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Multi-Hospital Nurse Staffing Effort


In the summer of 2008, a four hospital system contacted DHCG desiring to improve its Nursing Division staffing requirements.  Fifty-six nursing units within the four hospitals were included in the project. These nursing units included the typical acute care units, Labor and Delivery, NICU, Emergency Department and all critical care units.  Delta HCG devised a method whereby certain units were designated as a model for all other similar units.  These model units served as a baseline for determining the staffing on their “sister” units.  Employing work sampling (direct observation), census adjusted staffing guides, and industry benchmarks, DHCG consultants determined the staffing requirements for all 56 units in a three month period of time.  DHCG also utilized these methods to fine-tune the resource staffing pool for all four hospitals.  Hourly staffing patterns were designed for the Emergency Departments and Labor and Delivery.

Goal of the Project

The overall goal of the project was to develop viable staffing on all shifts for all units.  Non-direct patient care, such as management, training, education, and orientation, were also accommodated in the staffing requirements.  NDNQI, NACHRI, and DHCG benchmarks were used to compare developed HPPD requirements.  The hospitals did not use an acuity system.


DHCG consultants utilized the following five approaches to analyze the data and make recommendations:

1. Data Analysis:  Census data were acquired for all 56 units for a 12 month period and broken into seasons; showing high, medium and low census seasons.

2. Census Adjusted Staffing Guides:  DHCG developed a sensitive census adjusted staffing guide approach to determine staffing levels and their impact at each census level on the overall staffing requirement.  These census adjusted guides were reviewed with each manager to determine appropriate breaks in census when skill mix changes needed to be made.

3. Observations:  A minimum of 24 hours was spent in each model nursing unit observing activities performed by each nurse every 10-15 minutes. The patient flow, work flow, and staffing of those departments was assessed during these 24 hours of work sampling.

4. Benchmarking:  Benchmarks drawn from NDNQI, NACHRI, and DHCG’s own database were used to validate the development of the HPPD requirements derived from the Census Adjusted staffing guide approach and the work sampling approach.

5. Analysis:  Information gleaned from the previous four steps was compiled and analyzed.  With this information, recommendations for staffing and process improvements were made.  Cost and benefits were attached to each recommendation.  This information was used to right size the Nursing Resource Pool and assist in reducing the use of travelers.


Outcomes from this project were:

Net Staff savings:  23 FTEs (inclusive of having to add staff in areas of shortfall)

Net Cost Savings: $1.9 million annually


The client consisted of four hospitals with bed capacities of:

  • 368 Beds (including a small Children’s Hospital)
  • 349 Beds
  • 291 Beds
  • 427 Beds