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BRINGING YOUR NURSE STAFFING COMMITTEE TO LIFE: Staffing, Scheduling & Budgeting for the Bedside Clinician Cathe Clapp, RN, MN Barbara Hyland-Hill, RN,

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Presentation on theme: "BRINGING YOUR NURSE STAFFING COMMITTEE TO LIFE: Staffing, Scheduling & Budgeting for the Bedside Clinician Cathe Clapp, RN, MN Barbara Hyland-Hill, RN,"— Presentation transcript:

1 BRINGING YOUR NURSE STAFFING COMMITTEE TO LIFE: Staffing, Scheduling & Budgeting for the Bedside Clinician Cathe Clapp, RN, MN Barbara Hyland-Hill, RN, MN, CNAA-BC June 22, 2010 - Wenatchee June 23, 2010 – Spokane June 24, 2010 – Renton July 14, 2010 - Lynnwood Ruckelshaus Nurse Staffing Steering Committee

2 2 WA State Staffing Legislation – House Bill 3123 (2008) All hospitals must establish a Nurse Staffing Committee Composition at least 50% direct care nurses Create staffing plans If the CEO does not adopt staffing plans, must provide written explanation Staffing plans must be posted in public area Collect data on 5 NSQI and submit to WSHA Report nurse staffing with adverse events reporting

3 3 Ruckelshaus Nurse Staffing Steering Committee Our Objectives Provide you with basic concepts about: Provide you with basic concepts about: Budgeting (Staffing/Labor Budget) Budgeting (Staffing/Labor Budget) Staffing and Scheduling Staffing and Scheduling Nurse Sensitive Indicators Nurse Sensitive Indicators Staffing Committee Effectiveness Staffing Committee Effectiveness Have you apply the concepts Have you apply the concepts You leave with a toolkit (tools and resources) You leave with a toolkit (tools and resources) You will be able to share your learnings with your committee members (Train the Trainer) You will be able to share your learnings with your committee members (Train the Trainer)

4 4 Ruckelshaus Nurse Staffing Steering Committee Agenda Budgeting 101 Budgeting 101 Staffing and Scheduling Made Simple Staffing and Scheduling Made Simple Nurse Sensitive Indicators for Dummies Nurse Sensitive Indicators for Dummies Making the Staffing Committee Work Making the Staffing Committee Work Putting It All Together – Case Application Putting It All Together – Case Application

5 Budgeting 101

6 6 Ruckelshaus Nurse Staffing Steering Committee Personal Budget Income Income Salary – Pay check Salary – Pay check Interest/investment earnings Interest/investment earnings Expenses Expenses House payment or rent House payment or rent Utilities Utilities Food Food Insurance Insurance Car payment Car payment Gas Gas Etc Etc

7 7 Ruckelshaus Nurse Staffing Steering Committee What is a budget? A Plan Coordination of revenue and expenses Coordination of revenue and expenses Specific period of time – usually 1 year Specific period of time – usually 1 year Formalized → written down Formalized → written down Forecast the future Forecast the future An Educated Guess

8 8 Ruckelshaus Nurse Staffing Steering Committee Functions of the Budget Financially operationalize an organization’s goals and objectives Financially operationalize an organization’s goals and objectives Keep management informed Keep management informed Evaluate performance Evaluate performance Refine program development and plan Refine program development and plan Educate Educate Increase cost awareness Increase cost awareness

9 9 Ruckelshaus Nurse Staffing Steering Committee Budgeting Process Understand your organization’s process, forms, timeline, terminology, fiscal year Understand your organization’s process, forms, timeline, terminology, fiscal year Planning Planning Department Goals & Objectives Department Goals & Objectives Projected Units of Service (Volume and Acuity) Projected Units of Service (Volume and Acuity) Preparing Preparing Monitoring and Controlling Monitoring and Controlling Reporting Reporting

10 Staffing Budget (Labor, Personnel, Manpower)

11 11 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Units of Service Unit of Service (UOS) – measure of product or service produced by the department Unit of Service (UOS) – measure of product or service produced by the department For Nursing Departments For Nursing Departments Inpatient UnitsPatient Days Inpatient UnitsPatient Days Outpatient UnitsVisits Outpatient UnitsVisits Emergency DepartmentVisits Emergency DepartmentVisits Surgical UnitsProcedures (Major & Minor) Surgical UnitsProcedures (Major & Minor)Minutes Labor & DeliveryDeliveries Labor & DeliveryDeliveries Procedures (Ante partum) OP OncologyTreatments OP OncologyTreatments

12 12 Ruckelshaus Nurse Staffing Steering Committee The Story of Your Unit Who are your patients? Who are your patients? DRG, age, drugs/therapies/treatments used DRG, age, drugs/therapies/treatments used What are their needs? What are their needs? Acuity, severity of illness Acuity, severity of illness What are your hours of operation? What are your hours of operation? 24/7 24/7 Other: Mon-Fri, 8 am – 5 pm Other: Mon-Fri, 8 am – 5 pm Collect information on: Collect information on: Volumes Volumes Length of stay Length of stay ADT ratio/churn factor ADT ratio/churn factor Number of procedures Number of procedures Do you have outpatients or 23-hour stay patients? Do you have outpatients or 23-hour stay patients? Is the census done at midnight? Is the census done at midnight?

13 13 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Nursing Hours

14 14 Ruckelshaus Nurse Staffing Steering Committee Required Care Hours Projected UOS volume Projected UOS volume Determination of workload hours Determination of workload hours Direct nursing care hours per pt day (or UOS) standard Direct nursing care hours per pt day (or UOS) standard Patient Classification System – Case Mix Patient Classification System – Case Mix Desired Fixed Staffing Coverage Desired Fixed Staffing Coverage

15 15 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts - FTEs FTE = Full Time Equivalent FTE = Full Time Equivalent Equivalent of 1 full-time employee working for 1 year Equivalent of 1 full-time employee working for 1 year 1.0 FTE = 2080 hrs/yr (8 hrs X 5 days X 52 wks) 1.0 FTE = 2080 hrs/yr (8 hrs X 5 days X 52 wks) = 40 hrs/wk (8 hrs X 5 days) = 80 hrs/2 wks (8 hrs X 10 days) FTEs are converted to positions which are filled by employees FTEs are converted to positions which are filled by employees

