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UMass Memorial Health Harrington Hospital

Acute Care
3 North
Adult Medical / Surgical Combined

Variance Info
Current Posted Planned Worked Hours Per Patient Day	11.70
Actual Worked Hours Per Patient Day	10.27
Variance	-1.43
% Variance from Budget	-12.20%

Reason For +/- 5% Variance From Budget
No explanation required No explanation of staffing hours was required if the unit's actual worked hours were within +/- 5% of the 2008 submitted unit staffing plan.
Fluctuating day to day census The number of patients on the patient care unit varied significantly from day to day impacting the overall actual staffing hours provided in 2008.	X
Lower daily census than planned The actual average number of patients per day on the unit was less than the planned average patients per day submitted in the displayed 2008 staffing plan.
Higher daily census than planned The actual average number of patients per day on the unit was greater than the planned average patients per day in the displayed 2008 staffing plan.	X
Higher patient care needs than planned The average patient required more care than expected and that took more staff than the displayed 2008 staffing plan.	X
Lower patient care needs than planned The average patient required less care than expected and that took less staff than the displayed 2008 staffing plan.
Staff vacancies The unit had more job openings than planned and that impacted the average staffing hours on the unit.	X
Adjusted for patient care needs The average actual patient care requirements were different than what was submitted in the 2008 unit staffing plan.
Minimum fixed staffing requirements A minimal level of staffing is required on each unit regardless of the number of patients or their care needs. Adjusting to a minimum fixed staffing level increases staffing care hours.
Care delivery model changes The way in which direct care staff are assigned to care for patients changed.
Increased 1:1 staffing requirements The number of patients on this unit requiring one nurse assigned to one patient was higher than planned.	X
Closure of unit The unit was closed at some point and that impacted overall staffing hours.
Not admitting to beds due to staffing Patients were not admitted to the unit because there were lower staffing levels on the unit than planned.	X
Increased census to telemetry patients The number of patients requiring cardiac monitoring was higher than the 2008 staffing plan.
Plan based on high needs in critical care The 2008 critical care staffing plan based staffing on high acuity or patient care requirements.
Increased staff hours to facilitate admissions and discharges This unit required more staffing than expected because of the number of patients being admitted and discharged from the unit each day.
Change in patient mix The actual type of patients admitted on this unit was different from the development of the 2006 staffing plan requirements.

Other Reasons for +/- 5% Variance
Unable to carve out orientation/preceptor hours, council work, transporting patients, response to emergency calls (e.g. Code Blue, Dr. Stat & RRT) Unable to care out class time (e.g. ACLS, behavioral crisis training, restraint training) QA and other Performance Improvement initiatives are performed by staff during their clinical work hours Receives floats from other nursing units when those units have low census or are closed Staff do EKG's after hours PCA's are utilized as patient observers for 1:1 requirements when the census is low and/or a patient observer is not available to call in Staff perform Social Services duties on weekends because Social Service does not provide weekend coverage Staff perform Respiratory therapy whenever the Respiratory therapists are tied up and/or are too busy

Additional Comments
One wing of 3N closed for rennovation (max capacity 20) on 5/22/08 Harrington Hospital is currently rennovating the medical-surgical units. The units at this reporting last year were housed together and the staff had been combined as one cost center Rennovations required that part of the unit be closed for remodeling, thus necessitating the unit to become divided again. This split occurred in May 2008. While the unit is once again divided into two cost centers, the unit staff still function as one. Staff currently float from one floor to the other and are not permanently stationed on one unit. As census demands, one floor may have additional nursing personnel over the other.

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