The purpose of this assignment is to prepare students to make staffing decisions based on sound financial management principles and compliance guidelines.
Scenario: You are the nurse leader of a 30-bed medical surgical unit and have to account for all staffing, including any discrepancies. Using sound financial management principles, complete the \”NUR-621 Topic 8: Staffing Matrix\” in the provided Excel template.
After completing the matrix, compose an 1,000-1,250-word reflection answering the following questions:
Why is it important to use a staffing matrix in your health care setting?
Briefly describe your staffing matrix. How many FTEs (full-time equivalent) on the staffing roster are required to cover daily needs? What units of services or work measurement did you use and why? What financial management principles did you use to determine your staffing matrix?
Explain how you adjusted your staffing based on changes in the patient census.
You receive your financial report for the month. You have used more FTEs than what was budgeted for your census. How will you make up the variance? How would you reallocate resources to make up for the variance and still comply with guidelines?
Include two to four peer-reviewed references in your essay, including the textbook.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.
Benchmark: Staffing Matrix and Reflection
Student’s Name
Institutional Affiliations
Benchmark: Staffing Matrix and Reflection
Healthcare organizations are always working to improve the quality of care that they provide to patients. As Charlotte (2017) points out, safe staffing is critical to the provision of safe, effective, quality, and reliable health care to patients. Therefore, nurse leaders should collaborate with direct care nurses to develop an optimal staffing plan for their units. When developing staffing plans for their units, nurse leaders must consider a number of variables. These include financial metrics and nurse-sensitive indicators (Griffiths et al., 2021). According to Charlotte (2017), healthcare settings should use staffing ratios that will enable them to save money while at the same time meeting the healthcare needs of their patients. They can consider using a Staffing Matrix to tailor their staffing capacities to the needs of patients based on the changing census. The purpose of this assignment is to apply financial management principles to analyze a Staffing Matrix of a 30-bed medical-surgical unit.
The Importance of Using a Staffing Matrix
The use of a staffing matrix in the healthcare setting is advantageous in numerous ways. A staffing matrix is a tool that enables nurse leaders to select the most appropriate staffing models for their units (American Association of Critical-Care Nurses, 2018). Using the tool, the nurse leader in the health care setting is able to determine the right number of nurses to allocate to the unit based on the number of patients hospitalized in the unit at any given time. Additionally, a staffing matrix enables the nurse leader to consider the unique financial circumstances of the unit, patients’ needs, and the available number of nurses to provide quality and cost-effective health care (Charlotte, 2017). The healthcare setting is able to reap maximum benefits from using a staffing matrix because the nurse leader collaborates with relevant stakeholders and direct care nurses to ensure its effective use.
The healthcare setting has managed to provide quality healthcare, improve staff satisfaction, and control costs by using a staffing matrix. It has witnessed improvements in a number of quality metrics since it started to use a staffing model. For example, the facility recently recorded a 30% reduction in patient falls. Besides, it has not recorded any cases of pressure ulcers, catheter-associated urinary tract infections (CAUTIs), or central line-associated bloodstream infections within the past month. Cases of hospital-acquired pressured ulcers reduced from 10 to 3. These improvements in quality outcomes have increased the overall HCAHPS scores for the unit. The American Association of Critical-Care Nurse (2018) reported that the use of a staffing matrix helps healthcare settings to raise their HCAHPS scores with patients expressing satisfaction with the types of care that they are receiving from the nurses.
Increased staff satisfaction, reduced turnover, and increased savings are some of the benefits that the healthcare setting has attained by using a staffing matrix to organize its staffing model. Riley et al. (2021) conducted a prospective study to assess how implementing a staffing matrix would affect nurse satisfaction in a rehabilitation unit. They found that a staffing model improved nurse satisfaction by 35%. The matrix enhanced role assignment among nurses thereby providing a work environment where nurses could effectively address patients’ needs. As reported by the American Association of Critical-Care Nurses (2018), a nurse staffing matrix can produce a positive dollar variance shift on the budget enabling a healthcare setting to gain money and make significant cost savings. From these analyses, other healthcare organizations can understand why it is important for them to use a staffing matrix to organize their staffing models.
The Staffing Matrix, Calculation of FTEs, Units of Services, and Financial Management Principles
A Description of the Staffing Matrix
The staffing matrix for the unit describes the registered nurse (RN) as the direct caregiver in a 30-bed medical-surgical unit. The unit utilizes two shifts: day shift and night shift. The scheduled hours of work are; 7 a.m. to 3.00 p.m., 3.00 pm to 11 pm, and 11 pm to 8 pm. The shift length is 8 hours each. The number of staff required in every shift fluctuates as patient census changes. Essentially, more nurses are assigned to the unit during Day and Night shifts when more beds are occupied and fewer nurses are assigned with the patients’ census is low. Due to a reduction in the number of services that nurses are required to perform in the facility at night, fewer nurses are assigned at night than at day time. The ratio of nurses to patients during Day shift is 1:3 while the ratio of nurses to patients at night is 1:4. The nurse leader strives to manage workloads in the unit while at the same time ensuring that nurses are able to work comfortably to address patients’ needs. The nurse leader also integrates economic factors into decision-making when making adjustments on staffing.