16 16 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - DNCH General Medical Unit Bed Capacity 36 Pt Days (UOS) 11,790 ADC % occupancy 32.389.7% 11,790 pt days/365 days 32.3 ADC/36 beds X 100 DNCH/UOS8.14Standard DNCH Required/Yr FTES95,97146.1 11,790 pt days X 8.14 DNCH 95,971 hrs/2080 DNCH Required/Day # Staff 262.9332.9 32.3 ADC X 8.14 DNCH 262.93/8 hr shifts

17 17 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - Acuity Pt Acuity Level DNCHPPD Pt Days Workload Hours 13.01,0613,183 25.23,67519,110 38.84,87642,909 413.01,70422,152 518.24748,627 Total11,79095,981DNCH 46.1 FTEs X =

18 18 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - Fixed

19 19 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - DNCH General Surgical Unit Bed Capacity 32 Pt Days (UOS) 10,760 ADC % occupancy pt days/365 days ADC/36 beds X 100 DNCH/UOS7.82Standard DNCH Required/Yr FTES pt days X DNCH DNC hrs/2080 DNCH Required/Day # Staff ADC X DNCH DNC hrs/8 hr shifts

20 20 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - DNCH General Surgical Unit Bed Capacity 32 Pt Days (UOS) 10,760 ADC % occupancy 29.592% pt days/365 days ADC/36 beds X 100 DNCH/UOS7.82Standard DNCH Required/Yr FTES84,14340.5 pt days X DNCH Yearly DNC hrs/2080 DNCH Required/Day # Staff 230.6928.8 ADC X DNCH Daily DNC hrs/8 hr shifts

21 21 Ruckelshaus Nurse Staffing Steering Committee Workload Hours - Allocation Staffing Model Staffing Model Total pt care, Team, Modular, Primary Care, Partnership (Dyad) Total pt care, Team, Modular, Primary Care, Partnership (Dyad) % RN, % LPN, % NA-C % RN, % LPN, % NA-C Length of shifts – 8, 10, 12 hr Length of shifts – 8, 10, 12 hr % care allocated per shift % care allocated per shift

22 22 Ruckelshaus Nurse Staffing Steering Committee Required DNC Staff Per Day General Medical Unit ADC = 32.3 DNCH 8.14 Required Hrs = 262.93 Required staff = 32.9 (Hrs by shift) Days40%(105.17)Eve30%(78.88)Nights30%(78.88)Total (by skill mix) RN (71%) 9.3 (105.17 X.71/8) 7.0 (78.88 X.71/8) 7.0 23.3 LPN NA-C (29%) 3.8 (105.17 X.29/8) 2.9 (78.88 X.29/8) 2.9 9.6 Total (by shift mix) 13.19.99.932.9

23 23 Ruckelshaus Nurse Staffing Steering Committee Required DNC Staff Per Day General Surgical Unit ADC = 29.5 DNCH 7.82 Required Hrs = Required staff = (Hrs by shift) Days40%Eve35%Nights25%Total (by skill mix) RN (71%) LPN NA-C (29%) Total (by shift mix)

24 24 Ruckelshaus Nurse Staffing Steering Committee Required DNC Staff Per Day General Surgical Unit ADC = 29.5 DNCH 7.82 Required Hrs = 230.69 Required staff = 28.8 (Hrs by shift) Days40%(92.28)Eve35%(80.74)Nights25%(40.95)Total (by skill mix) RN (71%) 8.2 (92.28 X.71/8) 7.2 (80.74 X.71/8) 5.1 (40.95 X.71/8) 20.5 LPN NA-C (29%) 3.3 (92.28 X.29/8) 2.9 (80.74 X.29/8) 2.1 (40.95 X.29/8) 8.3 Total (by shift mix) 11.510.17.228.8

25 Required DNC FTEs Per Year General Medical Unit UOS = 11,790 DNCH 8.14 Required Hrs = 95,971 Required FTEs = 46.1 Days40%Eve30%Nights30%Total (by skill mix) RN (71%) 13.19.89.832.7 LPN NA-C (29%) 5.44.04.013.4 Total18.513.813.846.1

26 Required DNC FTEs Per Year General Surgical Unit UOS = 10,760 DNCH 7.82 Required Hrs = Required FTEs = Days40%Eve35%Nights25%Total (by skill mix) RN (71%) LPN NA-C (29%) Total

27 Required DNC FTEs Per Year General Surgical Unit UOS = 10,760 DNCH 7.82 Required Hrs = 84,143 Required FTEs = 40.5 Days40%(33,658)Eve35%(29,450)Nights25%(21,035)Total (by skill mix) RN(71%)11.5 (33,658 X.71/2080) 10.1 (29,450 X.71/2080) 7.2 (21,035 X.71/2080) 28.8 LPN NA-C (29%) 4.7 (33,658 X.29/2080) 4.1 (29,450 X.29/2080) 2.9 (21,035 X.29/2080) 11.7 Total16.214.210.140.5

28 28 Ruckelshaus Nurse Staffing Steering Committee Non-Productive Hours Coverage for anticipated time off (backfill or replacement) Coverage for anticipated time off (backfill or replacement) How does your organization define Non- Productive Hours? How does your organization define Non- Productive Hours? PTO, Vacation, Sick Leave, Holiday, Bereavement, FMLA, Education/Professional PTO, Vacation, Sick Leave, Holiday, Bereavement, FMLA, Education/Professional What categories of staff must be replaced What categories of staff must be replaced RN, LPN, NA-C, HUC, Monitor Tech, Surgical Tech, etc RN, LPN, NA-C, HUC, Monitor Tech, Surgical Tech, etc

29 29 Ruckelshaus Nurse Staffing Steering Committee Non-Productive Hours How does your organization budget for Non- Productive coverage? How does your organization budget for Non- Productive coverage? Ave % of non-productive time Ave % of non-productive time Vacation15 days Holiday 9 days Average sick 6 days Education 2 days 32 days = 256 hrs (8 hr shift) 32 days = 256 hrs (8 hr shift) 2080 - 256 = 1824 prod DNCH 256/1825 = 14% 46.1 DNC FTEs X 1.14 = 52.6 – 46.1 = 6.5 NP FTEs

30 30 Ruckelshaus Nurse Staffing Steering Committee Non-Productive Hours How does your organization budget for Non- Productive coverage? How does your organization budget for Non- Productive coverage? Calculate by category of staff replaced and type of NP time Calculate by category of staff replaced and type of NP time Vacation Vacation Sick leave Sick leave Holiday Holiday Education/Professional leave Education/Professional leave # days by staff category X 8 hours X DNC FTE 2080

31 31 Ruckelshaus Nurse Staffing Steering Committee Productive – Fixed Staff Positions whose hours are set and do not adjust with pt census, volume or acuity Positions whose hours are set and do not adjust with pt census, volume or acuity Manager, CNS, Unit-based educator Manager, CNS, Unit-based educator Health Unit Coordinator, Monitor Tech Health Unit Coordinator, Monitor Tech Need to know: Need to know: # of days/week and shift coverage # of days/week and shift coverage Are they replaced when off? Are they replaced when off?

