Nursing Hours Per Patient Day
UTA_3
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 FTEs required. 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
