4 Essentials to Build (And Sell) A Highly Effective Staffing Plan

As a nurse executive well-known for her business acumen, Pamela Hunt, MSN, RN, NEA-BC, believes matching your staffing plan to your productivity target is an essential skill every perioperative nurse leader has to get right.

“When you can successfully translate clinical need into financials, you are not only addressing patient safety goals, but also showing responsibility to your organization that you are keeping your team in a productive state,” Hunt says.

Unfortunately, the skills a leader needs to build a solid, evidence-based staffing plan and defend it for approval are often learned on the job with plenty of trial and error.

Through her 15 years in a perioperative nurse executive role, Hunt has honed her formula for dialing-in a staffing approach and she shares a few key points to help her nurse colleagues.

1. Understand Staffing Need

   Smart perioperative staffing involves many factors, but boiled down to general steps for the process, Hunt says the first two moves are the relatively simple ones.

   Step 1: Determine how many staff members and the skill mix you need in your department to achieve productivity goals, meet the highest standards of patient safety, and reduce the risk for dissatisfaction, which can lead to turnover and bump up orientation and traveler costs.

   Step 2: Calculate how many staff members and what skill mix you currently have and compare with the plan to determine where there might be a gap requiring additional staff.



2. Translate Clinical Staffing Need to Financial Cost

   With your staffing needs calculated, the next step is justifying your plan and associated costs with financial leadership, as well as clinical leaders.

   To present your plan, draft an executive summary that outlines what you are asking for, metrics to project improvement, and data around the negative impact if your plan is not approved. Then provide clear support on these points in your discussion and hand-outs.

   “Make sure to walk into this meeting with your data and your bottom-line ask, as well as the negative effects that will result if your plan is not approved, including projections on turnover, the need for travelers to fill staffing gaps, and the potential impact on quality of care," Hunt suggests.



3. Match Staffing with Productivity

   “Once you are successful in calculating the people you need, you must then demonstrate you can keep your team in positive productivity—this is the constant challenge,” Hunt advises. She says the next steps are more difficult to zero in on because of the many factors that affect productivity.

   Step 3: Understand your given productivity target. This is a target that is hopefully agreed upon by the department leadership and the finance department. Benchmarking data is often used to determine the target for organizations. Productivity targets in the OR are most commonly described as staff hours worked per OR minute (patient in the room to patient out of the room). 

   The calculation is:  measurement of work (total number of OR minutes in a given period of time) multiplied by agreed-upon budgeted staff hours per OR minute.  An example might look like this:

   12,000 OR minutes recorded in a pay period x 0.13 (budgeted staff hours per OR minute) = 1560 productive hours worked if your department was 100% productive. 

   The target for productive staff hours worked per OR minute is usually somewhere between 0.11 and 0.13 hours per OR minute depending on the type of cases performed and the average number of staff members provided for each case. 

   Consider the following example:

   You lead a high-acuity OR. Most cases require 1 circulator, 2 scrubs and a nursing assistant who is shared between two rooms for activities such as transport and room turn. Therefore, your average need is 3.5 staff members per room. To support this OR there are 4.5 fixed positions that also report to this cost center. These are positions that can support one or many ORs but are needed regardless of OR volume, such as director, charge RN, inventory clerk, scheduler, or educator. 

   For the sake of this example, 0.5 FTE of the director, a charge RN, a scheduler, an inventory clerk and an educator make up this group. This gives the 4.5 fixed FTE to support this department. 

   So, the budgeted target may be calculated as 3.5 clinical staff + 4.5 fixed staff = 8.0 needed for every hour that a patient is in the room:

   8.0 hours   =   0.13 productive hours per OR min.         60 minutes/hour 

   Your organization may have selected a budgeted target that does not reflect your work. That is why understanding this calculation and comparing it to your budgeted target is an important step to ensure your team has the correct resources.

   Step 4: Understand how to calculate your variance to the productivity target.

   Here’s a handy formula Hunt uses to calculate staffing utilization percentage on a regular basis to understand and quickly respond to a productivity/staffing gap:

   Calculate Productive Hours defined as: Regular Hours, Call-In Hours, Overtime, Emergency Call-in

   

   Example:

   

    

4. Refine Staffing Practices to Retain Staff and Contain Costs

Managing your staff in a responsible way is another important factor Hunt says can help you maintain your productivity and show positive metrics with your staffing plan. Here are a few staffing pearls she follows to stay on track:

• Always flex to volume
• Ensure your payroll is correct (make sure people who clock into your department work there)
• Monitor overtime to ensure it’s value-added
• Minimize turnover and therefore minimize orientation costs
• Be flexible with the schedule to decrease lag time between patients
• Minimize the use of premium dollars such as weekend only programs and retention incentives

“Although this work may be foreign to us, we have to learn about the work of developing a staffing plan, be responsible to this plan and the staffing budget, and understand how to analyze and respond to productivity variances,” Hunt stresses. “We simply can no longer be successful in our role without understanding all of these aspects of responding in a way that ensures quality and cost containment.”

Free Resources for Members

AORN Leader Membership- Join or renew as a leader member to get solutions beyond clinical challenges, like staffing and budgeting, while also supporting your professional passion. Learn more.

AORN Position Statement on Perioperative Safe Staffing and On-Call Practices

(AORN has developed an interactive staffing model calculator for members.)

AORN Journal CNE Articles

Improving OR Efficiency (1.6 CHs)

Maximizing Efficiency and Reducing Robotic Surgery Costs Using the NASA TLX Staffing Model (1.5 CHs)

Clinical Issues July 2017 (1.1 CHs)

Clinical Issues October 2017 (1.2 CHs)

Clinical Issues June 2018 (1.5 CHs)

Webinars

Recruitment, Retention & Recognition = Satisfaction (1 CH)