Calculating Paid FTEs and Positions WOW!!! Your brain is probably already on overload, but the best is yet to come!!! Now, if you believe that, we have some beach front property in Arizona for sale… Interested? Seriously, to complete the determination of staffing process, you must know how to figure paid FTEs and the number and type of positions needed. Paid FTEs differ from the FTEs you have previously figured because paid FTEs include both worked and non-worked hours. What you have done so far is to calculate worked FTEs. · Non-worked Hours = Total shifts non-worked x 8 hours per shift
  • 12. An example of calculating Non-worked Hours for a full-time employee is as follows: Sick leave = 10 shifts per year Vacation = 15 shifts per year Holidays = 8 shifts per year Training = 5 shifts per year Misc. = 2 shifts per year Total = 40 shifts per year Non-worked Hours = 40 shifts x 8 hours = 320 hours per employee Note: The number of non-worked hours for an employee is determined by the organization, which ensures consistent allocation of non-worked hours allocated. Although employees with seniority might have more vacation hours than new employees, for the purposes of this module, all employees have the same allocation of non-worked hours. Here goes! Is your computer smoking yet??? Calculate the number of Non-worked Hours for any employee of 3A, using formulas in Excel, based upon the following data: Sick leave = 12 shifts per year Vacation = 10 shifts per year Holidays = 6 shifts per year Training = 3 shifts per year Misc. = 3 shifts per year Total = 34 shifts per year Non-worked Hours = _________________ Calculating the non-worked hours is essential prior to figuring the Paid-to-Worked Ratio (PWR) for an organization. The PWR
  • 13. allows you to determine the total number of paid FTEs required to staff your nursing unit. As explained earlier, paid FTEs is a combination of worked FTEs and the replacement FTEs needed when, for example, someone is on vacation, ill, or at an education seminar. Replacement FTEs are necessary in order to maintain established staffing patterns by replacing an employee (who is calculated in Caregiver Hours) who is off, on vacation, etc. with a person of equal skill classification (RN for RN, LVN for LVN, etc.). Replacement FTEs need to be budgeted when the staffing pattern is established so that you are not using overtime to staff the unit, or staffing at levels below requirements. Paid FTEs is a requirement for being able to put a dollar figure to a staffing plan. · PWR = Annual Paid Hours for a full-time employee (Annual Paid Hours) – (Non-worked Hours) Using an example of 320 non-worked hours per employee, PWR = __2080___ = 2080 2080-320 1760 PWR = 1.18 To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the PWR. · Paid FTEs = Worked FTEs x PWR Using an example of having 6.6 worked FTEs of NA, and the PWR calculated above, calculate the number of Paid FTEs required: Paid FTEs = 6.6 x 1.18 = 7.79 *Format Paid FTEs to 2 decimal places Remember that when an employee who is off is not replaced
  • 14. with another comparable employee, such as the nurse manager or clinical specialist, the Paid FTEs are equal to Worked FTEs. Calculate the Paid FTEs (Worked FTEs plus replacement) in the following staffing plan, using PWR = 1.18. Put your formula in the appropriate cells in Excel. STAFF S M T W T F S SHIFTS WORKED FTEs PAID FTEs* NM 0 1 1 1 1 1 0 5 1.0 RN 5 6 6 6 6 6
  • 16. TOTAL 14 15 15 15 15 15 14 103 20.6 *Format Paid FTEs to 2 decimal places. Easy, isn’t it? Well, you are almost done with this section. Close your eyes, take a deep breath, and forge onward! Now we are going to learn how to assign positions to a staffing pattern. Positions do not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A positionis not the same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positions so that you will have the correct number of staff to implement the staffing pattern. In a staffing pattern that gives every other weekend off, the number of positions required is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8-hour shift. Let’s say that on a typical nursing unit at your facility the number of RN shifts worked every Saturday and Sunday are five, and six RN shifts are worked Monday through Friday. The number of RN positions required would be 10. For positions that are not replaced by another comparable employee (e.g. Nurse managers), the number of positions needed for that skill classification is equal to the actual number of employees in that classification. For example,
