Effective Staffing

a tool used to compare productivity across facilities to establish performance goals.

Benchmarking

are care management tools that outline the expected clinical course and outcomes for a specific patient type.

Clinical pathways

generally defined as the follow-through in patient care that is inherent in having the same nurse return to care for patients in subsequent shifts on sequential days of the week.

Continuity of care

time spent providing hands-on care to patients.

Direct care

1.0 = 40 hrs or five 8 hr shifts per week 0.9 = 36 hrs or three 12 hr shifts per week 0.8 = 32 hrs or four 8 hr shifts per week 0.6 = 24 hrs or two 12 hr or three 8 hr per week 0.4 =16 hrs or two 8 hr shifts per week 0.3 =12 hrs or one 12 hr shift per week 0.2 = 8 hrs or one 8 hr shift per week

FTE

5 days per week x 8 hrs a day = 40 hrs a week 40 hrs a week x 52 weeks per year = 2080 hrs per week.

FTE hours

is a measure of the work commitment of an employee who works five days a week or 40 hrs per week for 52 weeks a year. (2080 hrs of work time) (Includes worked time and non worked time) (When counting FTE count only the productive hrs available for each staff member b/c this this represents the amount of time to meet the patients needs)

Full time equivalent (FTE)

divided the nursing work into functional roles that are then assigned to one of the team members. example..RN med nurse and assessments

Functional nursing

is time spent on activities that support pt care but are not done directly to the patient. (documentation, order entry, time consulting with others, time spent on other outstanding issues)

Indirect care

the JC does not mandate staffing levels but does assess the effectiveness. JC monitors at least 4 indicators: two human resource indicators and two clinical indicators.

JC

refers to the average of number days a patient is in the hospital from day of admission till day of discharge.

Length of stay (LOS)

amount of nursing care required per patient in a 24 hr period and is usually based on midnight census and past unit needs, expected unit practice trends, national benchmarks, professional staffing standards, and budget negotiations. (only reflects productive nursing time needed)

NHPPD

20 pts on unit 5 staff x 3 shifts = 15 staff 15 staff each working 8 hrs= 120 hrs available in a 24 hr period 120 nursing hrs / 20 pts = 6.0 NHPPD

NHPPD Nursing hours per patient days

is care focused on patient needs rather than staff needs. Required care is brought to the patient example radiology...Right person doing the right thing.

Patient centered care or Patient focused care

a measure reflecting patient admission, transfer, and discharge.- all are RN intensive procedures. (as patient length of stay shortens the intensity and need of NHPPD increases)

Patient turnover

care delivery model that clearly delineates the responsibility and accountability of the RN and designates the RN as the primary provider of care to patients.

Primary nursing

is a process in which unit staff take leadership in creating and monitoring the work schedule while working within defined guidelines.

Self-scheduling

the percent of RN staff compared to other direct care staff. example..40 FTE budgeted with 20 being RN's and 20 are other staff = RN skill mix of 50%. If 40 FTE with 30 RN's the skill mix would be 75%.

Skill mix

articulates how many and what kind of staff are needed by shift and day to staff a unit of department.

Staffing plan

is a care delivery model that assigns staff to teams that then are responsible for a group of patients.

Team nursing

a variety of volume measures that are used to reflect different types of patient encounters as indicators of nursing workload.

Units of service

is a second strategy to improve patient care and reduce hospital cost through coordination of care.

case management

grouping of patients to which nursing acuity is assigned based on past organizational experience. (established by the federal government for reimbursement purposes) (sorted by patient disease of condition) (then used by hospitals to determine the cost of nursing care and negotiating contracts with payers for specific patient populations)

diagnostic-related groups (DRGs)

refers to a unit that sees patients for defined episodes of care; dialysis, or ambulatory care units are good examples.

episodic care unit

occurs any time the nurse caring for a group of patients reports off to the nurse on an oncoming shift.

handoff

a hospital that provided care to patients 24 hrs a day, seven days a week.

inpatient unit

delivery system that is a kind of team nursing that divides a geographic space into modules of patients, with each module cared for by a team of staff led by an RN.

modular nursing

benefit time such as vacation, sick time, and education time.

nonproductive hours

measure of nursing workload that is generated for each patient.

patient acuity

a measurement tool used to articulate the nursing workload for a specific patient group of group of patients over a specific period of time.

patient classification system (PCS)

Vacation time - 15 days or 120 hrs Sick time - 5 days or 40 hrs Holiday time - 6 days or 48 hrs Education time - 3 days or 24 hrs Total nonproductive hrs = 232 hrs 2080-232=1848 hrs of productive work time available for each staff member with these benefits.

productive and nonproductive hrs

hours worked and available for patient care.

productive hours

the nurse is responsible for the total care for assigned patients for the shift worked.

total patient care

is calculated by taking the total number of patients at census time, usually midnight, over a period of time, for example weekly, monthly, or yearly, and dividing the number of days in the time period, (many institutions base their staffing on ADC)

Average daily census (ADC)