32 32 Ruckelshaus Nurse Staffing Steering Committee Non-Productive Impact FTE NP % NP FTE Total FTE Manager1.0--1.0 RN32.714%4.637.3 NA-C13.414%1.915.3 HUC2.814%.43.2 Total49.96.956.8

33 33 Ruckelshaus Nurse Staffing Steering Committee Indirect Care Hours Paid, worked hours related to unit/dept function Paid, worked hours related to unit/dept function Orientation Orientation Inservice education – CPR, mandatory education Inservice education – CPR, mandatory education Staff meeting time Staff meeting time Shared governance meetings Shared governance meetings Committee time/work Committee time/work QA, Clinical Pathways, Standards, etc QA, Clinical Pathways, Standards, etc

34 34 Ruckelshaus Nurse Staffing Steering Committee Indirect Care Hours Calculated by type of activity by skill mix Calculated by type of activity by skill mix # staff X # hrs X # times = hrs Orientation Orientation Turnover by category Turnover by category Anticipated Retirements Anticipated Retirements Ave # days oriented Ave # days oriented New graduates New graduates Do you take? Do you take? Do you have a Residency Program? How long is it? Do you have a Residency Program? How long is it? Are the new graduates hours expensed centrally or to unit? Are the new graduates hours expensed centrally or to unit?

35 Indirect Care Hours Indirect Productive Hours Annual Hrs Hrs#StaffTotal Hours Hours FTE Education and Meetings RN Education & Meetings 40642,5601.2 NA-C Education & Meetings 2032640.3 HUC/MT Education & Meetings 207140.1 Subtotal1.6 Orientation RN (average # days – 15) RN (average # days – 15)1205600.3 NA-C (average # days – 10) NA-C (average # days – 10)804320.2 HUC (average # days – 15) HUC (average # days – 15)1201120.1 Subtotal.6 Total 2.2

36 36 Ruckelshaus Nurse Staffing Steering Committee Staff Per Day & FTE Budget Direct Care # Staff/Day 32.9 FTEs Direct Nursing Care Direct Nursing Care46.1 Fixed Staff Fixed Staff3.8 14% Non-Productive 14% Non-Productive6.9 Indirect Time Indirect Time2.2 Total Paid FTEs 59.0 + + +

37 37 Ruckelshaus Nurse Staffing Steering Committee Premium Pay Shift differential Shift differential Weekend differential Weekend differential Charge nurse, certification, preceptor differential Charge nurse, certification, preceptor differential Overtime Overtime Standby and call back pay Standby and call back pay

38 38 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Hours Per UOS UOS are compared in a ratio to paid or direct hours required to deliver the service or product UOS are compared in a ratio to paid or direct hours required to deliver the service or product Common Productivity Standard in Nursing Common Productivity Standard in Nursing Nursing Hours Per Pt Day (HPPD) Nursing Hours Per Pt Day (HPPD) Direct Care Hours Direct Care Hours Productive Hours Paid/UOS Productive Hours Paid/UOS Total Hours Paid/UOS Total Hours Paid/UOS

39 39 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Formulas Average Daily Census (ADC) Average Daily Census (ADC) Total pt days # of days (week, month, year) Average Length of Stay (ALOS) Average Length of Stay (ALOS) Total pt days # of discharges Percent Occupancy Percent Occupancy Total pt daysCensus or ADC Total # bed days availableBeds available or

40 40 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Formulas Total Direct or Total Productive Hrs/UOS Total Direct or Total Productive Hrs/UOS Total direct or productive hrs Patient days or UOS Total Paid Hours/UOS Total Paid Hours/UOS Total paid hrs Patient days or UOS

41 41 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Formulas Average Hourly Rate Average Hourly Rate Total salary $ Total hours paid Total Productive Salary Expense/UOS Total Productive Salary Expense/UOS Total productive salary $ Patient Days or UOS Total Salary Expense/UOS Total Salary Expense/UOS Total productive salary $ Patient Days or UOS

42 42 Ruckelshaus Nurse Staffing Steering Committee Sample Cost Center Report

43 43 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Variance Analysis A variance is the difference between the Budgeted amount and the Actual results A variance is the difference between the Budgeted amount and the Actual results Favorable versus Unfavorable variance Favorable versus Unfavorable variance Variance analysis is a component of budget monitoring to investigate and explain why differences occurred Variance analysis is a component of budget monitoring to investigate and explain why differences occurred Individual manager accountability for budget variances Individual manager accountability for budget variances

44 44 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Variance Analysis Flexible Budget Variance Analysis Flexible Budget Variance Analysis Variance is a function of: Variance is a function of: Volume (output)(Patient Days or UOS) Volume (output)(Patient Days or UOS) Price or Rate(Ave Hourly Rate) Price or Rate(Ave Hourly Rate) Quantity or Use(Nursing Hours Used) Quantity or Use(Nursing Hours Used) f (Volume + Quantity + Price) f (Volume + Quantity + Price)

45 45 Ruckelshaus Nurse Staffing Steering Committee Basic Concepts – Staffing Costs What affects Staffing Costs? Volume (UOS) Volume (UOS) Total Hours Paid Total Hours Paid Direct Care Hrs – Pt Acuity, ADT ratio, staffing to matrix Direct Care Hrs – Pt Acuity, ADT ratio, staffing to matrix Indirect Care Hrs – Orientation of new staff, mandatory inservices or meetings Indirect Care Hrs – Orientation of new staff, mandatory inservices or meetings Non-Productive Hrs – Sick leave, vacation, FMLA, holiday Non-Productive Hrs – Sick leave, vacation, FMLA, holiday Average Hourly Rate Paid Average Hourly Rate Paid Overtime or premium pay situations Overtime or premium pay situations Registry or Traveler use Registry or Traveler use Skill mix used Skill mix used

46 46 Ruckelshaus Nurse Staffing Steering Committee Staffing and Scheduling Made Simple

