Nursing FTE budgets are crucial in managing nursing resources in healthcare organizations. The concept of the FTE, or full-time equivalent, is used to determine the number of nursing hours required to provide the desired level of patient care for a given (usually average) patient volume, the amount of time off employees are expected to take, & the time needed to cover educational activities for all employees.^[1]Jones, C., Finkler, S. A., Kovner, C. T., & Mose, J. (2018). Financial Management for Nurse Managers and Executives (5th ed.). Saunders. Traditionally, “productive” and “nonproductive” have been used to describe nursing FTE time.^[2]Jones, C., Finkler, S. A., Kovner, C. T., & Mose, J. (2018). Financial Management for Nurse Managers and Executives (5th ed.). Saunders. However, these terms can be problematic and create misconceptions about the value of nursing activities. Recently, leaders have called for revised nursing budget terminology that better reflects the value and importance of nursing activities.^[3]Begley, R., et al. (2020). The Business of Caring: Promoting Optimal Allocation of Nursing Resources: 23. This blog post proposes alternative terms that can better reflect the value and reality of nursing work.

The terms used to describe nursing FTEs can impact how nurses are perceived and valued within healthcare organizations. The traditional terms “productive” and “nonproductive” have their roots in management engineering, a field that emerged in the early 20th century to improve the efficiency of industrial processes. In the context of nursing, however, these terms can create misconceptions about the value of nursing activities.

To address the disconnect between the current terminology and the work of nursing care delivery, this blog post proposes the alternative terms of “patient care” for “productive” and “patient care support” for “nonproductive” hours and FTEs to describe nursing time. These terms are patient-centered and better reflect the value and reality of nursing work.

“Patient Care FTEs” refers to the nursing hours directly devoted to patient care activities, such as administering medications, performing assessments, documenting care, and providing patient education. This term emphasizes the value of nursing activities provided by these FTEs that directly impact patient outcomes, and the term also highlights that patient care is the core business of nursing.

On the other hand, “Patient Care Support FTEs” refers to nursing time spent on activities that support the delivery of patient care, such as education, time off, and other administrative tasks. This term acknowledges the importance of these activities in ensuring that nursing staff are adequately trained, rested, and supported, which can improve a variety of quality, safety, and financial metrics. It also avoids the negative connotations associated with the term “nonproductive,” which can imply that these activities are unimportant and lack value.

Describing nursing FTEs in terms of patient care and patient care support keeps the concept of the patient central to budget discussions. These terms also support a more holistic view of the nursing budget by emphasizing that all aspects contribute to patient care. The current direct care, productivity-focused approach to evaluating nursing care delivery neglects the importance of traditional nonproductive activities in supporting that care delivery. The language of Patient Care FTEs and Patient Care Support FTEs highlights the importance of all nursing activities in achieving the core business goal of safe and effective patient care with positive patient outcomes and reinforces the idea that these activities are valuable and essential in caring for patients.

Using patient-centered terms to describe FTEs could also help to reduce burnout and improve nurse retention. Burnout is a significant issue in nursing, with many nurses citing high workloads and insufficient support as contributing factors.^[4]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, … Continue reading By acknowledging the importance of time off in reducing burnout, supporting patient care delivery, and allocating FTEs to provide adequate time for employees to rest and recharge, healthcare organizations can help to reduce the workload and stress on nursing staff. Acknowledging the importance of employee time off to nursing care delivery can help to prevent burnout and improve nurse satisfaction and retention.

Patient Care Support also covers the resources needed to provide the orientation and education required to maintain workforce competency. With the increase in nursing turnover^[5]Nursing Solutions, Inc. (2022). 2022 NSI National Health Care Retention & RN Staffing … Continue reading, the loss of expertise due to baby boomers retiring^[6]Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences: Time to Change Our Present Course. Nursing Economic$, 39(5), … Continue reading, the decrease in average nurse tenure at facilities^[7]Johnston Thayer, Joe Zillmer, Neil Sandberg, Anna R. Miller, Paul Nagel, Alissa MacGibbon. (2022). ‘The New Nurse’ Is the New … Continue reading, and even new nurses leaving the bedside after a few years^[8]Kreedi, F. , Brown, M. , Marsh, L. , & Rogers, K. (2021). Newly Graduate Registered Nurses’ Experiences of Transition to Clinical Practice: A Systematic Review. American Journal of … Continue reading, education and orientation are more important now than ever. Maintaining workforce competency is essential for patient safety and positive patient outcomes.

The Patient Care and Patient Care Support categorization of time also helps to facilitate the care-centric view of resource allocation. At a high level, nursing time is separated into patient and non-patient care time, and this separation conceptually supports evaluating resource availability and allocation via care-centric modeling. Having two broad categories to categorize shifts simplifies understanding and visualization of allocating available resources.

In conclusion, the terms used to describe nursing FTEs can impact how nursing activities are perceived and valued within healthcare organizations. The traditional terms “productive” and “nonproductive” have their roots in management engineering and can create misconceptions about the value of nursing activities. By using alternative phrases such as “Patient Care FTEs” and “Patient Care Support FTEs,” healthcare organizations can better recognize the value and reality of nursing work while emphasizing the importance of patient-centered care in financial discussions.