8.5 Budgets and Staffing
Economics and health care reimbursement models affect health care institutional budgets that ultimately affect nursing staffing. A budget is an estimate of revenue and expenses over a specified period of time, usually over a year. There are two basic types of health care budgets that affect nursing: capital and operating budgets. Capital budgets are used to plan and evaluate major projects and investments, such as new facilities or equipment. Operating budgets include personnel costs and annual facility operating costs.[1] Typically 40% of the operating budgets of health care agencies are dedicated to nursing staffing. As a result, nursing is often targeted for reduced hours and other cutbacks.[2]
What is the value of a nurse? Nurses are priceless to the clients, families, and communities they serve, but health care organizations are tasked with calculating the cost of delivering high quality nursing care in an affordable manner using safe staffing models. All members of the health care team must understand the relationship between economics, resources, budgeting, and staffing and how these issues affect their ability to provide safe, quality care to their patients.
As health care agencies continue to adapt to meet “Pay for Performance” reimbursement models and deliver cost-effective care to an aging population with complex health needs, many nurses are experiencing changes in staffing patterns.[3] Strategies implemented by agencies to facilitate cost-effective nurse staffing include acuity-based staffing, team nursing, mandatory overtime, floating, on call, and off with benefits.
Acuity-Based Staffing
Historically, inpatient staffing patterns focused on “nurse to patient ratios” where a specific number of patients were assigned to each registered nurse during a shift. Acuity-based staffing is a patient assignment model that takes into account the level of patient care required based on the severity of a patient’s illness or condition. As a result of acuity-based staffing, the number of clients a nurse cares for often varies from shift to shift as the needs of the patients change. Acuity-based staffing promotes efficient use of resources by ensuring nurses have adequate time to care for complex patients.
Read more information about acuity-based staffing in the “Prioritization” chapter.
Team Nursing
Team nursing is a common staffing pattern that uses a combination of Registered Nurses (RNs), Licensed Practical/Vocational Nurses (LPN/VNs), and Assistive Personnel (APs) to care for a group of patients. The RN is the leader of a nursing team, making assignments and delegating nursing care to other members of the team with appropriate supervision. Team nursing is an example of allocating human resources wisely to provide quality and cost-effective care. In order for team nursing to be successful, team members must use effective communication and organize their shift as a team.
Read more about team nursing in the “Delegation an