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EXECUTIVE SUMMARY
* Hours per patient day (HPPD) is a metric that is easy to use in determining budgeted FTE and in comparing staffing across organizations.
* There are many considerations in determining the appropriate HPPD.
* The combination of automated patient acuity, staffing, and human resource systems provide a wealth of information for determining the budgeted HPPD and in making defensible requests for adjustments in HPPD.
* No matter how much data we have about staffing levels, nurse education and skill levels, the environment of care, or patient acuity, the real key is determining the outcomes we need to compare staffing against.
* We must quantify the savings associated with positive outcomes and get this information in the hands of the public so they can make informed decisions.
Despite the fact that hours per patient day (HPPD) is a metric that has been used for decades to budget nursing departments and examine nursing productivity, there is growing criticism HPPD is inadequate in determining or evaluating appropriate nurse staffing (Douglas, 2014; Jenkins & Welton, 2014). In a recent presentation by Dr. Linda Aiken (2014), she wisely stated HPPD is not a metric you would want to use with patients. If you tell patients they are receiving 8 hours of nursing care per day, they may wonder what is happening the other 16 hours of their hospital day. Patients are more likely to understand that a nurse is taking care of three patients at a time.
While this makes sense for patients, there are other considerations for internal and external comparisons and budgeting. Some believe staffing ratios are the answer to determining appropriate staffing and others recommend using patient assignments (Jenkins & Welton, 2014), but in reality it all boils down to hours per patient day, whether it is registered nurse (RN) hours per patient day, worked hours per patient day, direct hours per patient day, or paid hours per patient day. Hours per patient day is a metric that is easy to use in determining budgeted full-time equivalents (FTE) and in comparing staffing across organizations. It is a metric we can relate to and quickly translate into how many patients are assigned to one staff member. It can also be used to translate the...