| Reason For +/- 5% Variance From Budget |
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No explanation required
No explanation of staffing hours was required if the unit's actual worked hours were within +/- 5% of the 2017 submitted unit staffing plan.
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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 2017.
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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 2017 staffing plan.
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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 2017 staffing plan.
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Higher patient care needs than planned
The average patient required more care than expected and that took more staff than the displayed 2017 staffing plan.
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X |
Lower patient care needs than planned
The average patient required less care than expected and that took less staff than the displayed 2017 staffing plan.
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Staff vacancies
The unit had more job openings than planned and that impacted the average staffing hours on the unit.
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X |
Adjusted for patient care needs
The average actual patient care requirements were different than what was submitted in the 2017 unit staffing plan.
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X |
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.
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Care delivery model changes
The way in which direct care staff are assigned to care for patients changed.
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Increased 1:1 staffing requirements
The number of patients on this unit requiring one nurse assigned to one patient was higher than planned.
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Closure of unit
The unit was closed at some point and that impacted overall staffing hours.
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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.
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Increased census to telemetry patients
The number of patients requiring cardiac monitoring was higher than the 2017 staffing plan.
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X |
Plan based on high needs in critical care
The 2017 critical care staffing plan based staffing on high acuity or patient care requirements.
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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.
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Change in patient mix
The actual type of patients admitted on this unit was different from the development of the 2017 staffing plan requirements.
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| Other Reasons for +/- 5% Variance |
| Spaulding Cambridge utilizes the Quadramed acuity tool to assess changes in acuity and adjust staffing requirements as needed. 3 West also had an increase in complex ventilator weaning patients directly admitted form the ICU setting which increased their Quadramed acuity. Fluctuating census with cancelled late admissions resulted in some staff variances. Also staff's incidental overtime increased due to the need to stay to complete documentation requirements.
Spaulding Cambridge instituted a new EPIC documentation system in June. During the implementation process the Hospital increased unit staffing to allow clinical staff the time to learn the new tool. The Hospital monitors stall's incidental overtime utilization and works closely with staff members to assist them with work flow improvements.
3 West also experienced some RN turnover resulting in the hiring of many new graduate RN's. As the new graduate RN's transition off of an 8 week orientation we see an increase in their incidental overtime as they work on improving their work flow. We review this on a weekly basis and have seen consistent reductions in incidental overtime as they assimilate to their new roles. |
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| Additional Comments |
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