Nurse staffing continues to be a hot topic in healthcare today. Academic reports and news stories continue to report the nursing shortage, significant numbers of nurses leaving or considering leaving the profession, and challenges in the educational pipeline for training new nurses.^[1]Zhavoronkova, M., Custer, B., Neal, A. (2022, May 23). How to ease the nursing shortage in America. Center for American Progress. … Continue reading^[2]Glatter, R., & Papadakos, P. (2023, January 10). The coming collapse of the U.s. health care system. Time. https://time.com/6246045/collapse-us-health-care-system/^[3]Ulrich, B., Cassidy, L., Barden, C., Varn-Davis, N., & Delgado, S. A. (2022). National nurse work environments – October 2021: A status report. Critical Care Nurse, e1–e18. … Continue reading Elevated vacancy rates make providing time off, orientation, and education to staff challenging.^[4]Nursing Solutions, Inc. (2023). 2023 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

But what if there were a simple concept you could learn in less than 5 minutes that could improve your understanding of your staffing capacity, help to demystify your budget, and empower you to better advocate with administration and finance for resources?

In this blog post, I’ll give you a brief explanation of this simple yet powerful concept.

Care-Centric Modeling Simplified For Better Nurse Staffing

Pull out your smartphone and start your stopwatch app.

You need three pieces of information to get started with simplified care-centric modeling.

1. Your filled FTEs (full-time equivalents) by skill
2. Your budgeted number of productive or patient care FTEs by skill
3. The status of employees in these FTEs, such as orientee, on leave, light duty, temporarily assigned to another unit, or any other status that would prevent them from fully participating in patient care and covering for another employee using non-productive time.

Once you have the above information, you plug the values into this formula:

For example, you would take your Filled FTEs for RNs and deduct your budgeted RN Patient Care FTEs, Orientation FTEs, Leave, and Other FTEs that cannot provide coverage for a fully productive employee. The result of that calculation is your Available Replacement FTES.

Multiply your available replacement FTEs by 40 hours per FTE; that is how much time you can spend each week on non-patient care shifts while preserving the resources needed for patient care when creating your future schedules.

You can stop your stopwatch now.

You should have been able to read through the concept basics in just a couple of minutes.

That’s it. That’s the foundation of care-centric modeling for nursing workforce management.

If I didn’t explain any further, you could start using this formula right now and would begin to develop insights about your available workforce and your staffing capacity as you entered different numbers into the formula.

Keep reading to learn more about how this formula works and how to use it to manage your workforce effectively!

If you are attending the AONL conference in Anaheim, California, next week and would like to connect for an in-person discussion, send me a message on LinkedIn or via my contact form here on the blog.

Care-Centric Modeling Explained

Have you had the experience of you (if you’re the manager) or your nurse manager posting a new schedule alongside an overtime signup sheet? If so, there’s a simple explanation: When creating schedules, the manager approved more time off and education requests than they had the resources to cover and then put what’s left over at the bedside.

Arbitrary time off guidelines such as “You can allow X number of employees off per week.” or “You can allow Y percent of employees off per week.” are ineffective and often wrong. With the fluctuating resources available for patient care, you must calculate your available replacement (non-productive) resources before creating your schedule.

This is what we’re doing with the simplified Care-Centric Modeling formula.

Care-Centric Modeling is a resource allocation model for the scheduling process. It is not a productivity model. Under the model, employees may be scheduled to one of two states: independently participating in patient care or not independently participating in patient care.

Let’s take a closer look at the elements of the formula:

Filled FTEs

Filled FTEs represent the total FTE hours available from your employees. You should be able to get this information from your position control report. If you don’t have access to a position control report, your finance representative should be able to provide you with this number. You could also do it manually by adding up the FTEs of your hired employees.

Patient Care FTEs

Patient Care FTEs represent the FTEs from your budget needed to provide the expected patient care level for the budgeted patient volume. By subtracting Patient Care FTEs from your Filled FTEs, you reserve those hours for your baseline schedule before granting any non-productive time requests. This is the care-centric aspect of the process.

The Patient Care FTEs value is typically used to generate your nursing staffing plan, which forms the baseline for schedule creation. This information can be found in your budget, or from your finance representative if you don’t have access to it. If needed, you can calculate it manually by adding the hours for each skill on your baseline nursing staffing plan for a week and dividing by 40. See the below image for an example of the manual process for calculating FTEs.

Orientation FTEs

It’s important to note that while orientees may participate in patient care and may count towards productivity, they cannot independently replace a fully productive employee taking time off, leave, or education time. As a result, orientation FTEs must be deducted from the Available Replacement FTEs.

Leave and Other FTEs

Leave and Other FTEs cover situations where an employee cannot independently participate in patient care on your unit, such as when they are on leave or temporarily assigned to another unit. A recent example of Other FTEs would be an employee of your unit temporarily assigned to a COVID unit for a month. While the employee may still be on your position control, they are unavailable for scheduling on your unit.

