Hours per Patient Day: Not the Problem, Nor the Solution.

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.

Building staffing science: two milestones.

Health care and nurse staffing present interesting challenges for nursing and health care leaders. The recently released Evidence and Excellence in Staffing (2nd edition) creates a framework for research and organizational improvement that leads to the development and sharing of best practices. A new model for staffing excellence has emerged with five core concepts. This new position paper calls for generating and disseminating 25-30 new best practices in nurse staffing across the care continuum over the next 3 years.

The CNO/CFO partnership: navigating the changing landscape.

With increasing pressure to cut costs, both real and immediate, and those forecasted and anticipated, the partnership and collaboration between nursing and finance will continue to take on new challenges. This partnership has historically been strained and does not always come easy due to differences in focus, different priorities, and inadequate communication, listening, and hearing. That needs to change and a strong CNO-CFO partnership is needed. Nursing leaders need to understand and appreciate the financial constraints and balance them with expected outcomes, and financial leaders need to understand and appreciate the core clinical business and what gaps in care mean to the financial viability of the organization and to patient outcomes. One health system developed a platform for change and is dedicated to the hard work involved in continuously working on those partnerships so when it comes to patient quality, safety, and financial performance, nursing and finance leaders are well positioned for future health care challenges.

Are your nurse managers ready for health care reform? Consider the 8 'Es'.

The most significant investment a nursing executive can make in an organization and to the delivery of quality patient care is the development of current and future front-line nurse managers. We are on the brink of massive changes in access and the delivery of health care. The front-line manager is in a critical position to make it all work and deliver what the public wants: better access, improved quality, and less cost. If front-line nurse managers are key stakeholders and will undoubtedly play a major role in health care reform, are they ready? Nurse leaders must evaluate, educate, embrace, enable, empower, espouse, engage, and excite frontline nurse managers in order to expand health care services efficiently and effectively.

Beyond the classroom to coaching: preparing new nurse managers.

Few would question that frontline nurse managers are critical to the success of any organization. They are the key interface with patients, nursing staff, medical staff, other clinical and ancillary staff, and administration. This makes the role one of the most difficult and one of the most important in any healthcare setting. Despite the importance of the role, many new managers receive little, if any, formal preparation. While hospitals are starting to send nurse managers to formal educational programs, the new manager receives little benefit if they do not have help putting it into practice. Even when there is a preceptor, chances are that new managers are still not getting what they need. Preceptors have multiple demands on their time and little, if any, formal preceptor training. One hospital that has successfully tackled this issue is Bryn Mawr Hospital, a Main Line Health System Magnet-designated hospital in suburban Philadelphia. Bryn Mawr Hospital engaged an experienced nurse executive to coach new nurse managers for 4 months on site. While participants agree face-to-face coaching is the most important component of this program, they also say having a seasoned coach gives them the confidence to ask questions they would not have felt comfortable exploring otherwise.