Health care organizations around the world are faced with increasing financial pressures, with no end in sight. As a consequence, hospital executives often turn to the largest portion of their budget—nursing labor—when making cuts. Yet, evidence shows that cutting costs through elimination of nursing positions comes with great risk to patient safety and quality of care.
This toolkit is designed to help nursing leaders find quality-conscious answers to the cost cutting mandate. It includes best practices, resources, and tools to better match staffing to patient demand and reduce labor costs while safeguarding nursing personnel.
Download the toolkit overview
Note: This toolkit was originally created for members of our Global Centre for Nursing Executives. While it was developed with an international audience in mind, the tools and practices are applicable to U.S. organizations.
4 steps to achieve sustainable, nurse-led cost savings
The tools below are structured into four steps to help nurse executives better match staffing to patient demand and reduce labor costs. Each step includes a brief introduction along with relevant tools and templates, implementation guidance, case studies, and other resources to help nurse executives achieve each of the steps.
- Establish Cost-Effective Safe Staffing Targets
- More Precisely Match Staffing to Predicted Demand
- Embed Flexibility to Respond to Unexpected Mismatches
- Fully Leverage the Skills and Training of Each Care Team Member
Step 1: Establish Cost-Effective Safe Staffing Targets
Budgeting and Staffing Introduction
Measure Patient Demand
Understand Patient Turnover and Workload Demands
- Tool: ADT calculation sheet
Use our calculation sheet to measure patient ‘churn’ or turnover and the workload associated with it.
- Toolkit: Review our ADT Efficiency Toolkit
Access this toolkit for resources on more efficiently managing patient throughput while addressing workload concerns of frontline staff.
- Resource: Overview of nursing workload assessments
Review this overview for our recommendations on implementing a workload assessment tool and a summary of key factors that an effective workload assessment tool should measure.
Calculate HPPD and Labor Costs
Step 2: More Precisely Match Staffing to Predicted Demand
Improve Current Scheduling Practices
Embed Flexible Shift Structures and Patient Placement Practices
- Case Study: Flexible Shift Patterns
Learn how one organization in the United States reduced wasted staff capacity by re-structuring their process for patient allocation and assignment.
- Tool: Patient Placement Algorithm Cheat Sheet
Follow the guidance in our cheat sheet to develop and utilize patient census goals to avoid the “partial people” math that leads to wasted staff capacity.
Step 3: Embed Flexibility to Respond to Unexpected Mismatches
Equip Managers to Track and Calibrate Daily Staffing Levels
Build Robust In-House Alternatives to Premium Labor
- Case Study: “Floater” support system
Learn how one organization in the United States built a robust nursing float pool and developed a comprehensive support system to help retain float pool staff.
- Tool: Float Pool Calculation Sheet
Use this calculation sheet to determine the number of staff you will need to recruit to your float pool.
Improve Float Pool Support System
Step 4: Fully Leverage the Skills and Training of Each Care Team Member
Optimize Skill Mix Based on Unit-Level Needs
- Case Study: Unit-level modelling
Learn how one organization in the United States used a time-and-motion study and computer simulation technology to determine the appropriate skill mix for their units.
Better Utilize Support Staff to Fully Leverage RNs
Reinforce Top-of-License Prioritization
- Resource: Achieving Top-of-License Nursing Practice
Read our 20 best practices for ensuring frontline nurses have the time and interprofessional support they need to practice to the full extent of their training and skills.
- Case Study: Customized care teams
Learn how one organization in Canada took a structured approach to re-defining their staffing model and embedding bundled practices to prevent staff from slipping back into old habits.
Download the toolkit overview
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