calculate full-time equivalents for a nursing unit and analyzing a variance scenario.
Answer the questions and complete the calculations required for the two sections of the assignment.
• Calculations of full-time equivalents (FTEs)
• Variance analysis
Submit your answers on a Word document, with the heading of Week 4 Assignment. For the questions requiring a written response, please adhere to proper grammar and syntax, and provide references.
For the questions requiring calculations, show all your work and follow the format that has been provided for the calculations in the lesson for Week 4.
PREPARING THE PAPER
Section One—Calculation of Full-Time Equivalents
Personnel Budget Case Study
Linda Watson has recently accepted a position as the assistant administrator for the department of nursing at St. Joseph Hospital. There have been both personnel and financial problems at St.
Joseph Hospital, and recently, the Catholic Healthcare System purchased the hospital. Like Linda, all of the management staff is new. Linda’s first priority is to assist the nurse managers in
preparing their cost centers’ personnel budgets for the coming fiscal year. She has decided to begin with the nurse manager on 1 West, a step-down nursing unit. Linda wants to do extensive data
collection and create a solid base for making projections.
1. Suggest all the information Linda needs to collect to prepare a budget for 1 West; be sure to include background data on the unit itself as it relates to previous budgets, nursing staff, and the
organization. In other words, summarize your approach to this Case Study—briefly state the organization’s goals (customer-service orientation) for the coming year, trends, any changes in trends
that you may anticipate—such as growth in the patient population and the types of data that need to be collected in order to make decisions about staffing levels and ratios.
2. Linda has collected the following information, in addition to what was asked in question number one:
Average Daily Census 30
Unit Capacity 32
Average HPPD 8.8
Total Care Hours 96,360
Productive hours/employee/year 1,780
Nonproductive hours/employee/year 300
Total Hours/employee/year 2,080
Nurse aides 10%
Average Salary per Employee Category:
Nurses Aide $14.00/hour
Calculate the number of productive full-time equivalents (FTEs) that would be needed. Show your calculations.
3. How many RNs, LVNs, and nurses aides will be needed to staff this unit, assuming staff will be working 12-hour shifts? In other words, how many person-shifts will be required during a 24-hour
Day Shift 50%
Night Shift 50%
4. Assign staff by type and by shift.
Day Shift 50%
Night Shift 50%
5. Convert staff positions to FTE positions.
Section Two—Variance Analysis
Variance Analysis Case Study
During the month of February, an outpatient surgery clinic has incurred a significant unfavorable variance. The director of the clinic is quite concerned, as this has never occurred before. The
director gathers information on total nursing care hours, average hourly rate of the employees, and total patient visits to determine what caused the variance. In addition, the director receives
the patient acuity levels for the month of February.
1. BPi $40.00
2. BQi 5.0 hours per care per patient
3. BQo 340 visits
4. APi $45.00
5. AQi 5.6 hours per care per patient
6. AQo 400 visits
1. Compare the original budget to the flexible budget and calculate the volume variance. Compare the flexible budget to the actual budget and determine the price and quantity variances. Work
through the entire analysis process as presented in your lesson for Week 4, and remember to show your calculations.
2. What factors caused the difference in the variances? Analyze all the factors that made the differences and why the variances occurred.
Category Points % Description
Background Information 15 15% Typically, the description of the maximum level of performance is provided here
Calculation of Full-Time Equivalents (FTEs) 10 10%
Shifts Required During a 24-Hour Period
Staff Assigned by Type and Shift 10 10%
Staff Positions to FTEs 10 10%
Calculation of Volume Variance 10 10%
Calculations of Price and Quantity 10 10%
Calculation of Total Variance 10 10%
Analysis of Variances 15 15%
A quality assignment will meet or exceed all of the above requirements.
Assignment Criteria Exceptional
Outstanding or highest level of performance Exceeds
Very good or high level of performance Meets
Competent or satisfactory level of performance Needs Improvement
Poor or failing level of performance Developing
Unsatisfactory level of performance
Possible Points = Points
Background Information 15 Points 13 Points 12 Points 6 Points 0 Points
Background information for budget analysis is thoroughly and clearly identified and stated. Background information for budget analysis is partially identified and stated, but could be more thorough
or clear. Background information for budget analysis lacks thorough and clear statements. Background information for budget analysis is minimally identified and stated. Background information for
budget analysis is not identified or stated.
