understanding the central responsibilities of the nurse manager

7/28/2019 Understanding the Central Responsibilities of the Nurse Manager

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Understanding the Central Responsibilities of the NurseManagerOne of the central responsibilities of the nurse manager on a clinical unit is to provide the appropriate

number and mix of nursing staff (nursing care hours [NCH]) to match actual or projected patient care

needs (patient care hours) that will result in safe, effective, quality care for the patients on the unit.

While the nurse manager may plan, organize, staff, direct, and controldoing a multitude of things

simultaneously all day longthe purpose of a great deal of this activity is to ensure that this

responsibility will be carried out. Appropriate staffing has become even more critical as the focus on

quality care at a reasonable cost has become paramount. To develop a master staffing pattern, a

nurse manager must determine how many hours of nursing care are required, based upon available

patient classification system information. Once the hours of required nursing care are determined, the

number of full-time equivalents (FTEs) can be calculated. One full-time equivalentis equal to 40 hours

per week, 80 hours per two-week pay period, or 2,080 hours per year. There are several methods to

determine required FTEs once a desirable staffing pattern has been established.

Activity 1:

The Situation

In the unit where you are planning the budget, it has been determined that patients need 4 hours of

RN nursing care hours per day (NHPD), 2 hours of LPN nursing care/day and six hours of unlicensed

assistive personnel (UAP) care/day. This information is based on data from last year, and assumes no

change in patient census or acuity for the upcoming year. The average daily census is 32 patients.

Figure 17-1: The Staffing Plan

Instructions

1. Using the information from the Situation above, determine the nursing care hours (NCHs) foreach category of staffper pay period and enter it into the middle column in the table below.

Number of RNs: _________

Number of LPNs: _________

Number of UAPs: __________

2. Using the figures above, determine how many FTEs in each category of staffwill beneeded to staff this unit per pay period and enter it into the table.

3. How might the number of nursing care hours needed in each category of care in the staffingpattern have been determined?

Category of StaffNursing Care Hours

per Pay Period

Number of FTEs Required

in Each Category

RNs

LPNs

UAPs

Total nursing staff

4. Figure 17-2: Total Required Nursing Care HoursActivity 2:


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Another method for determining FTEs is to calculate a fraction that can be used as a constant to

determine replacement hours needed to cover non-productive hours for each position. Non-productive

hours include vacations, holidays, personal days, and so on. Non-productive hours are paid out of the

unit budget but not worked. Since a hospital is open for business 24 hours a day and seven days a

week (24/7), the non-worked "benefit" hours must be covered by replacements, and must be planned

for in the budgeting process.

The replacement factor can be calculated by determining the average number of vacation days, paid

holidays, personal days, bereavement days, and other paid days off that an organization provides, and

the average number of sick days per employee as experienced by the unit or cost center.

Example: To determine replacement time at Hospital X:*

Benefit time Hours/shift Replacement hours/year

15 vacation days x 8 hours/day = 120 hours

8 holidays x 8 hours/day = 64 hours

4 personal days x 8 hours/day = 32 hours

5 sick days x 8 hours/day = 40 hours

Total = 256 hours to replace/year

To determine the FTE replacement requirement, divide the replacement time by the annual FTE hours

paid:

256 benefit hours paid

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2080 total hours paid = 0.12

This means that for each position on a unit, an additional 0.12 FTE must be included in the budget as

a replacement for the non-worked hours.

*See Sullivan and Decker textbook, Chapter 12, Budgeting and Managing Resources, for more.

This formula accounts for the non-productive time that must be covered. However, it does not include

the coverage needed for a seven-day workweek. Each position, or FTE, works 40 hours a week (or 36

hours a week in a 12-hour shift pattern). The additional hours needed to cover the extra two days per

week also must be included in budget planning. A second method often used to calculate needed

nursing hours for budgeting purposes is to calculate the needed hours as a fraction, as above. Below is

a representation of how that is done. The factor used to represent the extra two days per week that

must be covered is 0.4. (Let's call this relief time for the purposes of this activity.) Combined with the

factor for benefit time, the manager now has a constant that can be used to calculate needed nursing

care positions for budgeting purposes.

