Reflection on the Staffing Matrix Discussion Paper

The purpose of this assignment is to prepare you to make budgeting decisions regarding staffing based on sound financial management principles and compliance guidelines.

For this assignment, you are the nurse leader of your unit and have to account for all staffing. Using sound financial management principles, develop a Staffing Matrix that includes labor hours using Excel.
You may choose to develop your Staffing Matrix based on your current work setting or on a 30-bed inpatient unit. Develop your matrix as though all beds are full. Reflection on the Staffing Matrix Discussion Paper

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After completing the Staffing Matrix, write a 750- to 1,000-word essay addressing the following:

Describe the difference between a staffing model and a staffing matrix. Explain which type of staffing model you are using.
Explain why it is important to use a staffing matrix in your health care setting. What are the budgetary implications?
Briefly describe your staffing matrix. How many FTEs (full-time equivalents) on the staffing roster are required to cover daily needs? What sound financial management principles did you use to determine your matrix?
Explain how you would adjust your staffing based on changes in the patient census.
Explain how you would adjust your staffing based on changes in the patient acuity.
Submit your Staffing Matrix and your essay as one deliverable. Reflection on the Staffing Matrix Discussion Paper

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24 bed unit
–6 Pediatric beds (min staffing 1:3)
–6 Gyn surgical beds (min staffing included with Post Partum)
–12 Post Partum beds ( includes 14 babies with moms, min staffing 4 couplets/1 nurse )
1 unit secretary per shift ( 2-12 hour shifts per day)
2 CNA per shift Reflection on the Staffing Matrix Discussion Paper

Staffing in healthcare is a crucial pillar of human resource management. Healthcare organizations are mandated to allocate adequate human capital to improve patient outcomes. Besides, effective staffing controls costs by ensuring resource allocation matches patient care demands. There are tools for enabling managers to allocate staff, including the staffing matrix (Theriault et al., 2019). In this essay, the author reflects on the staffing matrix. They begin by differentiating the staffing model from the staffing matrix and identify the staffing framework they applied for their scenario (24-bed unit).  The author also discusses the relevance of the staffing matrix in a healthcare setting and budgetary implications. They also describe the staffing matrix developed for a 24-bed unit with post-partum, pediatric, and gyn-surgical beds. Lastly, the author outlines staffing adjustments they would make based on patient census and acuity. Reflection on the Staffing Matrix Discussion Paper

Staffing Model and Staffing Matrix

The staffing model differs from the staffing matrix. The staffing model is the framework for determining human resources demand. It is the approach healthcare managers use when developing staffing grids or matrices for various units. Theriault et al. (2019) discussed three factors considered in staffing, including resource levels, staff mix, and team stability. The authors explained the dimension of resource levels as the availability of a workforce that can sufficiently serve all units in a hospital. Staff mix was described as the composition of care to meet patient needs, while team stability is the staff retention and absenteeism. These determinants are critical when preparing a staffing matrix. Another article by Griffiths et al. (2020) identifies more approaches for determining staffing needs. They include volume-based (patient-to-nurse ratio), budget-based,  multi-factorial (patient census, skill mix, ratios), professional judgment, and benchmarking. Based on the literature, staffing models are tools for making staffing matrices. The staffing matrix is a guideline that shows staff needs based on patient census. However, it is adjustable depending on changes in patient volume and acuity. Considering the definition of a staffing model,  the author used the volume-based approach to develop the staffing matrix for the 24-bed unit. Reflection on the Staffing Matrix Discussion Paper

Relevance of Using Staffing Matrix in Healthcare Setting and Budgetary Implications

It is crucial to use a staffing matrix in the healthcare setting. For example, in my 24-bed unit hospital with post-partum, gyn-surgical, and pediatric sections,  a staffing grid is required to determine the staff needed for each section.  The staffing matrix guides unit leaders on the staff requirements based on patient volume. However, it is not a static document. The nurse managers can change it based on the patient acuity, and other factors, including staff absenteeism or shortage.  Reflection on the Staffing Matrix Discussion Paper The staffing matrix ensures that patients have adequate staff at any given time for best outcomes (Dall’Ora et al., 2022). The staffing matrix has budgetary implications because the more labor hours, the higher the staffing expenses on the operating budget. The matrix can be used as a cost-containment strategy to ensure only required full-time equivalents (FTEs) work in a particular unit and for the specific patient census (Theriault et al., 2019).