Interpreting and Using Available Replacement FTE Data to Improve Nurse Staffing

Your Available Replacement FTEs represent the resources available for non-patient care shifts after scheduling the resources required to meet your budgeted level of patient care. Let’s take a look at a few care-centric modeling scenarios for a mock unit budgeted for 30 total FTEs with 15% of the total budgeted FTEs for non-productive time:

In Scenario #1, your unit is operating at full capacity with no one on leave or orientation. You have a budgeted total of 30 full-time equivalents (FTEs) and require 25.50 FTEs for patient care, with 4.50 FTEs allocated for non-productive time. You also have 180 available replacement hours each week for scheduled and unscheduled time off and education.

In Scenario #2, your unit is facing a 7.5% vacancy rate. You still require 25.50 FTEs for patient care, leaving only 2.25 available replacement FTEs, which equates to 90 hours per week for non-patient care shifts. Scheduling more than 90 non-productive hours per week will create unfilled shifts at the bedside. The last time we saw an average RN vacancy rate of around 7.5% was in 2015.^[5]Nursing Solutions, Inc. (2015). 2015 NSI National Health Care Retention & RN Staffing Report.

Prior to the pandemic, the average RN vacancy rate was approaching 10%, as seen in Scenario #3. At this rate, the unit has a vacancy of 10% and only 1.50 available replacement FTEs, which is only one-third of the budgeted available FTEs.

Scenario #4 builds on Scenario #3, with the addition of two 0.9 FTEs on orientation and one 0.9 FTE on leave. The combination of vacancies, orientation, and leave has depleted the available replacement resources, leaving the unit short by 48 hours of staff needed for baseline staffing each week. This is before the first time off or education day request is granted and before considering the average weekly call-in hours. Any non-patient care shift scheduled will lead to another unfilled shift at the bedside.

Nursing Solutions, Inc. reported an average RN vacancy rate of 15.70% last month.^[6]Nursing Solutions, Inc. (2023). 2023 NSI National Health Care Retention & RN Staffing Report. https://www.nsinursingsolutions.com/Documents/Library/NSI_National_Health_Care_Retention_Report.pdf

A 15.70% vacancy rate for our mock unit wipes out our available replacement resources before scheduling anyone for leave, orientation, scheduled or unscheduled time off, and education.

At this point, you may be wondering how this information can help you improve your staffing.

Understanding the care-centric modeling formula and performing the necessary calculations can equip you with valuable data to inform your decision-making.

For example, you can now make understaffing a conscious decision by balancing the available resources for time off and education with the staff required for patient care. This approach can also facilitate communication and collaboration with nursing administration and finance regarding resource needs.^[7]Robyn Begley, Pamela F. Cipriano, Todd Nelson. (2020). The Business of Caring: Promoting Optimal Allocation of Nursing Resources. … Continue reading By presenting the available resources for patient care, time off to prevent burnout, and education to improve workforce competency, patient safety, and patient outcomes, you can better advocate for your staff.

Furthermore, when combined with other financial, scheduling, staffing, quality, safety, and productivity data, the care-centric modeling calculation data becomes a vital component of a data-driven, evidence-based approach to workforce management. Schedules are the foundation for daily nurse staffing operations, and quickly assessing the ability of available resources to provide the desired budgeted baseline scheduling can inform the nurse manager and nursing leadership of problem areas weeks in advance.

For instance, if a nurse manager anticipates that three 0.9 RNs will go on medical leave in 3 months, they can quickly assess the impact on their scheduling capacity and begin exploring options for supplementing staff. This information provides the nurse manager, administration, and finance with a simple, measurable metric to help inform collaboration and decisions on resource allocation, hiring, recruitment, and retention activities for units with resource shortages.

When the data is rolled up for all units, it provides leadership and finance with an assessment not just of the resources available for patient care but also the resources available for time off and education.

It’s worth noting that the care-centric modeling calculation considers the additional dimension of an FTE’s ability to be scheduled for patient care, which is often not included in standard position control reports that finance and nursing leadership may be reviewing. A unit may be “fully hired” according to their position control report but may be in a negative replacement scenario due to the number of employees on leave and orientation. By having this information in your staffing analysis, you can better understand your unit’s staffing capacity, make more informed decisions regarding resource allocation, and better advocate for the resources your unit needs.

In Conclusion…

Nurse staffing remains a critical issue in healthcare, and the nursing shortage, high vacancy rates, and challenges in the educational pipeline further exacerbate the situation. Care-Centric Modeling is a resource allocation model that can help demystify your budget, improve your staffing capacity, and empower you to better advocate for resources with administration and finance. This simple yet powerful concept requires just three pieces of information to get started. The simplified formula calculates your available replacement FTEs, representing the resources available for non-patient care shifts. By using care-centric modeling, you can better manage your workforce, more effectively allocate your resources, and ensure that patient care remains a top priority.

If you would like a more in-depth discussion of advanced care-centric modeling techniques and how they can empower and educate all stakeholders in the nursing staffing and scheduling process by increasing transparency, awareness, and understanding of available scheduling capacity, send me a message on LinkedIn or via my contact form here on the blog.