You have been reviewing reports, and over the past 6 months since the surgeon came on board you notice an unfavorable salary variance. You also have been tracking the actual census, and the ADC on average remains at 20; however, six of the patients have higher acuity.

QUESTION

The nurse manager of a medical-surgical unit has a budgeted ADC of 20. A new vascular surgeon has been admitting patients to the unit, which is requiring an increase in nursing care to treat these additional patients. The current budgeted HPPD is 7.59. You have been monitoring the number of patients with the higher acuity in anticipation of budget planning.

You have been reviewing reports, and over the past 6 months since the surgeon came on board you notice an unfavorable salary variance. You also have been tracking the actual census, and the ADC on average remains at 20; however, six of the patients have higher acuity. You are proposing the configuration of the unit is changing to a blended model with an overall ADC of 20. The blend is 70% medical-surgical (ADC and 30% stepdown (6 ADC).

Answer the following Questions below along with 2 peer responses.

You need to discuss the issues with the nurse leader you report to.

1.  What discussion points should you plan to cover? Will there be a need for additional FTE caregivers to care for the change in acuity? If so, how many FTEs? Have you been staffing above the staffing guideline using OT?

2.  The assumption is you are using OT to cover the additional clinical requirements. Financial reports indicate for the 6-month period OT expense is $125,000, which is unfavorable to the budget. What are your recommendations? Compare the cost of OT used over the past 6 months with the cost of hiring the additional RNs.

3.  Develop a revised staffing grid. (very basic does not need to be complex)

ANSWER

Optimizing Staffing Levels in a Medical-Surgical Unit: Addressing Acuity Changes and Financial Considerations

Introduction

In the dynamic healthcare environment, ensuring appropriate staffing levels in medical-surgical units is crucial to provide safe and efficient patient care. The introduction of a new vascular surgeon and an increase in patients with higher acuity can significantly impact staffing requirements and financial considerations. This article addresses the need for discussions with nurse leaders, explores the potential need for additional FTE caregivers, evaluates the use of overtime (OT) versus hiring additional RNs, and proposes a revised staffing grid to optimize staffing levels while balancing patient acuity and budgetary constraints. By addressing these key points, healthcare organizations can make informed decisions to maintain quality care while managing costs effectively.

When discussing the issues with the nurse leader, the following points should be covered:

 The impact of the new vascular surgeon on patient admissions and the resulting increase in nursing care requirements (Woo et al., 2017). This should include a discussion on the higher acuity patients and their specific care needs.

The current budgeted average daily census (ADC) of 20 and the proposed blended model with 70% medical-surgical (ADC) and 30% stepdown (6 ADC). It should be emphasized that this new configuration may require additional FTE (full-time equivalent) caregivers to adequately care for the change in acuity.

The need to evaluate whether the unit has been consistently staffing above the staffing guideline using overtime (OT). It is important to assess whether the current staffing levels are sufficient to meet patient needs or if additional FTEs are required.

 In regards to the unfavorable salary variance and the use of OT to cover the additional clinical requirements, the following recommendations can be made:

Conduct a thorough analysis of the cost of OT used over the past 6 months, which is reported as $125,000, and compare it with the cost of hiring additional registered nurses (RNs). This analysis should take into account the hourly rate of OT and any associated benefits or overtime premiums.

Consider the long-term financial implications of relying heavily on OT. While it may seem like a short-term solution, the continued use of OT can lead to increased expenses and potential burnout among staff members. It is important to find a balance between using OT and hiring additional RNs to ensure adequate staffing levels (Communication and Dissemination Strategies to Facilitate the Use of Health-Related Evidence | Effective Health Care (EHC) Program, n.d.).

Assess the availability of qualified RN candidates in the market and the time required to recruit and onboard new staff members. This will help determine the feasibility and timeline for hiring additional FTEs.

The revised staffing grid should be developed to optimize staffing levels based on the proposed blended model with an overall ADC of 20 (70% medical-surgical and 30% stepdown). The grid should consider the acuity levels of patients and the required nurse-to-patient ratios.

The staffing grid should aim to achieve a balance between providing safe and high-quality patient care while managing costs effectively (Clarke, 2008). It should take into account factors such as nurse workload, skill mix, patient acuity, and unit-specific needs.

While a detailed staffing grid is not required in this context, it should provide a basic outline of the number of RNs required for each shift, considering the average patient acuity and nurse-to-patient ratios recommended for medical-surgical and stepdown units. This will serve as a starting point for further evaluation and adjustment based on ongoing patient admissions, acuity changes, and budget constraints.

Overall, the goal of the revised staffing grid is to ensure that the unit is adequately staffed to meet patient needs, while also taking into account the financial implications and budget constraints of the healthcare organization.

References

Clarke, S. P. (2008, April 1). Nurse Staffing and Patient Care Quality and Safety. Patient Safety and Quality – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK2676/ 

Communication and Dissemination Strategies To Facilitate the Use of Health-Related Evidence | Effective Health Care (EHC) Program. (n.d.). https://effectivehealthcare.ahrq.gov/products/medical-evidence-communication/research-protocol 

Woo, B. F. Y., Lee, J. R., & Tam, W. W. (2017). The impact of the advanced practice nursing role on quality of care, clinical outcomes, patient satisfaction, and cost in the emergency and critical care settings: a systematic review. Human Resources for Health, 15(1). https://doi.org/10.1186/s12960-017-0237-9