Calculation of Full-Time Equivalents (FTEs) 10 Points 0 Points
Calculation of FTEs is correct. Calculation of FTEs is incorrect.
Shifts Required During a 24-Hour Period
10 Points 0 Points
Shifts required during a 24-hour period are correctly calculated. Shifts required during a 24-hour period are incorrectly calculated.
Staff Assigned by Type and Shift 10 Points 5 Points 0 Points
Staff assigned by type and shift are correctly calculated.
Staff assigned by type is correctly calculated; staff assigned by shift is incorrectly calculated.
Staff assigned by type is incorrectly calculated; staff assigned by shift is correctly calculated.
Suggest: One of the following is not correctly calculated: staff assigned by type or staff assigned by shift. Both staff assigned by type and by shift are not correctly calculated.
Staff Positions to FTEs 10 Points 0 Points
Calculation of staff positions to FTEs is correct. Calculation of staff positions to FTEs is incorrect.
Calculation of Volume Variance 10 Points 0 Points
Calculation of Volume Variance is correct. Calculation of Volume Variance is incorrect.
Calculations of Price and Quantity Variance 10 Points 0 Points
Calculation of Flexible Budget Variance is correct. Calculation of Flexible Budget Variance is incorrect.
Calculation of Total Variance 10 Points 0 Points
Calculation of Total Variance is correct. Calculation of Total Variance is incorrect.
Analysis of Variances 15 Points 13 Points 12 Points 6 Points 0 Points
Analysis of variances is thoroughly and clearly identified and stated. Analysis of variances is adequately identified and stated. Analysis of variances is partially identified and stated. Analysis
of variances is minimally identified and stated. Analysis of variances is not identified and stated.
Content Subtotal 100 of points
Total Points _____of points
With the current economic climate of healthcare, the nurse executive needs to be proficient in the management of fiscal and human resources. A key component of the nurse-executive role, as
identified by the American Organization of Nurse Executives (AONE) Nurse Executive Competencies (AONE, 2005) is business skills. Business skills encompass both financial management and human-
resource management. The first step in either area is an assessment of the resources of the organization, the strategic plan for the organization, and current needs of the organization. Without
this assessment, the nurse executive cannot effectively develop and manage resources.
“What is a budget? In simple terms, a budget is a statement of a financial plan over a period of time. A budget provides guidance on how the resources of an institution will be used to meet its
strategic plan. The organization’s financial performance is measured against the budget. In some healthcare institutions, middle- and upper-level managers’ performance appraisals and incentives are
aligned with the fiscal performance of the institution.
The nurse executive will start the budgeting process by comparing the actual results of the prior fiscal year with the proposed budget of that year. This review also involves an evaluation of the
outcomes of the strategic plan against the budget. The next step in the process is to review the current strategic plan, determine the resources needed to meet the goals for patient care, and
establish the needs of the nursing department. To accomplish that step, the nurse executive must have, at minimum, the following data: patient days, patient acuity, length of stay, staffing model,
staff mix, number of open positions by level, number of anticipated vacancies by level, cost of agency staff by unit, projected salary increases and bonuses, cost of staff benefits, educational
needs of the staff in the upcoming fiscal year, and anticipated nonproductive staff time. Other information that will be crucial to the budgeting process will include any anticipated regulatory
changes, regulatory surveys anticipated for the fiscal year, status of equipment on nursing units, and anticipated changes in reimbursement. The nurse executive cannot develop the budget in
isolation. Input by nurse managers, unit directors, the finance department, and the human resource department is critical to a successful budget development cycle.
Calculating a Salary Budget
The salary budget is generally the largest element in the budget of the organization. The salary budget is established by determining the number of full-time-equivalent (FTE) staff needed for the
fiscal year. To prepare a salary budget, the first step is to figure out the volume of work for the coming year. The amount of work performed by a unit/department is referred to as the workload.
Workload can be measured in a variety of ways, such as the number of patient days, number of outpatient visits, and number of operations per day. Each cost center determines the measure that is
most appropriate for its unit of service. The next step of the budget process will be to predict the number of units of service that will be provided the coming year. This is usually based on the
past year’s number of units, plus a predicted incremental increase for the coming year, based on population increases and needs.
