U.S. Department of Health and Human Services
Indian Health Service: The Federal Health Program for American Indians and Alaska Natives
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Planning, Evaluation & Research

RRM Category: INPATIENT CARE

RRM Module: Inpatient Nursing

Overview:

The RRM Inpatient Nursing - staffing module estimates the requirements for nursing staff to provide all inpatient nursing services. Inpatient Nursing Service contains distinct and separate services, organized by unit with separate nursing stations by specialty, i.e., General Medicine, Surgical, pediatrics, Obstetrics, Newborn, Operating/Recovery Room, and ICU/CCU. Most units have their own nurse manager. The workload parameters that are the key variables in the staffing estimation are the Average Daily Patient Load (ADPL) and the number of surgical or OB/GYN cases, plus deliveries. This module estimates the need for Nurse Managers, Registered Nurses, LPN/Technicians, and Clerical Support by type of nursing unit. The ADPL is computed as patient days divided by 365; however, this quotient is increased by 25% to account for staffing requirements to meet peak workload periods.

Services Description:

Nurses provide acute care services 24 hours per day, 365 days per year to patients with a high intensity of illness. The patients have multi-system problems, are at risk for complications, and are relatively unstable. These patients may be no longer dependent, but may still require complex technologies. Rapid changes in the patient's condition may occur and nursing assessments and management of multiple problems is essential.

Inpatient Nursing Service contains distinct and separate services, organized by unit with separate nursing stations by specialty, i.e., General Medicine, Surgical, pediatrics, Obstetrics, Newborn, Operating/Recovery Room, and ICU/CCU. Most units have their own nurse manager.

Special Justification
Select Nursing staff will not be generated until HSP bed days threshold is meet. The HSP threshold for inpatient services is 5,150 bed days. For remote locations a special justification is given for facilities where the bed days total 2,600 or more. The positions effected by this remote justification are asteriated (*) in the following staffing criteria listing.

Staffing Criteria:

* Fixed Nurse Administration - Staff of 6.0 FTEs for each inpatient facility, plus 1.0 FTE for each nursing station.

* Administrative Nursing Clerical Support - Staff of 1.0 FTE for each hospital.

* Fixed Registered Nurse - General Medicine/Surgery staff of 14.650 FTEs for each facility with 10 GM/S ADPL, plus 0.30 FTEs Registered Nurse - General Medicine/Surgery for every 1 ADPL - General Medicine/Surgery above 10.00 ADPL - General Medicine/Surgery.

* Fixed LPN/Technician - General Medicine/Surgery staff of 4.650 FTEs for each facility with 10 GM/S ADPL, plus 0.160 FTEs LPN/Technician - General Medicine/Surgery for every 1 ADPL - General Medicine/Surgery above 10.00 ADPL - General Medicine/Surgery.

* Fixed Clerical Support - General Medicine/Surgery staff of 1.000 FTE for each facility with 10 GM/S ADPL, plus 0.10 FTEs Clerical Support - General Medicine/Surgery for every 1 ADPL - General Medicine/Surgery above 10.00 ADPL - General Medicine/Surgery.

* Fixed Registered Nurse - Pediatrics staff of 12.960 FTEs for each facility with 12 Peds ADPL, plus 1.62 FTEs Registered Nurse - Pediatrics for every 1 ADPL - Pediatrics above 12.00 ADPL - Pediatrics.

* Fixed LPN/Technician - Pediatrics staff of 8.000 FTEs for each facility with 12 Peds ADPL, plus 0.60 FTEs LPN/Technician - Pediatrics for every 1 ADPL - Pediatrics above 12.00 ADPL - Pediatrics.

* Fixed Clerical Support - Pediatrics staff of 1.800 FTEs for each facility with 12 Peds ADPL, plus 0.10 FTEs Clerical Support - Pediatrics for every 1 ADPL - Pediatrics above 12.00 ADPL - Pediatrics.

NOTE: To qualify for Labor and Delivery/Newborn/Nursery 125 annual deliveries are required

* Fixed Registered Nurse - Obstetrics staff of 0.80 FTE for every 1 OB/GYN ADPL, plus 1.50 FTE for every 200 deliveries above 400 deliveries.

* Fixed LPN/Technician - Obstetrics Staff of 0.40 FTE for every 1 OB/GYN ADPL.

* Fixed Clerical Support - Obstetrics staff of 0.10 FTE for every 1 OB/GYN ADPL plus 0.50 FTE for every 200 deliveries over 400 deliveries.

* Fixed LPN/Technician - Newborn staff of 0.8 FTEs for every newborn ADPL.

* Fixed Clerical Support - Newborn staff of 0.0167 FTE for every 1 newborn ADPL.

Fixed Registered Nurse - Nursery staff of 1.0 FTE for each facility with bassinets, plus 1 FTE for every 2.0 newborn ADPL above 2 newborn ADPL.