Example: Determining Total FTEs for Budget Planning

1 FTE

+ 0.12 (benefit replacement time)

+ 0.4 (additional shifts/wk)

= 1.52 FTE (factor used in calculating budget

Figure 17-3: Understanding 24/7 coverage (Relief time)


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One full-time person working eight-hour shifts works 40 hours a week, or 80 hours per pay period.

Each eight-hour workday of a full-time employee's workweek is considered to be 20%, or 0.2 FTE (5 x

0.2 = 1 FTE). This is one way to visualize the personnel it takes to cover a unit seven days a week, 24

hours a day. (24/7 is shortcut jargon you'll hear in the workplace.) We'll call this relief time.

M = 20% or 0.2T = 20% or 0.2

W = 20% or 0.2 5 workdays = 1.0 FTE

Th = 20% or 0.2

F = 20% or 0.2

100%= 1.0 FTE

What about Saturday and Sunday?

Sat = 20% or 0.2

Sun = 20% or 0.2 2 workdays = 0.4 FTE (to cover the weekend)

So, you see, it takes 1.0 FTE plus 0.4 FTE (let's switch to talking about positions, not people) to cover

"relief" for the full-time equivalent position to have two days off per week so that seven days per week

are staffed. This also must be calculated when determining a staffing budget for the next year. So we

will use the factor 1.4 FTEs to account for seven-days-per-week coverage.

Instructions

1. Complete the equation below to determine how many hours of non-productive time each staffmember is entitled to per year. Hint: see Chapter 12 in S&D textbook

On your unit, all employees receive the following benefit package:

7 holidays/year x _____ = _____

10 sick days/year x _____ = _____

14 vacation days/year x _____ = _____3 personal days/year x _____ = _____

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Total per year _____

2. Using the formula in the example above, Determining FTE Replacement Time, calculate thereplacement factor for this hospital unit.

1 FTE + ______ (benefit replacement factor) = _____ FTEs

3. Now add the relief time factor from Figure 17-3 to obtain a constant factor that you can usedto determine the total FTEs in each skill category for your budget.

1 FTE + _____ (benefit replacement factor) + _____ (relief time factor) = _____ FTE

4. Finally, apply this constant factor to calculate the number of FTEs for the unit described inbelow.

Shift RNs LPNs UAPs

Day Shift 4 2 2


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Evening Shift 4 1 2

Night Shift 2 2 1

Number of RNs: _________

Number of LPNs: _________

Number of UAPs: __________

Number of Staff from

Activity 1

Factor from #3,

Activity 2 applied

Number of FTEs Required in

Each Category

RNs

LPNs

UAPs

Total nursing staff

Figure 17-4: Total Required Nursing Care Hours

FYI: The figure below demonstrates a comparison of eight-hour shifts and 12-hour shifts in terms of

obtaining a constant calculation factor for budgeting purposes.

For Your Information: Are More Nurses Needed for 12-hour Shifts?

For eight-hour shifts: 1.4 x 3 shifts/day = 4.2 FTEs for 24-hour day x seven days per week similar formula can be used to come up with a coverage factor for a unit using a 12-hour

pattern: three shifts/week x 12 hours/shift = 36 hours per week; 36/40 = 0.9 (Each full-time

employee covers 0.9 FTE with this schedule.) Therefore, it takes 2.1 FTEs to staff one 12-hour

shift each day, seven days a weekthat is, two people working three 12-hour shifts and one

person working one 12-hour shift (0.9 FTE + 0.9 FTE + 0.3 FTE = 2.1 FTEs for seven days perweek).

2.1 x 2 shifts/day = 4.2 FTEs to cover 24-hour day x seven days per week

understanding the central responsibilities of the nurse manager

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