Budgeting is based on a patient-classification system, which is the amount of resources used related to different levels or categories of patient acuity. For example, let’s say that a certain
cardiac-observation unit is forecasting 12,500 patient-days for the coming year. Assume that this unit classifies these 12,500 patients into one of four categories: category one being fewest
resources used or lowest acuity; and category four being most resources used or highest acuity patients. Assume that, for category one, the average-patient-care-hours equals 1.5 hours of nursing
care provided to these patients during a 24-hour period; for category two, 5.0 care hours; for category three, 8.0 care hours; and, for category four, 12.0 hours of nursing care is provided to
these patients during a 24-hour period. Hours-per-patient-day (HPPD) is the number of hours of nursing care delivered per patient. To calculate HPPD, the total-care-hours required for the year is
divided by the number of patient days.
Calculating Hours Per-patient-day
1. Establish Hours-Per-Patient-Day (HPPD)
a. Calculate the total-care-hours required for the year:
# of Patient Days X Average Care Hours/24 Hours = Total Care Hours
1 1,000 1.5 = 1,500
2 2,500 5.0 = 12,500
3 4,000 8.0 = 32,000
4 5,000 12.0 = 60,000
12,500 106,000 total-care-hours needed
b. Calculate the hours-per-care-per-patient-day (HPPD):
Total-Care-Hours Required for the Year / Number of Patient Days
106,000 / 12,500 = 8.48 care hours
Thus, for this cardiac observation unit, an average of 8.48 nursing-care hours are provided to patients per a 24-hour period. Once the manager has the workload forecasted, the next step is to
determine the staff requirements for the unit. Staff mix varies from hospital to hospital and may consist of RNs, LPNs, and aides. The manager needs to determine how many full-time equivalents
(FTEs) will be required to provide patient care. One FTE is equivalent to 2,080 hours per year (40 hours per week times 52 weeks). A 0.9 FTE is equivalent to 36 hours per week; a 0.6 FTE is equal
to 24 hours per week. If the manager calculated FTE requirements by dividing total-care-hours by 2,080 to determine the number of FTEs for the unit, this would underestimate the needed FTEs. This
calculation would assume that all 2,080 paid hours were worked by the staff member. However, employees take vacation time, sick leave, and educational days—which are nonworked time, or
nonproductive hours. Instead, we must relate to productive hours rather than paid hours. Data on nonproductive hours are generally provided by the institution’s payroll department and equal between
15–20% of paid hours. In our example, let’s say that productive hours equal 85% of the employee time worked, which would equal 1,768 productive hours.
2. Apply HPPD to Census and Determine Full-Time Equivalents (FTEs)
a. Determine FTE requirements for number of expected patient -care hours:
Total Care Hours /1,768 productive hours per FTE
(1,768 = 85% of 2,080; 40 hours per week X 52 weeks per year = 2,080; less vacation, sick, education time)
106,000 / 1,768 = 59.95 FTEs = 60 FTEs
Next, the manager must determine how to allocate the number of FTEs per position type and shifts. To calculate how many staff members will be working every day, first determine the number of care
hours that are required per day.
3. Establish Positions by Type and Shift
a. Calculate number of staff required per 24-hour period:
Divide total care hours by 365 days per year
106,000 / 365 = 290 hours of care per day
Assuming employees work 12 hour shifts:
290 / 12 = 24.2 shifts per 24-hour period
Let’s say in our example, 80% of the shifts are allocated to RNs and 20% to aides. Assume that 50% of the RN/aide shifts are for day shift (7a–7p) and 50% for the night shift (7p–7a).
Staff Requirements Continued
3. b. Assign staff by type:
80% RN staff; 20% aides
.80 X 24.2 = 19.4 RN shifts ? 20 RN shifts
.20 X 24.2 = 4.8 aide shifts ? 4 aide shifts
c. Assign staff by shift:
Day Shift Night Shift Total
RNs 9.7 ? 10 9.7 ? 10 19.4 ? 20
Aides 2.4 ? 2 2.4 ? 2 4.8 ? 4
To establish staff positions, it is important to calculate the relationship between shifts per day and FTEs. This is the point where replacement is accounted for as well assuring that the unit is
covered 24/7—the number of staff who are needed to the number of FTEs to be employed.
Staff to FTE
4. Convert Staff Positions to FTE Positions
a. Calculate FTEs by type and shift:
Divide total FTEs required by the 24.2 daily staff shifts
59.95 / 24.2 = 2.48
Each person-shift calls for employing 2.47 FTEs. An adequate number of FTEs are needed to provide coverage for the other 3–4 days out of the week, vacation, sick time, and education time.