47 47 Ruckelshaus Nurse Staffing Steering Committee Creating Position Control and Schedules DEMAND DEMAND Patient Type Patient Type Patient Volume and Acuity Patient Volume and Acuity Demand Variations (churn, time of day, days of week, months, seasons) Demand Variations (churn, time of day, days of week, months, seasons) RESOURCES RESOURCES Roles (Fixed and Variable) Roles (Fixed and Variable) FTE Mix FTE Mix Days of the week Days of the week Shifts Shifts

48 48 Ruckelshaus Nurse Staffing Steering Committee 48 Staffing Model Revisit, or build from the ground up, so allows manager and staff to understand all of the elements of staffing and resource use Revisit, or build from the ground up, so allows manager and staff to understand all of the elements of staffing and resource use Start with budgeted average daily census and the direct care staff FTE budget Start with budgeted average daily census (DEMAND) and the direct care staff FTE budget (RESOURCES)

49 49 Ruckelshaus Nurse Staffing Steering Committee From Budget to a Balanced Schedule… you need Unit Census and FTE Budget Staffing to Census (and Acuity) Matrix Core Daily Staffing Model (at census or occupancy target) Add in Non Productive FTEs Position Control (Personnel Budget)

50 50 Ruckelshaus Nurse Staffing Steering Committee Indirect Care Hours Paid hours related to unit/dept function not in DNCHs Paid hours related to unit/dept function not in DNCHs Orientation Orientation Inservice education – CPR, mandatory education Inservice education – CPR, mandatory education Staff meeting time Staff meeting time Shared governance meetings Shared governance meetings Committee time/work Committee time/work QA, Clinical Pathways, Standards, etc QA, Clinical Pathways, Standards, etc

51 51 Ruckelshaus Nurse Staffing Steering Committee Staffing Model Indirect Productive Hours Annual Hrs Hrs#StaffTotal Hours Hours FTE Education and Meetings RN Education & Meetings 40 CNA Education & Meetings 20 USMT Education & Meetings 20 Total Education and Meetings EXAMPLE RN Education 407329201.4 Do same for any other identifiable indirect and/or non- productive hours i.e. vacation

52 52 Ruckelshaus Nurse Staffing Steering Committee Non-Productive Impact FTE NP % NP FTE Total FTE Manager1.0--1.0 RN32.714%4.637.3 NA-C13.414%1.915.3 HUC2.814%.43.2 Total49.96.956.8

53 53 Ruckelshaus Nurse Staffing Steering Committee Unit Budget Overview General Medical Unit Bed Capacity 36 Pt Days (UOS) 11,790 ADC % occupancy 32.389.7%DNCH/UOS8.14 DNCH Req/Yr FTES46.1 DNCH Req/Day # Staff/ 8 hours 32.9 Non-Productive FTEs (14%)6.9 Total Unit FTEs 56.8

54 54 Ruckelshaus Nurse Staffing Steering Committee Consider # of Days per week to Staff 1 FTE needed x days to staff # of days per week per FTE 12 hour shifts:.9 FTE x 7 days of staff = 2.1 FTE 3 days per week 8 hour shifts: 1.0 FTE x 7 days of staff = 1.4 FTE 5 days per week

55 55 Ruckelshaus Nurse Staffing Steering Committee Aim of Improving Staffing and Scheduling Systems and Processes The Right Staff The Right Staff In the Right Place In the Right Place At the Right Time At the Right Time At the Right Cost At the Right Cost Doing the Right Thing Doing the Right Thing

56 56 Ruckelshaus Nurse Staffing Steering Committee Why is it worth it? High quality care High quality care Eliminating a last minute crisis mode Eliminating a last minute crisis mode Decreases labor intensive re-work Decreases labor intensive re-work Agreements between key players Agreements between key players Reduce use of temporary agency and premium pay Reduce use of temporary agency and premium pay Support staff satisfaction Support staff satisfaction

57 57 Ruckelshaus Nurse Staffing Steering Committee Why is it worth it? To provide high quality care to our patients by effectively managing our scheduling and staffing practices. To provide high quality care to our patients by effectively managing our scheduling and staffing practices. Move us to more proactive planning and problem solving with the goal of eliminating a last minute crisis mode of operation. Move us to more proactive planning and problem solving with the goal of eliminating a last minute crisis mode of operation. Standardize and streamline processes and increase accuracy which in turn decreases labor intensive re-work. Standardize and streamline processes and increase accuracy which in turn decreases labor intensive re-work. Create role agreements between key players that help make working together more pleasant and effective. Create role agreements between key players that help make working together more pleasant and effective. Reduce use of temporary agency and premium pay in a sustainable fashion. Reduce use of temporary agency and premium pay in a sustainable fashion. Support staff satisfaction with equitable treatment as well as reasonable and transparent accommodations when appropriate. Support staff satisfaction with equitable treatment as well as reasonable and transparent accommodations when appropriate.

58 58 Ruckelshaus Nurse Staffing Steering Committee Monthly schedules including vacations etc Long range clinical program development forecasts Hiring projections Annual budget and census projection Seasonal volume projections Weekly forecast Daily shift census and acuity Annual FTE budget: direct, indirect etc Staffing plan: position control Weekly and 24 hour staffing plans THE PATIENTS THE STAFF The Moment Of Truth We GO LIVE 24/7

59 59 Ruckelshaus Nurse Staffing Steering Committee High Level Staffing and Scheduling Overview

60 60 Ruckelshaus Nurse Staffing Steering Committee Overuse of the Word “STAFFING” “We are having a 2 hour surge in census every afternoon from 3 to 5 pm” “Our position control is unbalanced. The mix of 8 and 12 hour shifts has weekly gaps in scheduled coverage from 3 to 7pm” “We are scheduling to our average census and are unable to meet peak patient census days which have been occurring 17 days per month in the last 6 months.”

