Scenario: Mary Jane Smith has recently accepted a position as nurse manager on 1 West, a medical surgical nursing unit at Mercy Hospital Center. Part A: Identify the nursing-sensitive indicators Mary Jane should consider in making staffing decisions. Discuss how nursing-sensitive indicator data can be utilized to enhance the safety and quality of patient care. Discuss the relationship between nurse staffing and two of the following: urinary tract infections, pneumonia, upper bleeding, shock, or length of stay. Part B: Mary Jane has been asked by the Chief Nursing Officer to prepare a personnel budget for the coming fiscal year. Mary Jane has collected the following information, in addition to what she has determined, based on nursing-sensitive indicator data discussed in
Part A. Patient Data Average Daily Census 28 Unit Capacity 30 Average HPPD 8.8 Total Care Hours 96,360 Staff Data Total Hours/employee/year 2,080 Average Salary per Employee Category RN $36.00/hour $22.00/hour Nurse’s Aide $12.00/hour
Calculate the number of full-time equivalents (FTEs) that would be needed. Show your calculations. Explain HPPD. How would the acuity of the unit affect HPPD?
Explain how diagnosis related groups (DRG’s) and Case Mix Index (CMI) affects hours per patient day. Review the staffing plan for last year. What outcomes would you use to evaluate this staffing plan? Based on this data, would you recommend any changes for the upcoming year?
SOLUTION
- Nursing-Sensitive Indicators (NSIs) for Staffing Decisions: Nursing-sensitive indicators are measures that reflect the quality and effectiveness of nursing care provided to patients. Mary Jane should consider the following NSIs in making staffing decisions for 1 West:
- Urinary Tract Infections (UTIs)
- Pneumonia
- Upper GI Bleeding
- Shock
- Length of Stay
- Utilizing NSI Data to Enhance Patient Care Quality and Safety:
- Monitoring NSI data allows Mary Jane to identify trends and patterns in patient outcomes related to nursing care. For example, if there is an increase in UTIs or pneumonia cases, it may indicate a need for additional nursing staff to provide more comprehensive care, such as timely turning and mobilizing patients to prevent complications.
- By correlating NSI data with nurse staffing levels, Mary Jane can determine the impact of staffing on patient outcomes. Adequate nurse staffing has been shown to reduce the incidence of adverse events such as UTIs, pneumonia, and pressure ulcers, ultimately enhancing patient safety and quality of care.
- Relationship between Nurse Staffing and UTIs/Pneumonia:
- Adequate nurse staffing levels can positively impact patient outcomes related to UTIs and pneumonia by ensuring timely assessment, monitoring, and implementation of infection prevention measures.
- For example, nurses with lower patient-to-nurse ratios have more time to perform thorough assessments, implement proper hygiene protocols, and provide patient education on infection prevention measures. This can lead to early detection and management of urinary and respiratory symptoms, reducing the risk of UTIs and pneumonia.
Part B:
- Calculating FTEs:
- FTEs = Total Care Hours / Total Hours per Employee per Year
- FTEs = 96,360 / 2,080 (RN) = 46.34 RN FTEs
- FTEs = 96,360 / 2,080 (Nurse’s Aide) = 46.34 Nurse’s Aide FTEs
- Explanation of HPPD:
- HPPD (Hours per Patient Day) is a measure used to determine the average number of nursing care hours provided per patient in a 24-hour period.
- It is calculated by dividing the total number of nursing care hours worked in a unit by the total patient census for the same period.
- Impact of Acuity on HPPD:
- Higher patient acuity levels typically require more nursing care hours per patient day. Patients with complex medical conditions or those requiring intensive monitoring and interventions will increase the HPPD for the unit.
- Mary Jane needs to consider the acuity level of patients on 1 West when calculating staffing needs to ensure adequate coverage to meet patient care requirements.
- DRGs and CMI Affect on HPPD:
- Diagnosis-Related Groups (DRGs) categorize patients based on their diagnosis, treatment, age, and other factors. The Case Mix Index (CMI) reflects the relative resource intensity of a hospital’s case mix.
- Higher CMI values indicate a higher acuity level of patients and may result in increased nursing care needs, leading to higher HPPD requirements.
- Staffing Plan Evaluation Outcomes:
- Outcomes to evaluate the staffing plan include patient satisfaction scores, NSI trends, staff turnover rates, and incident reports related to patient care quality and safety.
- Mary Jane should also assess whether the staffing plan met budgetary goals and staffing efficiency metrics.
- Recommendations for Changes:
- Based on the data and outcomes, Mary Jane may recommend adjustments to staffing levels to address any identified deficiencies or areas for improvement. This could involve reallocating resources, hiring additional staff, or implementing strategies to enhance staff retention and satisfaction.