1. Hampton, Michelle PhD, RN, CCRN

Article Content

Often indicated as a top priority, managing labor costs is vital to sustaining an organization's financial health.1 The American Organization of Nurse Executives identifies business skills, specifically financial management, as an essential nurse leader competency.2 We're required to maintain optimal staffing numbers to avoid having too few-or too many-employees, thus missing budget productivity targets.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

Healthcare executives note three keys to productivity management: supervision, information, and planning. Supervision involves continuous oversight of staffing, scheduling, and flexing the workforce. Information includes accurate and timely data specific to budget targets, benchmarks, and operating reviews. Planning entails proactive budget, staffing, and workforce management.


Position control management tools (PCMTs) are frequently used by nurse managers to monitor unit-level staffing and budgets. These tools provide an overview of current filled positions, which are compared against unit staffing requirements to identify staffing gaps. PCMTs have become highly sophisticated electronic tools that employ predictive analytics and advanced labor strategies. Positive outcomes of the more savvy tools include 97% accuracy when predicting staff needs 30 days out from the shift, 75% of open shift hours filled more than 2 weeks in advance, marked increases in RN satisfaction, and 4% to 7% savings in overall labor spending.3


Recently, a 726-bed, Magnet(R)-recognized, tertiary care facility partnered with an operational consulting firm to develop more efficient and effective staffing and scheduling processes. Through this partnership, an innovative PCMT was developed and implemented. The new tool allows executive leadership, department managers, and human resources (HR) the ability to constantly plan for the right people, in the right place, at the right time, while controlling the amount and type of labor resources and maintaining productivity standards.


Innovative design

The PCMT is a spreadsheet-based document housed on the organization's intranet site. The tool is integrated with HR's workforce management system, allowing for continuous data feeds. It's comprised of a home page that links to six sections: 1) staffing grid, 2) optimal patterns report, 3) position control, 4) position variance, 5) skill mix summary, and 6) full-time equivalent (FTE) projections.


* The staffing grid includes the unit staffing matrix, which is based on the unit's operational budget. The staffing grid shows the budget neutral staffing plan at various census points and includes the direct care hours per patient day (DCHPPD). The grid denotes various job classifications (RN, patient care technician [PCT], and charge nurse) and is used by nursing leadership to support daily staffing decisions.


* The optimal patterns report includes optimal staffing configurations based on the planned average daily census and budgeted DCHPPD target. These configurations are derived from a sophisticated mathematical model that uses historical census and missed shifts to determine the most cost-effective staffing by the day of the week and shift. The optimal patterns report provides nursing leadership with unit-level FTE projections by job classification and shift.


* The position control is the foundation of the PCMT. Updated from the HR workforce management system, the tool captures all employees by shift, along with their respective title, job code, start date, FTE status, and any nonproductive status. The tool also tracks individual education levels, unit-based skills (such as charge nurse, intra-aortic balloon pump training, and continuous renal replacement therapy training), certifications, future nonproductive status, and anticipated termination dates.


* The position variance highlights any gap between the current FTE state (based on the position control) and the optimal FTE state, which is based on the optimal patterns report. The position variance displays data by job classification and shift. Gaps and overages in the FTE state are highlighted in green and red, respectively, for easy visualization of opportunities.


* The skill mix summary provides a visual depiction of positions and staff education levels that comprise the unit. For example, the skill mix summary offers an overview of job classes (RN, PCT, associate degree, baccalaureate degree, master's degree, and so on). This is utilized in unit-based goal setting and Magnet-required data analysis.


* The FTE projection gives nurse leaders a view of what FTE gaps can be anticipated up to four pay periods into the future based on future nonproductive status identified in the position control. These data support leaders in making future staffing decisions around utilization of contract labor or the acquisition of additional unit-based staff.



Workforce planning benefits

As nurse leaders, we're required to plan and execute a workforce to meet organizational demands while providing service levels that maximize productivity.4 The PCMT delivers an avenue for workforce planning by utilizing advanced labor strategies to make future projections. Information, including payroll, patient volumes, employee demographics, workload, staffing targets, and future nonproductive status, are input into a sophisticated algorithm to produce budget neutral predictive models for patient care demand and the needed workforce supply. Nurse managers, executive leaders, and HR staff members have real-time data at their fingertips to support staffing decisions for their unit. Because the PCMT is a spreadsheet-based document, leaders in nursing and HR have the ability to aggregate data at the unit, division, and organizational level.


The PCMT provides nurse leaders with additional benefits beyond workforce planning. The most commonly stated benefit includes the addition of the unit-based skill sets within the positon control section. This feature offers leaders the ability to develop a schedule that balances the specialized skill sets required to safely staff the unit. As a Magnet-recognized organization, the skill mix summary allows for quick visualization of the percentage of baccalaureate-prepared and certified nursing staff.


The right tool for the job

Most organizations understand the benefits of strategic planning. Many attempt to develop strategic staffing strategies; however, approaches are often unsuccessful and ineffective.5 The PCMT supplies nurse leadersss with an effective tool to make important decisions about unit staffing while maintaining productivity standards. It also provides a visual assessment so that unit-based and organizational staffing decisions can be made. In addition to its primary use, the PCMT can be used as evidence to support the appeal for open requisitions where needed. Aggregations can be performed at different organizational levels to give a global view of the system as a whole. This has improved our ability to monitor staffing budgets and given us the tools and transparency to make important decisions.




1. Goetz K, Janney M, Ramsey K. When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution. Nurs Econ. 2011;29(4):173-182. [Context Link]


2. American Organization of Nurse Executives. Nurse leader competencies. [Context Link]


3. Finn Partners. Predictive analytics in healthcare 2016: optimizing nurse staffing in an era of workforce shortages. [Context Link]


4. Lopes MA, Almeida AS, Almada-Lobo B. Handling healthcare workforce planning with care: where do we stand. Hum Resour Health. 2015;13:38. [Context Link]


5. Bechet T. Strategic Staffing: A Comprehensive System for Effective Workforce Planning. 2nd ed. New York, NY: Amacom; 2008. [Context Link]