The rising cost of healthcare is an important issue for patients and providers alike. Over half of U.S. hospitals were operating at a loss at the end of 2022. Between 2021 and 2023, Medicare reimbursement increased by just 5.2% as inflation skyrocketed by 12.4%.1 Hospitals in distress may lack the resources to maintain an optimal nursing staff, putting patient outcomes at risk. Optimizing nursing staff budgets is a critical concern with the quality and availability of patient care resting in the balance.
Understanding the Importance of Nurse Staffing
Several studies have found that the risk of mortality increases along with an RN’s patient load. Over the first five days of a patient’s stay in the hospital, each additional hour of RN care is associated with a 3% reduction in the risk of death.2 Meanwhile, each additional patient per nurse comes with a 7% increase in the likelihood of death within 30 days of admission.3
Nurses suffer from this as well. The likelihood of burnout increases by 23%, and the odds of job dissatisfaction go up 15% with each additional patient per nurse.3 These critical factors play a major role in nursing turnover. One in five nurses plan to leave their current position within a year, which makes retention a critical concern.
Assigning nurses to longer shifts is an inadequate solution. Nurses who work more than 12.5 hours per shift on two or more consecutive days are three times more likely to commit a medication error.4 Smart staffing solutions are essential to protect both patients and the nurses who care for them.
Analyzing Current Nurse Staffing Practices
Traditional nurse staffing practices utilize shift-based scheduling and static nurse-to-patient ratios. More flexibility is needed to provide for patients and facilitate responsive staffing. This begins with the appropriate nurse-to-patient ratio, which varies based on providers’ skill sets, patient acuity, and the number of admissions and discharges. To determine how your current nursing practices perform, analyze current and historical data across quantitative and qualitative metrics, including:
- Nurse-to-patient ratios
- Overtime hours
- Satisfaction scores
- Turnover rates
- Patient satisfaction
- Patient outcomes
- Nurse engagement
As staffing needs change, update these evaluations frequently to understand how your current practices are performing and where you can improve.
Calculating Nursing Staffing Needs
Determining your nursing staffing needs is a complex process. The following steps will help you calculate the number of nurses your facility requires.
Total Hours To Be Staffed
The total hours to be staffed are based on the number of rooms multiplied by the hours those rooms are available. In a hospital, this equation typically needs to account for 24/7 availability. However, other healthcare settings, such as a physician’s office, may only be open eight hours a day, five days a week.
For example:
- 10 rooms x 24 hours x 7 days = 1,680 staffed hours.
- 10 rooms x 8 hours x 5 days = 400 staffed hours.
Working Hours of Staff
The working hours of staff are the total working hours of all nurses needed to staff the available rooms. According to the California RN-to-patient staffing ratios, this is one nurse to every two patients in areas such as intensive care, post-anesthesia recovery, or labor and delivery. You need one RN for every four patients in pediatrics, the emergency room, telemetry, and other specialty care departments.
Assuming one patient per room, your working hours of staff for the above examples would become:
- 1:2 RN-to-patient ratio for 10 rooms staffed 24/7 = 0.5 nurses x 1,680 staffed hours = 840 staffed hours per week.
- 1:2 RN-to-patient ratio for 10 rooms staffed 8 hours, 5 days a week = 0.5 nurses x 400 staffed hours = 200 staffed hours per week.
Basic FTE
A single full-time equivalent (FTE) equals 2,080 worked hours within a year or 80 worked hours in a 14-day period. This breaks down to a standard 40-hour workweek. To determine the number of FTE workers required for your facility, divide the total staffed hours per week by 40. Following the two examples above, this would be:
- 840 hours/40 = 21 basic FTE hours.
- 200 hours/40 = 5 basic FTE hours.
Benefit Relief
Benefit relief hours are those hours needed to cover for a full-time nurse’s benefits. This includes everything from vacation and sick time to shift breaks. A basic employment package might include:
- 120 vacation hours
- 60 holiday hours
- 96 hours of sick leave
You should also account for break time. Assuming an employee works an eight-hour shift and receives two 15-minute breaks and one 30-minute lunch, your equation for 260 work days in a year would be:
- 260 days x 2 15-minute breaks (30 minutes) = 7,800 minutes/60 minutes per hour = 130 hours of breaks.
- 260 days x 30-minute lunch = 7,800 minutes/60 minutes per hour = 130 hours of lunches.
All the above hours combined total 536 benefit relief hours per staff member each year.
Relief FTE
To determine how many full-time employees you need to cover benefit relief hours, multiply benefit relief hours by FTE hours and divide by the basic FTE.
- 536 benefit relief hours x 21 FTE hours/2,080 basic FTE hours = 5.4 relief FTE hours.
- 536 benefit relief hours x 5 FTE hours/2,080 basic FTE hours = 1.3 relief FTE hours.
Total Minimum Direct Care Staff
Finally, add the FTE hours and relief FTE hours to determine how many nursing staff members you need for your facility.