61 61 Ruckelshaus Nurse Staffing Steering Committee Overview of Three Distinct Staffing and Scheduling Phases - from when requests are due until final schedule posted Scheduling Process - from when requests are due until final schedule posted - activity after the schedule is posted -up to 24 hrs before (72 hrs on weekends) Middle Flow - activity after the schedule is posted -up to 24 hrs before (72 hrs on weekends) -from 24 hrs before (72 hrs on weekends) to day of staffing Staffing Process -from 24 hrs before (72 hrs on weekends) to day of staffing Before the schedule is posted Before the schedule is posted Mid Process: Posted to 24-72 Hrs before Mid Process: Posted to 24-72 Hrs before Outcome -Balanced schedule - -Cost effective plan for filling vacancies Outcome -Balanced schedule - -Cost effective plan for filling vacancies Outcome - -Re-balancing of schedule prn Outcome - -Re-balancing of schedule prn Outcome - -Final staffing adjustments - -Float pool assignment Outcome - -Final staffing adjustments - -Float pool assignment 24 Hrs before to day of staffing Scheduling The Middle Staffing

62 62 Ruckelshaus Nurse Staffing Steering Committee Scheduling Philosophy   Schedules ensure enough staff with the right skills to provide safe, quality patient care 24/7   Schedules are proactive and account for all direct and non-productive staffing needs Patient Staff Manager Scheduler   Effective scheduling models minimize the ultimate last- minute staffing needs for a shift   Schedules are dynamic and flexible but changes are minimized

63 63 Ruckelshaus Nurse Staffing Steering Committee  Capable of creating schedules that meet unit needs  Recognizes importance of stakeholder “relationship” and role agreements in scheduling and staffing processes  Ability to flex schedules (up and down) based on patient and unit needs  Recognizes unit volumes and workload patterns  Recognizes special circumstances  Takes technology into consideration  Defines options for filling vacancies What are the characteristics of an effective unit scheduling process?

64 64 Ruckelshaus Nurse Staffing Steering Committee Scheduling Process Steps SchedulerManagerStaff Core and patterns are established Core and patterns are established Staff submit requests Staff submit requests Anticipated monthly variations Anticipated monthly variations Schedule adjustment are identified Schedule adjustment are identified Temporary schedule reviewed Temporary schedule reviewed Temporary schedule posted Temporary schedule posted Gaps (to core) are filled Gaps (to core) are filled Final schedule posted Final schedule posted Important to clarify the roles and responsibilities of key players in the Scheduling process

65 65 Ruckelshaus Nurse Staffing Steering Committee Staffing and Scheduling Definitions Balanced Schedule Nursing units have a pre-defined “core” number of staff for each day of the week and each shift. This “core” is based on budgeted HPPD/HPUOS along with expected patient volumes and acuity by day of the week and shift. A balanced schedule meets core staffing levels in the most consistent manner possible i.e. a surgical unit that schedules seven nurses early in the week and two less on weekends because of surgeries occurring early in the week. Rebalancing The process of exploring and scheduling additional hours to compensate for unplanned uncontrollable changes in scheduled hours and/or volume after the schedule is posted or any time up until the staffing process map begins at 24 hrs (72 hrs on weekends) Unbalanced Schedule  Okay - Multiple open positions  Not-Okay - Granting more than established caps - People not working to FTE status - Guaranteed patterns that create imbalance - Per Diems not working required shifts Non Productive (NP) Caps  Specified amount of NP shifts allowed per schedule. Non-productive hours include vacation and educational meetings.

66 66 Ruckelshaus Nurse Staffing Steering Committee Handy and Very Helpful Definitions Scheduling Changes / Trades Floating guidelines Contracted Agency (local and travelers) and Extension Contracted Agency (local and travelers) Premium Pay Approval including use of prescheduled OT / On Call Posting and offering vacant shifts at straight time on the unit, division, system-wide (monthly, weekly and daily) Approving vacation requests Trades Holiday schedules Personal Leave Expectations for hours worked by per diem staff Approving and scheduling non-productive time at the time of schedule creation Scheduling all FT and PT staff to assigned FTE Soliciting voluntary increased hours by PT staff at FSLA rates of pay

67 67 Ruckelshaus Nurse Staffing Steering Committee Source: Perspective on Staffing & Scheduling, September 2000 ADT Factor – AKA Workload Intensity Demand The decrease in patient length of stay and the drive to enhance unit throughput has increased work activity The decrease in patient length of stay and the drive to enhance unit throughput has increased work activity The number of admissions, discharges, and transfers are usually not reflected in patient classification systems and never in midnight census The number of admissions, discharges, and transfers are usually not reflected in patient classification systems and never in midnight census This activity consumes nursing care hours and must be considered when looking at daily staffing, particularly in nursing units where there is high patient turnover This activity consumes nursing care hours and must be considered when looking at daily staffing, particularly in nursing units where there is high patient turnover The Hidden Patient Demand

68 68 Ruckelshaus Nurse Staffing Steering Committee Calculation of the ADT Factor Divide the total number of Admissions, Discharges, Transfers In & Out, and Deaths in a designated 24-hour period by the Midnight Census to determine the ADT Factor Source: Perspective on Staffing & Scheduling, September 2000

69 69 Ruckelshaus Nurse Staffing Steering Committee ADT Factor - Example Nursing Unit Number of ADT Midnight Census Unit Specific Score Unit A 1512 125% turnover Unit B 525 20% turnover Source: Perspective on Staffing & Scheduling, September 2000

70 70 Ruckelshaus Nurse Staffing Steering Committee ADT Factor - Impact Has significant impact on budgeting and staffing effectiveness Has significant impact on budgeting and staffing effectiveness Works out to one hour of care required per patient turnover (Admission, Discharge, Transfer In, Transfer Out) Works out to one hour of care required per patient turnover (Admission, Discharge, Transfer In, Transfer Out)

71 71 Ruckelshaus Nurse Staffing Steering Committee ADT Factor - Example 2000 patient turnovers per year X 1 hour of care = 2,000 additional hours of care needed 2000 patient turnovers per year X 1 hour of care = 2,000 additional hours of care needed 2000/2080 =.96 additional FTE’s needed to manage patient turnover requirements 2000/2080 =.96 additional FTE’s needed to manage patient turnover requirements

72 72 Ruckelshaus Nurse Staffing Steering Committee ADT Factor – Typical Unit Percents  Medical/Surgical50 - 55%  Telemetry70 - 75%  Critical Care85 - 90%  Post Partum85 - 90%  Mental Health40%  Rehab25 - 30% Source: Perspective on Staffing & Scheduling, September 2000

73 73 Ruckelshaus Nurse Staffing Steering Committee Unscheduled Absences Most common staffing problem Utilization of unscheduled time is increasing Very costly – Every year, unscheduled absences costs $2,650 per salaried worker and $3,600 per hourly worker* Essential to monitor each pay period * Shiftwork Practices 2005, Circadian Technologies, as cited in Bureau of National Affairs, Inc., “Absence Management: Making the Critical Shift from Transactional to Strategic,” 2006.