Staffing Matrix Description

The staffing matrix for the 24-bed unit was created using the Microsoft Excel application. The matrix represents the staff required for the post-partum, pediatric, and gyn-surgical sections.  Reflection on the Staffing Matrix Discussion Paper The assumption is the unit is always in full occupancy (24). Therefore, the average daily census (ADC) was assumed to be 24. The other considerations were the patient-nurse ratios for the three sub-units. In the post-partum unit, which has 12 beds, the ratio was  4 couplets per 1 registered nurse (RN). The number of RNs per 12-hour shift was 3.  In the 6-bed pediatric unit, the ratio was 1:3, meaning two RNs. In the Gyn-Surgical unit, the ratio was 1:3, hence, two RNs.   Also, a nurse manager was allocated a day shift. Others were 1 secretary and 2 certified nurse assistants (CNA) per shift. The author assumed the hospital operated 24 hours in 7 days. They accounted for day and night shift workers. Daily labor hours based on these data were found to be 132 for the postpartum unit and 108 for the pediatric and gyn-surgical units. To calculate the FTEs for the units, the yearly nursing hours were determined for each unit. The author multiplied the weekly hours by 52 weeks. For example, 132 x 7 x 52=48048. The nursing hours were then divided by the hours an FTE should work per year (40 hours/week x52)=2080 (Griffiths et al., 2020). The FTEs for the postpartum unit are 23.1. For the other two units, the FTEs were 18.9. Based on the data, for the unit to work sufficiently, it must have the FTEs determined at full occupancy to be productive. Reflection on the Staffing Matrix Discussion Paper

Staffing Adjustments Based on Changes in Patient Volume

Changes in patient volume would require additional staffing. The current staffing matrix would need adjustments if the patient census increases or decreases. The FTEs and the nurse-to-patient ratios presented in the matrix are for 24 patients, 12 couplets in the post-partum, 6 pediatric patients, and 6 in gyn-surgical units. If the occupancy reduces to 114, with 8 in post-partum, 3 in the gyn-surgical, and 3 in the pediatric, the unit staffing levels may decrease. We would still maintain the nurse manager, and secretary per shift, but we would only need two RNs and 2 CNAs in post-partum, one RN and CNA for the rest two units. Likewise, an increase in the patient census would require an upward review of the staffing levels (Griffiths et al., 2020). Overall, the staffing matrix created is a guideline for determining staffing levels should the patient volume change. Reflection on the Staffing Matrix Discussion Paper

Adjustments Based on Patient Acuity

Patient acuity is one of the considerations when staffing. Changes in patient acuity would necessitate adjustments to the staffing matrix. Increased patient acuity, characterized by the multiplicity of procedures/nursing tasks and disease severity, would call for additional staff in the unit (Theriault et al., 2019). For example, the nurse-to-patient ratio in pediatric and gyn-surgical units is higher than that of the post-partum unit due to the condition of the patients and the required nursing tasks. Reflection on the Staffing Matrix Discussion Paper

Conclusion

A staffing matrix is an essential human resource management tool. It guides leaders on the staffing requirements per unit based on various factors, including average daily census and hours per patient days. However, it can be adjusted if patient census or acuity changes to ensure quality service and minimal labor costs.  Reflection on the Staffing Matrix Discussion Paper

References

Dall’Ora, C.,  Saville, C., Rubbo, B.,  Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International Journal of Nursing Studies, 134(104311), 1-12. https://doi.org/10.1016/j.ijnurstu.2022.104311.

Griffiths, P., Saville, C.,  Ball, J.,  Jones, J., Pattison, N.,  Monks, T., & Safer Nursing Care Study Group. Nursing workload, nurse staffing methodologies, and tools: A systematic scoping review and discussion.  International Journal of Nursing Studies, 103(103487). https://doi.org/10.1016/j.ijnurstu.2019.103487.

Thériault, M.,  Dubois, C. A., da Silva, R. B., & Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6(12) 1218-1229. http://dx.doi.org/10.1002/nop2.321. Reflection on the Staffing Matrix Discussion Paper