- 21 + 5.4 = 26.4 or 27 staff members.
- 5 + 1.3 = 6.3 or 7 staff members.
Innovative Nurse Staffing Models
Nurse staffing models are evolving toward a more robust and responsive shape. This puts the nurse in greater control and allows ample flexibility to meet the changing needs of the patient.
Float Pool Models
A float pool is a group of nurses who are thoroughly cross-trained to work in multiple departments. This allows for flexible deployment based on continuously changing factors such as acuity levels, admissions, and patient needs. Centralized float pools are managed through a central staffing office, while enterprise float pools are decentralized and operate at the hospital or unit level.
Flexible Shift Models and Self-Scheduling
Self-scheduling platforms allow nurses to build their own schedules, optimizing work-life balance and increasing job satisfaction. Offering flexible shift models lets nurses break out of the standard 8- or 12-hour shift to work the schedule that best suits their needs. Robust oversight and deep analytics are necessary to ensure proper coverage.
Telehealth and Virtual Nursing Models
Telehealth offers a less strenuous option that may keep experienced nurses in the industry longer. Offering virtual consultations and triage advice can also ease the strain on the ER and other departments by diverting patients who can manage their care at home.
Shared Governance Models
Shared governance models are built on input from both managers and nurses. Involving these frontline workers in major decision-making gives them ownership over the process, procedures, and outcome. This is the best way to ensure staff members are heard, respected, involved, and invested in staffing changes.
Temporary Staffing Services
Utilize staffing services to hire temporary talent during seasonal influxes in patients. This can provide additional capacity without committing to long-term employment, helping to manage fluctuating workloads and maintain patient care quality.
Implementing Cost-Effective Staffing Strategies
The key to managing nursing costs is to have the right people at the right time. In an unpredictable field such as healthcare, this requires adaptable processes that can respond quickly to fluctuating demand. Acuity-based staffing models provide essential information for optimizing the number of nurses assigned to each department and shift. Acuity-based models override the standard nurse-to-patient ratio and provide more accurate numbers based on the severity of each patient’s condition and their level of care.
Float pools allow you to move nurses from one department to another to avoid expensive overtime and make the best use of staff that’s already on hand. When more hands are needed, a staffing partner such as Medix can provide easy access to a skilled talent pool. Continuous use of data analytics and workforce implementation technology will help you streamline your model to keep costs low.
Balancing Budget Constraints with Quality Care
The healthcare industry has gradually shifted toward a profit-based model that runs hospitals like businesses rather than purpose-driven healthcare facilities. Reversing this trend is critical to protect the well-being of both the nurse and the patient. Numerous studies have shown that a higher workload results in suboptimal care. When nurses are overburdened, surgical patients are more likely to contract pneumonia, failure-to-rescue rates rise, and mortality within 30 days increases.
The best outcomes are achieved when hospitals allocate adequate funds to nurse staffing, focus on increasing the skill mix of nurses, and empower nurses to participate in staffing solutions. Utilizing these strategies pays off. Magnet-designated hospitals certified by the American Nurses’ Credentialing Center put nurses in leadership roles where they collaborate with the interprofessional team to set a new standard of excellence. After receiving Magnet designation, these hospitals get an average of $104.22 to $127.05 more per discharge, producing over $1,200,000 in additional funds each year.5
Addressing Nurse Burnout and Retention
Improper staffing is a major cause of nurse burnout, resulting in longer hours, greater workload, and compromised care. Rather than focusing on the cost of maintaining a larger staff, hospitals should consider the cost of the turnover caused by poor staffing strategies. The cost of hiring and training an RN is $28,400 to $51,700, and 18% of these new nurses leave within the first year. Nurse turnover costs hospitals $3.6 million to $6.5 million a year.6
Optimizing your staffing strategies is a valuable way to increase nurse retention. This can eliminate mandatory overtime, promote a flexible culture, and give nurses autonomy in scheduling. Other retention strategies include:
- Providing education reimbursement
- Facilitating mentoring programs
- Offering employee wellness programs
- Giving wage increases and bonuses
Future Trends in Nurse Staffing
As technological solutions become more powerful, these systems will play a larger role in informing staffing decisions, optimizing quality care processes, and protecting patients’ safety. In the future, look for staffing systems that:
- Allow nurses to find and pick up open shifts that fit their skill level, experience, and preferences.
- Integrate telehealth and virtual nursing roles robustly.
- Offer AI-optimized self-scheduling.
- Deliver complex demand forecasting.
- Optimize the integration of temporary, temp-to-perm, and permanent staff.
The need for skilled nurses is expected to increase due to the aging U.S. population, worsening physician shortages, and an increasing need for access to primary, mental, and behavioral healthcare. Partner with Medix to unlock the full potential of flexible nurse staffing strategies. With over 20 years of experience, we can help you optimize your nurse staffing budget, while simultaneously supporting financial stability, increasing nursing job satisfaction, and improving the quality of care for patients. Contact us today to get started.
