Laura 

Nursing Leadership and Management 

Discussion

1. Discussion Points with Nurse Leader

When discussing with the nurse leader regarding current staffing and budget problems. I will highlight the following points. First, I’ll discuss the shift in patient acuity. Since the new vascular surgeon started admitting patients to this unit, the acuity level of need rose for six out of twenty patients. The current budgeted Hours Per Patient Day (HPPD) of 7.59 was based on a typical medical-surgical patient population does not factor in the additional demand that these higher acuity patients bring. Patient acuity levels determine the degree of required nursing care that predicts the need for changes in the staffing models and actual delivery of safe patient care (Juvé‐Udina et al., 2020). Thus, I will suggest changing the distribution of patients to 70% Medical/Surgical and 30% Step down to meet current requirements.

I will also recommend the need for more Full-Time Equivalent (FTE) caregivers. The move now to have a more blended approach will have more step-down patients than before and this current staffing may not be enough to meet the needs of these patients. Various studies have provided evidence that patient outcomes are positively affected by increased staffing ratios and especially in the high-risk areas (McHugh et al., 2021). Determining the number of additional FTEs needed based on the new acuity levels will give an accurate idea of how many more staff are required.

Last, I will discuss the unfavorable salary variance and the use of overtime (OT) to maintain care levels. If OT has been consistently used to manage the additional clinical requirements, then we must look at other alternatives we have, for instance, employment more staff so as not to over burden the existing employees and avoid further budget overruns.

2. Recommendations for Reducing OT Expense

The unit has spent $125,000 on OT during the last 6 months, which is an unfavorable to the budget. As for my recommendation, I believe that OT should be decreased by hiring more Registered Nurses (RNs). OT may be more costly and less effective in the long-run. It is more economical to hire two full-time Registered Nurses (RNs) having an expenditure of roughly $160,000 per year than to remain using OT which may amount to $250,000 for the year. New employees will enable the provision of better patient care as well as ease some of the financial burdens.

3. Revised Staffing Grid