  • 17. if you have one Nurse Manager, you only need one position of NM. Determine the number positions required for each skill classification in the staffing pattern below. Watch out!! If you determine the total number of positions needed by adding the total shifts for Saturday and Sunday you will be WRONG because the NM doesn’t work on those days; you will not have counted that “position!” To get the accurate number of total positions, add the column of positions for each skill classification: STAFF S M T W T F S SHIFTS WORKED FTEs PAID FTEs POSITIONS NM 0 1 1 1 1 1 0 5 1.0 1.0
  • 20. PWR = 1.18 Putting it all Together Okay. Now it’s time to give you a real brain teaser. Let’s see if you can put it all together. Complete the information for the following staffing pattern. Assume 8 hour shifts, PWR = 1.15, and 220 patient days for a one-week period: STAFF S M T W T F S SHIFTS WORKED FTEs PAID FTEs POSITIONS NM 0 1 1 1 1 1 0
  • 23. Inserting the appropriate data from above, calculate the following using formulas in Excel: Calculate NHPPD: _____________________ Calculate Variable Hours: _________________ Calculate Fixed Hours: ____________________ Determining Paid NHPPD Up to this point, you have been learning how to determine Worked NHPPD and its components. Below are formulas for calculating the Paid NHPPD. For each question below, use formulas in the Excel answer sheet to display your answer. · Paid NHPPD = Worked NHPPD x PWR Using an example where a unit had a NHPPD of 9.69, and the allocated PWR of 1.12, calculate the Paid NHPPD: Paid NHPPD = 9.69 x 1.12 = 10.85 What is the Paid NHPPD with a Worked NHPPD of 15? · Paid Caregiver Hours = Worked Caregiver Hours x PWR The Variable Hours for that unit was 8.56. With a PWR of 1.12, calculate the Paid Caregiver Hours: Paid Caregiver Hours = 8.56 x 1.12 = 9.59 What are the Paid Caregiver Hours with Worked Caregiver Hours of 7.25? · Paid Fixed Hours = Worked Fixed Hours x PWR The Fixed Hours for our earlier example was 1.13. With a PWR of 1.12, calculate the Paid Fixed Hours: Paid Fixed Hours = 1.13 x 1.12 = 1.26 What are the Paid Fixed Hours with Worked Fixed Hours of 1.6? Note that you can calculate the Worked elements of NHPPD by dividing the paid NHPPD by the PWR. For example, if you know the Paid NHPPD is 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 1.12 = 9.69.
  • 24. Acuity and its Influence Just knowing your average daily census (ADC) and NHPPD may not be enough to create an accurate staffing pattern because these elements do not take into account the actual severity of the patients. If you are currently using an acuity system that assigns a numerical score to the severity level of the patients on your unit, you can adjust your staffing pattern to take into account the influence of patient severity. · Acuity = Average Acuity Score x Patient Volume for a Specified Time The Specified Time Period You have calculated 12.85 NHPPD for a unit that has 61 patient days in one week (ADC=8.7). Assume an acuity on that unit of 2 (on average, each patient requires 2 RVUs); calculate Adjusted Daily Census (reflects acuity): Acuity = 2 x 3176 Annual Patient Days 365 Days Acuity = 6352 Adjusted Patient Days 365 Days Acuity = 17.4 Adjusted Daily Census This value equals an adjusted average daily census that reflects the acuity of that patient population. The staffing pattern is then configured based on this adjusted average daily census. For example, with an ADC of 8.7 and NHPPD of 12.85, you would need 13.97 FTE. Factoring in the acuity value would indicate that you now need 27.9 FTE (17.4 patients * 12.85 NHPPD ÷ 8 hour shifts) to care for those 8.7 patients because of the acuity level. To further see how FTEs change in relation to the addition of acuity, please follow this example: A nursing unit has been told that they must maintain a worked NHPPD of 6.62 hours. The baseline workload unit volume is 12,500 patient days, requiring 39.78 worked FTEs. Remember how to calculate that? 6.62 NHPPD x 12,500 patient days =
