ANSWER
Discussion Response for Week 6/7: Points to Discuss with the Nurse Leader
I would discuss the following important points with the nurse leader:
Present Acuity Levels: Emphasize how the inclusion of the vascular surgeon’s patients increased patient acuity, necessitating a step-down level of care for six out of the twenty patients.
Needs for Staffing: In order to address the increased acuity needs, it is imperative that we move to a blended unit model that is 70% medical-surgical and 30% step-down. This will require additional Full-Time Equivalent (FTE) caregivers.
Use of Overtime (OT): Describe how an over dependence on overtime to fulfill the increased workload resulted in an adverse compensation variance, costing $125,000 over six months.
Implications for the Budget: Explain how a new staffing grid can lessen the financial impact of continuing overtime vs employing more employees.
Talk about how understaffing and an excessive reliance on overtime can jeopardize staff morale, retention, and patient safety.
Requirement for Extra FTEs: Applying the Hours Per Patient Day (HPPD) recommendation:
HPPD is 7.59 right now.
A step-down HPPD average of 12 hours per day is required for the step-down patients (6 ADC).
The HPPD for medical-surgical patients (14 ADC) is still 7.59.
FTE Calculation: FTEs needed each pay period = (HPPD × ADC × 14 days) ÷ 80 hours per FTE.
(7.59 × 14 × 14) ÷ 80 = 18.62 Medical-Surgical: (7.59 × 14×14) ÷ 80 = 18.62 FTEs.
The step-down is (12 × 6 × 14) ÷ 80 = 12.6 (12 × 6 × 14) ÷ 80 = 12.6 FTEs.
A total of 31.22 FTEs are required, which is an increase of about 4.6 FTEs above the present employment level.
2. Suggestions: OT vs. Hiring More Registered Nurses
OT Cost for Six Months: $125,000, or around $250,000 a year.
Cost of Hiring More RNs: The average RN makes about $80,000 a year. It would cost $368,000 a year to hire 4.6 more FTEs, but doing so would guarantee proper staffing and prevent employee fatigue.
Comparatively speaking, overtime may seem less costly initially, but it increases employee weariness, possible safety hazards, and turnover expenses. Purchasing more FTEs guarantees long-term care delivery, lessens the need for OT, and enhances employee and patient outcomes.
3. Updated Medical-Surgical Patient Staffing Grid Shift (14 ADC)Patients Who Step Down (6 ADC)5 RNs (7:1 ratio) + 1 UAP 3 RNs (2:1 ratio) is the total number of staff required for the day shift.Nine Employees, Evening ShiftThree registered nurses (2:1 ratio) plus one UAPThree RNs on a night shift (7:1 ratio) and eight staff membersTwo registered nurses (3:1 ratio)Five Employees
In order to minimize OT dependence and align staff ratios with patient acuity, this grid integrates the blended model with step-down care.
If you require any extra information or modification, please let me know!
QUESTION
Discussion Topic
Follow
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)