Fixed LPN/Technician - Nursery staff of 0.43 FTE for each facility with bassinets, plus 1 FTE for every 4.0 bassinets.

Fixed Clerical Support - Nursery staff of 0.33 FTE for each facility with bassinets.

NOTE: To qualify for and ICU a minimum of 876 ICU days are required.

Fixed Registered Nurse - ICU/CCU staff of 19.400 FTEs for each facility with 876 ICU days, plus 3.650 FTEs Registered Nurse - ICU/CCU for every 1 ADPL - ICU/CCU above 4.00 ADPL - ICU/CCU.

Fixed Clerical Support - ICU/CCU staff of 1.0 FTE for each facility with 876 ICU days, plus 0.25 FTEs Clerical Support - ICU/CCU for every 1 ADPL - ICU/CCU above 4.00 ADPL - ICU/CCU.

* Fixed Registered Nurse - Step Down Unit staff of 1.43 FTE for each facility with ICU/Surgical Beds, plus 1 FTE for every 4 ADPL in ICU/Surgery.

* Fixed LPN/Technician - Step Down Unit staff of 1.0 FTE for each facility with ICU/Surgical Beds, plus 1 FTE for every 4 ADPL in ICU/Surgery.

* Fixed Clerical Support - Step Down Unit staff of 2.0 FTEs for each facility with a Step Down Unit.

NOTE: To qualify for OR staff 450 surgical cases are required. This includes inpatient and outpatient surgery plus OB/GYN surgery.

Fixed Registered Nurse - Operating Room staff of 3.20 FTEs for each facility with an operating room, plus 1.33 FTEs Registered Nurse for every 200 above 800 General Surgery, OB/GYN Surgery and Ambulatory Surgery cases.

Fixed LPN/Technician - Operating Room staff of 1.60 FTEs for each facility with an operating room plus 1.0 FTE for every 200 above 800 General Surgery and OB/GYN Surgery cases. (Does not include ambulatory cases.)

Fixed Registered Nurse - Anesthesia Recovery staff of 1.0 FTE for each facility with an operating room plus 1.0 FTE for every 600 General Surgery, OB/GYN Surgery and Ambulatory Surgery cases above 600 cases.

Fixed Registered Nurse - Ambulatory Surgery staff of 2.0 FTEs for each facility with at least 450 ambulatory surgery cases.

NOTE: Psychiatric and observation services not available at IHS facilities, however, the stated criteria applies if the services are introduced in the future.

Fixed Registered Nurse - Psychiatric staff of 7.0 FTEs for each facility with a Psychiatric Unit, plus 0.70 FTEs Registered Nurse - Psychiatric for every 1 ADPL above 10.00 ADPL.

Fixed LPN/Technician - Psychiatric staff of 2.400 FTEs for each facility with a Psychiatric Unit, plus 0.18 FTEs LPN/Technician - Psychiatric for every 1 ADPL above 10.00 ADPL.

Fixed Clerical Support - Psychiatric staff of 1.0 FTE for each facility with a Psychiatric Unit, plus 0.10 FTEs Clerical Support - Psychiatric for every 1 ADPL above 10.00 ADPL.

* Fixed Registered Nurse - Quality Improvement staff of 1.0 FTE for each hospital with less than 50 staffed beds. Staff of 2.0 FTEs for each hospital of more than 50 staffed beds.

* Fixed Registered Nurse - Discharge Planning staff of 1.0 FTE for each hospital of less than 50 staffed beds. Staff of 2.0 FTEs for each hospital of more than 50 staffed beds.

Fixed Registered Nurse - Observation staff of 0.33 FTEs per sub acute care bed for each hospital with more than 1,095 sub acute bed days.

Fixed Registered Nurse - Patient Escort staff of 1.0 FTE for every 1,540 hours used to transport patients from the facility to a referral facility. (Does not include travel time to transport patients from residence to health care.

* Fixed Registered Nurse - Educator staff of 1.0 FTE for every 50 ADPL.

STAFFING FORMULAE

Driving Variables:
ADPL - General Medicine
ADPL - Pediatrics
ADPL - OB/GYN
ADPL - Newborns
GS Cases
OB Cases
Bassinets
ADPL - ICU/CCU
ICU/Surgical Beds
ICU Days
Step-Down Beds
OB/GYN Cases
Inpatient Surgical Cases
Ambulatory Surgical Cases
ADPL - Psychiatric
Staffed Beds
Sub Acute Care Days
ADPL Sub Acute Care
Patient Transport Hours

