ANSWER
Discussion for Week 6/7: Changing Staffing to Boost Acuity
1. Points to Discuss with the Nurse Leader: Staffing Issues and Patient Acuity The rising patient acuity linked to the new vascular surgeon’s admissions is the main topic of debate. Although the unit’s ADC stays at 20, nurse-to-patient ratios must be adjusted due to the acuity shift favoring step-down patients. The nursing staff’s workload is increased and existing resources are stretched when step-down patients need more extensive monitoring and care.
Staffing Needs: A blended unit model is suggested, consisting of 30% step-down (6 ADC) and 70% medical-surgical (14 ADC). Medical-surgical patients would need 14 ADC × 7.59 HPPD = 106.26 nursing hours per day if the present HPPD was set at 7.59. An HPPD of 10 is usually needed for step-down patients. This is equivalent to 60 nursing hours per day (6 ADC × 10 HPPD). The unit requires 13.85 shifts per day (rounded to 14 shifts) or 166.26 nurse hours per day.
Two more FTEs are needed to handle the increased workload given the current budgeted ADC manpower. The shortage is being covered by overtime (OT), resulting in an unfavorable variance of $125,000 over a six-month period.
2. Suggestions: Using OT Cost Analysis vs. Hiring More FTEs:
Costs of overtime: $125,000 spread over six months, or almost $250,000 a year.
FTE Costs: An RN makes, on average, $80,000 a year. The annual cost of hiring two more FTEs would be $160,000.
In comparison to continuing to rely on overtime, hiring two full-time employees would result in an annual cost savings of $90,000. Since continual overtime usage has a detrimental effect on nurses’ well-being and raises the likelihood of turnover, employing FTEs also has the added benefits of reducing burnout, improving nurse satisfaction, and improving the quality of patient care (Haddad et al., 2022).
It is advised to switch to recruiting two more full-time employees. This economical alternative lessens the financial and psychological strain of occupational therapy while improving staffing alignment with patient needs.
3. Updated Medical-Surgical Nurses Staffing Grid Shift (ADC 14)ADC 6 Step-Down NursesThe entire nursing day (7 AM–7 PM)Four registered nurses (1:4 ratio)Two registered nurses (1:3 ratio)Six o’clock (7 PM–7 AM)Three registered nurses (1:5 ratio)Two registered nurses (1:3 ratio)~7.59 HPPD for Med-Surg + 10 HPP + 5 Total Shifts/Day 14 References
Haddad, L. M., Toney-Butler, T. J., & Annamaraju, P. (2022). scarcity of nurses. StatPearls. From https://www.ncbi.nlm.nih.gov/books/NBK493175/, retrieved.
Homer, C., Buchan, J., Duffield, C. M., Roche, M. A., & Dimitrelis, S. (2021). a comparison of the expenses and turnover rates of nurses in various nations. Advanced Nursing Journal, 77(7), 2744–2751. Jan.14898 https://doi.org/10.1111
QUESTION
Week 6/7 Discussion. As written in the Week 6 Outline this discussion will be open and count for both Week 6 & Week 7 so you have that time frame to post; to give you an opportunity to get caught up on work, get assignments submitted etc.
Case Scenario:
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 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 have noticed 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 be changed to a blended model with an overall ADC of 20. The blend is 70% medical–surgical (ADC and 30% step-down (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 months 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)
Week 6/7 Discussion initial response is due between 7/28/2024 and 7/31/2024. The 2 peer responses are due by 9/7/2024 at 1159 p.m. EST (this will decrease discussion and hopefully lessen the workload a bit as you wrap up your final class assignments.
Please note the grading rubric for the discussion board.
As a reminder, all discussion posts must be a minimum of 350 words initial and 250 words peer responses, references must be cited in APA format 7th Edition, and must include a minimum of 2 scholarly resources published within the past 5 years.