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 24hour 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.
FullTime Equivalent (FTE):The equivalent of one fulltime 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 nonproductivetime. One employee, working fulltime 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 nonworked hours.
Worked Hours:The actual number of hours worked, including both regular and overtime hours, orientation hours, oncall hours, callback hours, and training/education hours. Also known as productive hours.
NonWorked 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 nonworked hours. Also known as nonproductive hours.
Paid Hours:The total amount of worked and nonworked hours an employee is paid for.
Position:One person working one job, regardless of the number of hours that person works. A position is notthe same as an FTE.
Shift:A designated number of hours that an employee works in a 24hour 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 nonworked (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/(2080265)=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 plusthe replacement FTEs needed during vacation, education, training, etc. to staff a cost center.
Cost Center:A unit or department in an organization.
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.
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 = 40 worked hours ¸80 hours = 0.50 FTE
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:
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.
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 guideto 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 24hour 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 shouldbe 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:
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 Hoursgives us how many hours within the NHPPD are spent providing direct nursing care. It is calculated:
Patient Days
In one example, the total shifts calculated = 103. There were 12 noncaregiver 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 Careare 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 nondirect patient care (e.g. patient teaching done by a CNS). Remember, this number is constant, since it is not affected by acuity or volume.
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 Hoursand 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 andFixed Hours of Care.
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? J
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 nonworked hours. What you have done so far is to calculate worked FTEs.
An example of calculating Nonworked Hours for a fulltime 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
Nonworked Hours = 40 shifts x 8 hours = 320 hours per employee
Note: The number of nonworked hours for an employee is determined by the organization, which ensures consistent allocation of nonworked 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 nonworked hours.
Here goes! Is your computer smoking yet??? Calculate the number of Nonworked Hoursfor 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
Nonworked Hours = __________
Calculating the nonworked hours is essential prior to figuring the PaidtoWorked 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.
(Annual Paid Hours) – (Nonworked Hours)
Using an example of 320 nonworked hours per employee,
PWR = __2080___= 2080
PWR = 1.18
To calculate paid FTEs required, multiply the worked FTEs for each classification of employee times the 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 positionsto a staffing pattern.
Positionsdo not designate time: they designate space or the number of employees needed for a specific skill type, e.g. RN. A positionis notthe same thing as a FTE! As obvious as it may seem, let us say that it is important to have the correct number of positionsso 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 positionsrequired is equal to the total number of shifts worked on weekends. As before, assume each shift worked is an 8hour 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 positionsrequired would be 10. For positionsthat are not replaced by another comparable employee (e.g. Nurse managers), the number of positionsneeded 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 positionof NM.
Determine the number positionsrequired 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
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 oneweek 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: ____
Up to this point, you have been learning how to determine Worked NHPPDand 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.
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?
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?
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 Workedelements of NHPPD by dividingthe paid NHPPD by the PWR. For example, if you know the Paid NHPPDis 10.85 and the PWR is 1.12, then the Worked NHPPD is 10.85 ¸1.12 = 9.69.
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.
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.
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