Personnel Categories:
Nurse Administration
Admin. Clerical Support
Registered Nurse - GM/Surgery
LPN/Technician - GM/Surgery
Clerical Support - GM/Surgery
Registered Nurse - Pediatrics
LPN/Technician - Pediatrics
Clerical Support - Pediatrics
Registered Nurse - Obstetrics
LPN/Technician - Obstetrics
Clerical Support - Obstetrics
LPN/Technician - Newborn
Clerical Support - Newborn
Registered Nurse - Nursery
LPN/Technician - Nursery
Clerical Support - Nursery
Registered Nurse - ICU/CCU
Clerical Support - ICU/CCU
Registered Nurse - S. Down Un.
LPN/Technician - St. Down Un.
Clerical Support - St. Down Un.
Registered Nurse - Operat. Room
LPN/Technician - Operat. Room
Registered Nurse - Anesth. Recovery
Registered Nurse - Ambul. Surgery
Registered Nurse - Psychiatric
LPN/Technician - Psychiatric
Clerical Support - Psychiatric
Registered Nurse - Quality Imp.
Registered Nurse - Discharge Pl.
Registered Nurse - Observation
Registered Nurse - Pat. Escort
Registered Nurse - Educator

MINIMUM STAFFING LEVELS (fixed):

Personal Category FTEs
Nursing Administration 6.00
Adm. Clerical Support 1.00
Registered Nurse - GM/SU 14.65
LPN/Technician - GM/SU 4.65
Clerical Support - GM/SU 1.00
Registered Nurse - Pediatrics 12.96
LPN/Technician - Pediatrics 8.00
Clerical Support - Pediatrics 1.80
Registered Nurse - Obstetrics 0.80
LPN/Technician - Obstetrics 0.40
Clerical Support - Obstetrics 0.10
LPN/Technician - Newborn 0.80
Clerical Support - Newborn 0.0167
Registered Nurse - Nursery 1.00
LPN/Technician - Nursery 0.43
Clerical Support - Nursery 0.33
Registered Nurse - ICU/CCU 19.4
Clerical Support - ICU/CCU 1.00
Registered Nurse - Step Down Unit 1.43
LPN/Technician - Step Down Unit 1.00
Clerical Support - Step Down Unit 2.00
Registered Nurse - OR/RR 3.20
LPN/Technician - OR/RR 1.60
Registered Nurse - Anesthesia Recovery 1.00
Registered Nurse - Ambulatory Surgery 2.00
Registered Nurse - Psychiatric 7.00
LPN/Technician - Psychiatric 2.40
Clerical Support - Psychiatric 1.00
Registered Nurse - Quality Improvement 1.00
Registered Nurse - Discharge Planning 1.00
Registered Nurse - Observation 0.33
Registered Nurse - Patient Escort 1.00
Registered Nurse - Educator 1.00

Plus, VARIABLE STAFFING LEVELS:

Personal Category FTEs per Driving Variables Min. Max.
Registered Nurse - GM/SU 0.300 1 ADPL - GM/SU 10.00 n/a
LPN/Technician - GM/SU 0.160 1 ADPL - GM/SU 10.00 n/a
Clerical Support - GM/SU 0.100 1 ADPL - GM/SU 10.00 n/a
Registered Nurse - Pediatrics 1.620 1 ADPL - Pediatrics 12.00 n/a
LPN/Technician - Pediatrics 0.600 1 ADPL - Pediatrics 12.00 n/a
Clerical Support - Pediatrics 0.100 1 ADPL - Pediatrics 12.00 n/a
Registered Nurse - Obstetrics 1.50 200 Deliveries 400 n/a
LPN/Technician - Obstetrics 0.400 1 ADPL - Obstetrics 125 n/a
Clerical Support - Obstetrics 0.50 200 Deliveries 400 n/a
LPN/Technician - Newborn 0.800 1 ADPL - Newborn 125 n/a
Clerical Support - Newborn 0.167 1 ADPL - Newborn 125 n/a
Registered Nurse - ICU/CCU 3.650 1 ADPL - ICU/CCU 4 n/a
Clerical Support - ICU/CCU 0.250 1 ADPL - ICU/CCU 4 n/a
Registered Nurse - Step Down U 1.00 4 Staffed SD Bed 4 n/a
LPN/Technician - Step Down U 1.00 4 Staffed SD Beds 4 n/a
Registered Nurse - OR 3.2 200 Gen, Amb, OB Surg 800 n/a
LPN/Technician - OR 1.00 200 Gen & OB Surg 800  
Registered Nurse - Anes. Recovery 1.00 600 Gen, Amb, OB Surg 600  
Reg. Nurse - Psychiatric 0.70 1 ADPL - Psych. 10.00 n/a
LPN/Technician - Psychiatric 0.180 1 ADPL - Psych. 10.00 n/a
Clerical Support - Psychiatric 0.100 1 ADPL - Psych. 10.00 n/a
Registered Nurse - Quality Improv. 1 50 Hospital Beds 50 2/fac.
Registered Nurse - Discharge Plan. 1 50 Hospital Beds 50 2/fac.
Registered Nurse - Observ. Bed 0.33 1,095 ADPL - Sub Acute 1,095 n/a
Registered Nurse - Patient Escort 1 1,540 Yearly Escort Hours 0.00 n/a
Registered Nurse - Educator 1 50 ADPL 0 n/a


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