Nursing Productivity For Charge Nurses/Front-Line Leaders Explained
Updated: Mar 17, 2020
In most inpatient nursing units, the charge nurse, or front-line leader, is responsible for the shift flow and safety of the unit.
They are in charge of several critical duties within the unit: they make assignments based on skill level, coordinate admittances, discharges, and transfers in and out of the unit, provide breaks, and act as a resource RN to the unit staff.
Charge nurses are also responsible for acting as a steward of hospital resources, specifically flexing staff off or on-call when the census is lower.
Maximizing Efficiency: A Simple Equation
If you are a charge nurse, you know it’s absolutely crucial to maximize employee efficiency while you’re on shift. You’ve almost certainly heard your supervisor ask—likely several times per shift—if you are going to send someone home on call, call them off, or float to another unit when the unit census is lower. You may wonder why they’re bothering you with this. It might seem that they are simply moving bodies around when there’s still the same amount of work to be done.
The answer? It’s all about productivity.
Let’s look at the math. For hospital budgeting purposes, productivity percentage is calculated by hours per patient day (HPPD) and nursing hours used (NHU) in 24-hours, usually turning over at midnight.
A new HPPD Earned is calculated annually at the end of the fiscal year. The number of total productive hours worked in a year is then divided by patient days in the same period to obtain HPPD Earned.
HPPD Earned = Total Nursing Hours Used/Patient Days in the same period
A Case Study
Let’s use one particular unit as an example. First, we’ll calculate the unit’s HPPD Earned for a new fiscal year.
The unit used 70,153 hours in a year. The average daily census was ten, or 3,650 patient days annually.
HPPD = 70,153/3,605 = 19.220
The charge nurse only needs to be familiar with a basic 24-hour productivity calculation. Since we’ve established the yearly HPPD Earned (19.220), this number will remain constant. At midnight, productivity is calculated as HPPD Earned divided by the total number of Nursing Hours Used (NHU) to gain a percentage for the 24-hour period.
Productivity % = Annual HPPD Earned/Total Nursing Hours Used
In an ICU nursing unit that runs on 12 -shift cycles, the higher the census, the better the productivity percentage. Regardless of what the number is during the day, the census number that matters is the one that’s taken at midnight.
To compare productivity percentages, let’s use some substitutions.
In this same unit where we’ve already established the annual HPPD Earned, there are 16 ICU beds. If your unit had 16 patients, and you transferred out or discharged eight patients by midnight, assuming that there were no further admits or transfers-in, your midnight census would be 8.
To complete the calculation, say the number of nursing hours used (NHU) was 192 (eight day-shift RNs, one day-charge RN, one CNA, four night-shift RNs, one night-charge, one CNA).
Productivity % = (HPPD Earned*Census Number)/ Nursing Hours Used
Productivity % = (19.220*8)/192 = 153.76/192 = 0.800 = 80%
On the other hand, let’s imagine that the midnight census was 15, and the NHU was 240 (eight day-shift RNs, one day-charge RN, one CNA, eight night-shift RNs, one night-charge RN and one CNA).
Productivity % = (19.220*15)/240 = 288.3/240 = 1.20 = 120%
While 80% is low, 120% is at the opposite end and may be overly optimistic. The ideal patient census to break even is about ten patients by midnight.
As you can see from the hypothetical calculations, the higher the census at midnight, the better the productivity. Conversely, a lower census at midnight equals a lower rate of productivity. This is why, as a charge nurse, staff must be flexed off or on call, even if it’s only for part of a shift.
Of course, for patient safety, there are justifiable circumstances where one-to-one staffing is necessary, or when additional staff is needed to take care of higher acuity patients.
The main points to take away are these:
1. Know your unit’s HPPD (hours per patient day).
2. Staff accordingly, taking into consideration patient safety and acuity as census lowers, send staff home, either on-call or off, as soon as you can.
3. If you anticipate a busy shift, the off-going charge nurse can staff up; then the oncoming charge nurse can send staff home as needed if no change or decrease in census occurs
4. One idea is to offer staff the option of taking extended lunches, but only if they wish to, as organizations cannot force staff to accept cuts in hours
5. Productivity % = HPPD Earned/Nursing Hours Used in a 24-hour period