  • 25. 82,750 hours/year. 82,750 2080 (hours worked by 1 FTE) = 39.78 worked FTEs. The workload unit volume, with an acuity of 1.08 factored, is now 13,500 patient days. The worked FTEs that would be required to care for this adjusted patient day volume would be: FTEs = NHPPD x Adjusted Workload Volume 2080 hours FTEs = 6.62 x 13,500 = 42.97 2080 An additional 3.19 FTEs are needed to account for the acuity of the patient population and to maintain a worked NHPPD of 6.62. How many more FTEs would be needed with an acuity level of 3.0 for this same volume of patients and 6.62 NHPPD? Use formulas in Excel to calculate your answer. Sheet1Assignment 1AvailableActualStudent Answer Sheet: Complete each section as indicated. PointsPointsWhen creating formulae, feel free to place "constant" numbers in separate cells (e.g. in the first section, you may wish to put 8, 40, and 80 in H7, H8, H9 to use the cell identifier in your formulae.)Calculating Hours and Shifts: 10 pointsInsert formulae to calculate appropriate hours and shiftsFTEsONE WEEK HOURSONE WEEK SHIFTSONE PAY PERIOD HOURSONE PAY PERIOD SHIFTS0.2811620.420.620.821222Calculating Worked FTEs: 5 pointsInsert formulae to calculate missing shifts and FTEs. Format FTE to 1 decimalSTAFF S M T W T F SSHIFTSFTEsNM011111051.0RN56666651LVN43333341NA44 444441US11111111TOTAL141515151515141Calculating NHPPD: 2.5 points:Insert formula in C29 to calculate NHPPD; format to 2 decimal placesUnit 3A# 8 hr. shifts98# Pt. Days61NHPPD:2.5Calculating Caregiver (Variable) Hours: 2.5 pointsInsert formula in C38 to calculate caregiver hours; format to 2 decimal placesUnit 3A Caregiver hoursRN Shifts54LVN Shifts14NA Shifts13Pt. Days61Caregiver Hours:2.5Calculating
  • 26. Fixed Hours: 2.5 pointsInsert formula in C47 to calculate fixed hours; format to 2 decimal places3A: # of shifts for Nurse Manager, Clin. Spec., & Unit SecretariesNM5CNS5US7Pt. Days61Fixed Hours:2.5Calculating Non-worked Hours: 5 pointsInsert formula in B58 to calculate the sum of non-worked shifts;Then, insert a formula in B59 to calculate the number of non-worked hours; format with 0 decimalsNumber of non- worked 8-hour shifts per year:Sick leave = 12 shifts per year12Vacation10Holiday6Training3Misc.3TotalShifts2.5Total Non-worked Hours2.5Calculating Paid FTEs: 7.5 pointsInsert formulae to calculate Paid FTEs using PWR of :1.18where appropriate; format for 1 decimalSTAFFSMTWTFSSHIFTSWORKED FTEsPAID FTEs*NM011111051.002RN5666665408.000.75LVN433333423 4.600.75NA4444444285.600.75US111111171.400.75TOTAL141 5151515151410320.602.5Calculating the number of required positions: 4 pointsInsert formulae to calculate the number of required positions (whole numbers)STAFF S M TW T F SSHIFTSWORKED FTEsPAID FTEsPOSITIONS (given: NM, CNS, RN)NM01111105111CNS01111105111RN2333332193.84.484L VN3333333214.24.961NA2444442244.85.661US3333333214.24 .961TOTAL10151515151510951922.061Putting it all TogetherStaffing Pattern: 21 pointsComplete the information for the following staffing pattern, by inserting formulae in appropriate cells. Assume:Hours/shift:8PWR:1.15Pt. Days:220for one-week periodSTAFF S M TW T F SSHIFTSWORKEDPAID FTEsPOSITIONS FTEs*NM01111101.5CNS01111101.5RN66666663.5LVN23333 323.5NA68888863.5US22222223.5TOTAL4Calculation of NHPPD, Variable, and Fixed hours for staffing pattern above: 12 pointsInsert formulae in D105, D107, and D109 to:Calculate NHPPD: 4Calculate Variable Hours: 4Calculate Fixed Hours: 4Determining Paid NHPPD: 12 pointsGiven the following data, insert formulae in cells I114, I115, and I116 PWR=1.12What is the Paid NHPPD with a Worked NHPPD of:154What are the
  • 27. Paid Caregiver Hours with Worked Caregiver Hours of:7.254What are the Paid Fixed Hours* with Worked Fixed Hours of: 1.64*These fixed hours are for staff who are replacedEffect of Acuity: Part A=5 points; Part B=11 pointsInsert formulae into cells J125 and J126 to answer the questions below:StandardAdj. AcuityPatient Volume1250012500NHPPD6.626.62Acuity Level (in RVU)03A. How many FTEs are needed to care for this patient volume (in column labeled Standard)?5B. What is the difference between the number of FTE needed for the actual volume, when acuity is taken into consideration?11Total Points1000 &P Sheet2 Sheet3