74 74 Ruckelshaus Nurse Staffing Steering Committee Unscheduled Absence Monitoring What staffing response does each unit have available to respond effectively to unscheduled absences? Overtime most commonly used as a response to deficit demands Overtime most commonly used as a response to deficit demands Evidence growing that overtime adversely impacts patient safety and quality of care Evidence growing that overtime adversely impacts patient safety and quality of care

75 75 Ruckelshaus Nurse Staffing Steering Committee Overtime Monitoring Guideline for overtime use is to keep it less than 5% of worked hours Guideline for overtime use is to keep it less than 5% of worked hours Overtime between 5 – 8% is symptomatic of financial distress Overtime between 5 – 8% is symptomatic of financial distress Overtime greater than 8% is symptomatic of serious distress Overtime greater than 8% is symptomatic of serious distress

76 76 Ruckelshaus Nurse Staffing Steering Committee Overtime Monitoring IOM report recommended limiting work hours to not more than 12 hours per day and not more than 60 hours per week as a safety measure IOM report recommended limiting work hours to not more than 12 hours per day and not more than 60 hours per week as a safety measure In the U.S., many states have legislated “No Mandatory Overtime” as a result of patient safety issues In the U.S., many states have legislated “No Mandatory Overtime” as a result of patient safety issues

77 77 Ruckelshaus Nurse Staffing Steering Committee Staffing Plan - Example Patient Care Link - http://www.patientsfirstma.org Winchester Hospital, MA – Medical Unit

78 78 Ruckelshaus Nurse Staffing Steering Committee Staffing Plan - Example Patient Care Link - http://www.patientsfirstma.org Winchester Hospital, MA – Medical Unit

79 Nurse Sensitive Indicators For Dummies

80 80 Ruckelshaus Nurse Staffing Steering Committee What we know… Preventable medical errors cost US healthcare system $17 billion/year (IOM) Preventable medical errors cost US healthcare system $17 billion/year (IOM) Medication errors cost nearly $3.5 billion/year (IOM) Medication errors cost nearly $3.5 billion/year (IOM) Medical errors cause ~ 195,000 deaths/ year in the US (Health Grades) Medical errors cause ~ 195,000 deaths/ year in the US (Health Grades)

81 81 Ruckelshaus Nurse Staffing Steering Committee Nursing Impact on Pt Outcomes There is a clear link between nurse staffing (ARNPs and RNs) and patient outcomes There is a clear link between nurse staffing (ARNPs and RNs) and patient outcomes RNs are the surveillance system for early detection and intervention for adverse outcomes RNs are the surveillance system for early detection and intervention for adverse outcomes Institutional advocate for patient centeredness Institutional advocate for patient centeredness The environment of practice is critical to safety The environment of practice is critical to safety

82 82 Ruckelshaus Nurse Staffing Steering Committee Nursing Impact on Pt Outcomes A study of medication errors in 2 hospitals over 6 months showed nurses were responsible for intercepting 86% of all medication errors before error reached the patient (Leape et al., 1995) A study of medication errors in 2 hospitals over 6 months showed nurses were responsible for intercepting 86% of all medication errors before error reached the patient (Leape et al., 1995) Leaner RN staffing/less RN hrs of care are associated with: Leaner RN staffing/less RN hrs of care are associated with: ↑ LOS (AHRQ, 2001; Needleman et al., 2002, 2006) ↑ LOS (AHRQ, 2001; Needleman et al., 2002, 2006) Nosocomial infections (UTI, post-op infection, pneumonia) (AHRQ, 2001; Needleman et al., 2002, 2006; Aiken et al., 2002) Nosocomial infections (UTI, post-op infection, pneumonia) (AHRQ, 2001; Needleman et al., 2002, 2006; Aiken et al., 2002) Pressure ulcers (AHRQ, 2001) Pressure ulcers (AHRQ, 2001) GI bleeding (Needleman et al., 2002, 2006) GI bleeding (Needleman et al., 2002, 2006) Cardiac arrests (Needleman et al., 2002, 2006) Cardiac arrests (Needleman et al., 2002, 2006) Patient deaths (Needleman et al., 2002, 2006; Aiken et al., 2002) Patient deaths (Needleman et al., 2002, 2006; Aiken et al., 2002)

83 83 Ruckelshaus Nurse Staffing Steering Committee Thus, what we know…. Nurses Patient Safety Nurses Quality Outcomes Quality Cost Effective Care Outcomes

84 84 Ruckelshaus Nurse Staffing Steering Committee Staffing Indicators NHPPD** NHPPD** On call/per diem use On call/per diem use Overtime Overtime Sick time Sick time Skill mix** Skill mix** % Agency hours % Agency hours Sitter hours Sitter hours Meal breaks Meal breaks Staff injuries Staff injuries Staff satisfaction Staff satisfaction Staff turnover rate** Staff turnover rate** Staff vacancy rate Staff vacancy rate Understaffing compared to staffing plan Understaffing compared to staffing plan Practice environment scale** Practice environment scale** ** National Quality Forum endorsed Nursing Sensitive Indicators

85 85 Ruckelshaus Nurse Staffing Steering Committee Clinical Indicators Patient falls** Patient falls** Patient falls with injury** Patient falls with injury** Pressure ulcer** Pressure ulcer** Infection rates Infection rates Urinary tract** Urinary tract** Postoperative Postoperative Central line** Central line** Ventilator related** Ventilator related** Pneumonia Pneumonia Adverse drug events Adverse drug events Injuries to pts Injuries to pts Upper GI bleeding Upper GI bleeding Shock/cardiac arrest Shock/cardiac arrest Length of stay Length of stay Failure to rescue** Failure to rescue** Restraint prevalence** Restraint prevalence** Smoking cessation Smoking cessation AMI, CHF, Pneumonia AMI, CHF, Pneumonia ** National Quality Forum endorsed Nursing Sensitive Indicators

86 86 Ruckelshaus Nurse Staffing Steering Committee Service Outcomes Patient satisfaction score Patient satisfaction score Patient complaints Patient complaints Family complaints Family complaints Patient satisfaction with pain management Patient satisfaction with pain management Patient satisfaction with ability to manage care at home (patient teaching/education) Patient satisfaction with ability to manage care at home (patient teaching/education) Patient satisfaction with nursing and overall care Patient satisfaction with nursing and overall care

