Coverage Factor to Determine the Shift to Shift Staffing Questions

I’m working on a health & medical discussion question and need the explanation and answer to help me learn.

Case Scenario: 

The nurse manager of a medical–surgical unit has a budgeted ADC of 20. A new vascular surgeon has been admitting patients to the unit, which is requiring an increase in nursing care to treat these additional patients. The current budgeted HPPD is 7.59. You have been monitoring the number of patients with the higher acuity in anticipation of budget planning.

You have been reviewing reports, and over the past 6 months since the surgeon came on board you notice an unfavorable salary variance. You also have been tracking the actual census, and the ADC on average remains at 20; however, six of the patients have higher acuity. You are proposing the configuration of the unit is changing to a blended model with an overall ADC of 20. The blend is 70% medical–surgical (ADC and 30% stepdown (6 ADC).

Answer the following Questions below:

You need to discuss the issues with the nurse leader you report to.

1.  What discussion points should you plan to cover? Will there be a need for additional FTE caregivers to care for the change in acuity? If so, how many FTEs? Have you been staffing above the staffing guideline using OT?

2.  The assumption is you are using OT to cover the additional clinical requirements. Financial reports indicate for the 6-month period OT expense is $125,000, which is unfavorable to the budget. What are your recommendations? Compare the cost of OT used over the past 6 months with the cost of hiring the additional RNs.

3.  Develop a revised staffing grid. (very basic does not need to be complex)