Calculation of FTEs
The nurse leader in the unit is charged with the responsibility of ensuring that the working hours assigned to every nurse will enable him or her to adequately address patients’ needs that he or she is required to meet. They achieve this by calculating full-time equivalents (FTEs). The Society for Human Resource Management (2022) defines full-time equivalent (FTE) as a unit of measurement that is equivalent to one single worker or employee as applicable to the environment in which he or she is working. FTE measures an employee and the workload that he or she is likely to have in the organization. From the staffing matrix in the excel file attached, the unit is operating on a 40-hour workweek. With a shift length of 8 hours each, every RN is scheduled to work for 40 hours per week. Dividing 40/40, the FTE is 1.0. From this calculation, 1.0 FTEs are required on the staffing roster to cover daily needs.
Units of Services
Part of a nurse leader’s role is to measure the amount of work done by nurses in each and every department. They achieve this by determining units of services. A unit of service measures the actual activity that enables the nurse leader to measure the amount of work done in each department (Saha et al., 2021). Since the unit has both day shift and night shift, it is important to note that most caring activities occur during the day but not at night. Therefore, the work measurement or units of services that have been used in the current scenario are admissions, discharges, and transfers (ADTs). The reason for choosing ADTs is that they are the activities that mostly occur during the day and are therefore appropriate parameters for measuring work (Saha et al., 2021). The nurse leader did not choose midnight census as the unit of service is that it is not a true reflection of the nursing activities that are taking place in the unit during Day shifts.
Financial Management Principles
Nurse leaders play a crucial role in managing finances and reducing expenditure in their units. In this respect, they need to understand and be able to apply financial management principles whenever they are making decisions that might affect the financial performance of their settings (Penner, 2017; Waxman, 2018). One of the financial management principles that the nurse used to determine the staffing matrix is that a budget must be based on the financial needs of a unit for it to support the unit to realize its objectives. The other principle that was applied is that when planning for activities, a nurse leader must ensure that the benefits that are expected from a unit’s activities exceed the costs involved in accomplishing those activities (Waxman, 2018). The application of these financial management principles has enabled the nurse leader to develop a staffing matrix that matches the available skills with the needs of the unit as well as those of patients.
Staffing Adjustments
In order to control costs, it is important to adjust staffing based on the changes in patient census. In the current scenario, the nurse leader reduced the number of nurses in the unit as patients’ census reduced. For example, as it is shown in the matrix, 10 nurses are assigned during the day to take care of 30 hospitalized patients while 8 nurses are assigned during the day when the unit has 24 hospitalized patients. By using this strategy, the nurse leader makes appropriate utilization of the nursing staff while at the same time controlling costs (Waxman, 2018; Penner, 2017).
Making Up for the Variance Based on the Financial Report
An important financial management principle for nurse leaders is to be able to determine the cause of unanticipated financial results, evaluate the activities involved, and take corrective actions. Using more FTEs than was budgeted for a particular patient census causes a negative variance in the budget (Society for Human Resource Management, 2022). In order to make up for the variance, the nurse leader should begin by identifying and eliminating the activities that contributed to the extra FTEs. This should be followed by relocating resources from activities that did not fully consume the funds assigned to them to fill the gap in the negative variance (Waxman, 2018). This should be done while complying with the guidelines set by the unit.
Conclusion
Today’s nurse leaders should possess financial management principles to enable them to manage funds and minimize expenses. As part of their role, nurse leaders should use a staffing matrix to organize their staffing models. This is important as it will enable them to improve financial performance. Besides, a staffing matrix will enable them to effectively manage patients’ needs while also considering the financial circumstances of their units. Generally, nurse leaders should apply financial management principles to calculate appropriate FTEs to use and make necessary staffing adjustments in accordance with guidelines.
References
American Association of Critical-Care Nurses. (2018). Team matrix improves staffing model. https://www.aacn.org/nursing-excellence/nurse-stories/team-matrix-improves-staffing-model
Charlotte, D. (2017). Staffing safe. Nursing Made Incredibly Easy, 12(4), 4. doi: 10.1097/01.NME.0000450293.95205.47
Griffiths, P., Saville, C., Ball, J. E., Jones, J., Monks, T., & Safer Nursing Care Tool study team (2021). Beyond ratios – flexible and resilient nurse staffing options to deliver cost-effective hospital care and address staff shortages: A simulation and economic modelling study. International Journal of Nursing Studies, 117, 103901. https://doi.org/10.1016/j.ijnurstu.2021.103901
Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing. ISBN-13: 9780826160010.
Riley, Y., Stitt, J., Hill, C. M., Stutzman, S. E., Venkatachalam, A. M., Aguilera, V., & Ifejika, N. L. (2021). Implementation of the MATRIX Staffing Grid Improves nurse satisfaction with rehabilitation unit staffing. The Journal of Neuroscience Nursing, 53(4):183-187. doi: 10.1097/JNN.0000000000000593. PMID: 34116557.
Saha, P., Sircar, R., & Rose, A. (2021). Using hospital Admission, Discharge & Transfer (ADT) data for predicting readmissions. Machine Learning with Applications, 5(100055), https://doi.org/10.1016/j.mlwa.2021.100055.
Society for Human Resource Management (SHRM). (2022). How do I calculate full time equivalent (FTE) hours? https://www.shrm.org/resourcesandtools/tools-and-samples/hr-qa/pages/calculateftehours.aspx#:~:text=The%20calculation%20of%20full%2Dtime,per%20week%20are%200.5%20FTEs.
Waxman, K. T. (2018). Financial and business management for the Doctor of Nursing Practice. 2nd ed. Springer Publishing Company