87 87 Ruckelshaus Nurse Staffing Steering Committee Core Measures (JCAHO) Surgical Care Improvement Project (SCIP) Surgical Care Improvement Project (SCIP) Heart Failure Heart Failure AMI AMI Pneumonia Pneumonia Pregnancy Pregnancy Children’s Asthma Care Children’s Asthma Care Hospital Inpatient Psychiatric Services Hospital Inpatient Psychiatric Services

88 88 Ruckelshaus Nurse Staffing Steering Committee CMS: Non-Reimbursed Conditions Preventable Hospital-Acquired Conditions Preventable Hospital-Acquired Conditions Object left in pt during surgery Object left in pt during surgery Air embolism Air embolism Blood incompatibility Blood incompatibility Catheter-associated urinary tract infection Catheter-associated urinary tract infection Pressure ulcer Pressure ulcer Vascular catheter-associated infection Vascular catheter-associated infection All surgical site infections All surgical site infections

89 89 Ruckelshaus Nurse Staffing Steering Committee CMS: Non-Reimbursed Conditions Preventable Hospital-Acquired Conditions Preventable Hospital-Acquired Conditions Falls with injuries Falls with injuries Ventilator associated pneumonia Ventilator associated pneumonia Staphyloccus aureus septicemia Staphyloccus aureus septicemia Deep vein thrombosis and pulmonary embolism Deep vein thrombosis and pulmonary embolism MRSA MRSA Clostridium difficile-associated disease Clostridium difficile-associated disease Wrong surgery Wrong surgery

90 90 Ruckelshaus Nurse Staffing Steering Committee Benchmarking and Reporting National Database of Nursing Quality Indicators (NDNQI) National Database of Nursing Quality Indicators (NDNQI) Collaborative Alliance of Nursing Outcomes (CALNOC) Collaborative Alliance of Nursing Outcomes (CALNOC) Washington State Hospital Association Washington State Hospital Association

91 91 Ruckelshaus Nurse Staffing Steering Committee WA State - NSQI Falls Falls Falls with injury Falls with injury Pressure ulcers Pressure ulcers Nursing hours per patient day Nursing hours per patient day Skill mix Skill mix

92 92 Ruckelshaus Nurse Staffing Steering Committee Cost Factors Related to Pt Safety Occurrence of the medical error Occurrence of the medical error Prevention of the medical error Prevention of the medical error Treatment of the medical error Treatment of the medical error Pay Now or Pay Later

93 93 Ruckelshaus Nurse Staffing Steering Committee Where to start…. Collect the data Collect the data What data are being tracked now? What data are being tracked now? Unit/department level Unit/department level Organization wide Organization wide Frequency of data collection Frequency of data collection Reports available Reports available Analyze the data Analyze the data Trends Trends Comparison to benchmark data Comparison to benchmark data Questions to ask Questions to ask Make the data visual and available Make the data visual and available Identify patterns or improvement opportunities Identify patterns or improvement opportunities

94 94 Ruckelshaus Nurse Staffing Steering Committee Sample Nursing Scorecard

95 95 Ruckelshaus Nurse Staffing Steering Committee Performance Measure Example Patient Care Link - http://www.patientsfirstma.org

96 96 Ruckelshaus Nurse Staffing Steering Committee Performance Measure Example Patient Care Link - http://www.patientsfirstma.org

97 97 Ruckelshaus Nurse Staffing Steering Committee Performance Measure Example Patient Care Link - http://www.patientsfirstma.org

98 98 Ruckelshaus Nurse Staffing Steering Committee Professional Nursing Organizations - Recommended Staffing Standards WSNA, 2010 - www.wsna.org/Topics/Safe-Nurse-Staffing/Toolkit/Documents/Staffing-Ratio-Grid.pdf

99 99 Ruckelshaus Nurse Staffing Steering Committee Professional Nursing Organizations - Recommended Staffing Standards WSNA, 2010 - www.wsna.org/Topics/Safe-Nurse-Staffing/Toolkit/Documents/Staffing-Ratio-Grid.pdf

100 100 Ruckelshaus Nurse Staffing Steering Committee Making the Staffing Committee Work

101 101 Ruckelshaus Nurse Staffing Steering Committee Too many meetings? Team building and conflict resolution Problem solve Set goals and make plans Accountability and tracking progress Share content

102 102 Ruckelshaus Nurse Staffing Steering Committee Meeting Tools Team Charter Team Charter Ground Rules for Teams Ground Rules for Teams Meeting Roles Meeting Roles Agenda Agenda Minutes Minutes Evaluations Evaluations

103 103 Ruckelshaus Nurse Staffing Steering Committee Type of Meetings Hospital-wide Hospital-wide Unit based Unit based Multidisciplinary Multidisciplinary that can be…. Short term projects Short term projects Ongoing standing committees Ongoing standing committees Focused sub-committees Focused sub-committees Tools work for all types of meetings…

104 104 Ruckelshaus Nurse Staffing Steering Committee Committee Charter Elements Purpose and Goals Purpose and Goals Membership and Sponsorship Membership and Sponsorship Boundaries Boundaries Decision Making and Levels of Authority Decision Making and Levels of Authority Roles and Responsibilities Roles and Responsibilities Ground Rules / Team Agreements Ground Rules / Team Agreements Meetings and Communications Meetings and Communications Measures of Success Measures of Success Go Slow to Go Fast

105 105 Ruckelshaus Nurse Staffing Steering Committee Communication Participate in developing solutions, changes and proposals. Opportunity to influence through giving feedback on what is already designed. Opportunity to influence final decision; participate in monitoring and taking corrective action. Full partners in reaching final decisions, formulation plans, monitoring and taking corrective action. Informed Consulted Input on Decision Making Full Decision Making Authority Developers 12345 1122334455 1122334455 Levels of Involvement

106 106 Ruckelshaus Nurse Staffing Steering Committee Other Supporting Stakeholders Medicine Medicine Ancillary and Support Departments Ancillary and Support Departments HR HR Finance Finance Quality Quality Staffing Office Staffing Office Medical Records Medical Records Communication and Marketing Communication and Marketing

107 107 Ruckelshaus Nurse Staffing Steering Committee Agendas Published prior to meeting to each member Published prior to meeting to each member Established at previous meeting Established at previous meeting Includes members’ names next to assigned agenda item Includes members’ names next to assigned agenda item Includes time allotment for each topic Includes time allotment for each topic

108 108 Ruckelshaus Nurse Staffing Steering Committee Effective Agendas Review objectives Review objectives Review agenda items Review agenda items Work through agenda items Work through agenda items Review assignments Review assignments Plan for next meeting Plan for next meeting Rate effectiveness of meeting Rate effectiveness of meeting

109 109 Ruckelshaus Nurse Staffing Steering Committee Minutes: Official Record List who was present (and who was absent if group membership is defined) List who was present (and who was absent if group membership is defined) Summary of decisions made for each agenda item Summary of decisions made for each agenda item List assignments List assignments Next meeting time and location Next meeting time and location Published within a week Published within a week Tailor to Your Needs : Legal? Functional? Communication Tool?

110 110 Ruckelshaus Nurse Staffing Steering Committee Team Ground Rules - Key - Established by Committee!

111 111 Ruckelshaus Nurse Staffing Steering Committee Ground Rules for Good Teams Assumption that each person wants to be here Assumption that each person wants to be here Team members speak freely and in turn Team members speak freely and in turn All team members and opinions are equal All team members and opinions are equal If you have something to say, say it in the room “No Meetings After the Meeting” If you have something to say, say it in the room “No Meetings After the Meeting” No sidebar communications No sidebar communications Each one must be heard - others listen attentively Each one must be heard - others listen attentively No one may dominate - no whining No one may dominate - no whining Problems are discussed, analyzed or critiqued, not people Problems are discussed, analyzed or critiqued, not people Honesty before cohesiveness Honesty before cohesiveness Consensus is the goal--finding solutions acceptable to everyone “ I can support this even if it isn’t the ideal solution” Consensus is the goal--finding solutions acceptable to everyone “ I can support this even if it isn’t the ideal solution” Silence is not understood to equal agreement. Making a request for someone’s point of view is acceptable. Silence is not understood to equal agreement. Making a request for someone’s point of view is acceptable. All agreements are kept unless renegotiated All agreements are kept unless renegotiated Once agreement occurs, speak with “ONE VOICE ” Once agreement occurs, speak with “ONE VOICE ”

112 112 Ruckelshaus Nurse Staffing Steering Committee Ground Rules for Good Meetings Meeting frequency and length defined Meeting frequency and length defined Start and end on time Start and end on time Come prepared; do homework Come prepared; do homework Members must attend regularly Members must attend regularly Stay on target Stay on target Leave rank at the door Leave rank at the door At least one bright idea per session At least one bright idea per session Identify problems and focus on solutions – input, discussion, decision Identify problems and focus on solutions – input, discussion, decision Review the objectives before we leave – realistic in scope Review the objectives before we leave – realistic in scope Leave with a sense of accomplishment – a purpose, making a difference Leave with a sense of accomplishment – a purpose, making a difference Expect work outside of the meeting – subgroups and task forces Expect work outside of the meeting – subgroups and task forces

113 113 Ruckelshaus Nurse Staffing Steering Committee Important Meeting Roles - Co-Chairs- Opens the meeting Opens the meeting Reviews the agenda Reviews the agenda Makes sure someone is taking notes & keeping track of time Makes sure someone is taking notes & keeping track of time Moves through the agenda one item at a time Moves through the agenda one item at a time Keeps the team focused Keeps the team focused Establishes an appropriate pace Establishes an appropriate pace Facilitates discussion and manages participation Facilitates discussion and manages participation Helps the team use appropriate decision-making methods Helps the team use appropriate decision-making methods Helps the team evaluate the meeting Helps the team evaluate the meeting Gathers ideas for the next meeting’s agenda Gathers ideas for the next meeting’s agenda Closes the meeting Closes the meeting (from The Team Handbook)

114 114 Ruckelshaus Nurse Staffing Steering Committee - Notetaker – Records minutes which include key topics, points made during discussion, decisions made, actions items (who will do what, and by when) Records minutes which include key topics, points made during discussion, decisions made, actions items (who will do what, and by when) Rotate turns taking minutes / seek secretarial support Rotate turns taking minutes / seek secretarial support Send minutes to Co-Chairs for review then distribute the minutes within one week of the meeting Send minutes to Co-Chairs for review then distribute the minutes within one week of the meeting Important Meeting Roles (from The Team Handbook)

115 115 Ruckelshaus Nurse Staffing Steering Committee - Timekeeper - Keeps track of time to help team move along Keeps track of time to help team move along Alerts the team when the allotted time is almost up so that the team can decide whether to continue discussion or table it Alerts the team when the allotted time is almost up so that the team can decide whether to continue discussion or table it Important Meeting Roles (from The Team Handbook)

116 116 Ruckelshaus Nurse Staffing Steering Committee - Discussion Scribe - Posts ideas on a flipchart or whiteboard Posts ideas on a flipchart or whiteboard Write legibly and large enough so that all can see Write legibly and large enough so that all can see Captures issues that do not directly relate to the topic on a parking lot (separate flip chart page) Captures issues that do not directly relate to the topic on a parking lot (separate flip chart page) Important Meeting Roles (from The Team Handbook)

117 117 Ruckelshaus Nurse Staffing Steering Committee Communications Between committees – vertical and horizontal Between committees – vertical and horizontal Between co-chairs and members of committees Between co-chairs and members of committees Between stakeholders and committees Between stakeholders and committees Members at large Members at large Multiple modalities Multiple modalities Over communicate: You are Educating a parade! Over communicate: You are Educating a parade!

118 118 Ruckelshaus Nurse Staffing Steering Committee Sources of Data and Examples Your committee is ready for data?Staffing/Scheduling Core staffing structure Core staffing structure Low Census days Low Census days Medical Records Documentation compliance Documentation compliance Length of stay Length of stay Unit/Department ER: Left without being seen ER: Left without being seen OR: Case start times OR: Case start times Patient satisfaction Patient satisfaction

119 119 Ruckelshaus Nurse Staffing Steering Committee Sources of Data and Examples Financial / Budget Cost per patient day Cost per patient day Volume or Units of service Volume or Units of service Payroll Absences Absences Overtime Hours Overtime Hours Human Resources Vacancies and Turnover Vacancies and Turnover Full Time/ Part Time Mix Full Time/ Part Time Mix Quality Medication errors Medication errors Infection rate Infection rate Patient falls Patient falls

120 Putting it All Together: Case Application

121 121 Ruckelshaus Nurse Staffing Steering Committee  Budgeting Scenario  Staffing and Scheduling Scenario  Creating a Council Charter  Workforce Planning Assessment  Staffing Committee Survey  Quality Scenario Putting it All Together Case Applications


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