Multiply 2.47 by the staff type needed per shift.
RNs days = 2.48 X 10 = 24.8
RNs nights = 2.48 X 10 = 24.8 (50 RNs)
Aides days = 2.48 X 2 = 4.96
Aides nights = 2.48 X 2 = 4.96 (10 aides)
59.5 FTEs = 60FTEs
Variance analysis is the difference between the actual results and the planned results, or the amount by which the results vary from the budget. Variances are calculated for three reasons. One is
to aid in preparing the budget for the coming year and future planning. The second reason is to aid in controlling results throughout the current year. By understanding why variances are occurring,
actions can be taken to eliminate some of the unfavorable variances over the coming months. The third reason is to evaluate the performance of units or departments and their managers.
At the end of a given time period, the organization compares actual results with the budget. Most organizations do this on a monthly basis. The simplest approach is to compare the total costs for
the entire organization with the budgeted costs for the organization. For example, suppose a hospital incurred $5 million in expenses and was budgeted for $4 million in expenses for the year; the
organization spent $1 million more than it had budgeted. The difference between the amount budgeted and the amount actually incurred is the total hospital variance. This variance is referred to as
an unfavorable variance because the organization spent more than was budgeted.
The volume variance is defined as the amount of variance caused simply by the fact that the patient volume has changed. For example, if the budget calls for 25,000 patient days, and there were
actually 30,000 patient days, it would be expected that it would be necessary to spend more to care for the additional 5,000 patients. The additional cost of resources needed to care for the
additional 5,000 patients constitutes the volume variance.
The price variance is the portion of the total variance caused by spending more or less per unit—for some resources—than had been anticipated. For example, if the average wage rate for nurses is
more per hour than was anticipated with the use of agency nurse or overtime, it would give rise to a price variance. Price variance could also be related to supplies. The purchasing department
predicts all prices used for supplies; if there is a variance, this may be related to paying higher prices than anticipated for patient supplies.
The third type of variance is the quantity variance. This portion of the overall variance for a particular line item that results from using more of a resource than was expected for a given work
load. For example, if more supplies were used per patient day than expected, that would give rise to a quantity variance, because the quantity, or number, of supplies used per patient day exceeded
expectations. Basically, this variance focuses on how much resources were used. If more nursing care resources were used per patient than was budgeted, this would translate into greater hours-per-
care per patient.
Flexible Budget Variance
Suppose that during the month of May, the 2nd-floor critical-care unit (CCU) at Wagner Hospital incurs a total variance of $57,840U (unfavorable). The unit manager of the CCU is extremely concerned
and wants to find out what caused the variance. To do so, the manager gathers the following information for the month of May: patient days (actual and forecasted), average pay rate for nurses, and
the budgeted hours-per-patient-day.
BPi = budgeted price—$33.00 per-hour budgeted nursing rate
BQi = budgeted quantity—12.0 hours- per- care per patient
BQo = 240 budgeted patient days
APi = $42.00 per-hour actual nursing rate
AQi = 14.0 actual hours-per-care per patient
AQo = 260 actual patient days
Suppose that the CCU had the following line item in their variance report for the month of May:
Actual Budget Variance
Nursing Labor $152,880 $95,040 $57,840 U
1. The first step for the manager is to calculate the original budget in terms of cost per patient day. In order to calculate cost per patient day, the manager multiplies the budgeted price by
budgeted quantity: $33.00 X 12.0 = $396 per patient day. For the month of May, 240 patient days are expected, and the budget is: $396 X 240 = $95,040.
BPi X BQi X BQo
$33 X 12.0 X 240
2. The next step for the manager is to find the change in volume of the flexible budget. This is the amount the manager would have expected to spend if the actual number of patient days would have
been known. The only change at this point is from BQo of 240 patient days to the new AQo of 260 actual patient days. The manager calculates the flexible budget as follows.
BPi X BQi X AQo
$33 X 12.0 X 260
Then, the manager compares the original budgeted amount to the flexible budgeted amount to determine the volume variance.
Flexible Budget Original Budget
BPi X BQi X AQo BPi X BQi X BQo
$33 X 12.0 X 260 $33 X 12.0 X 240
The difference between the original budget and the flexible budget is caused by a difference in the number of patient days. The volume variance is 7,920 U. Since patient days are higher than
expected, cost will be higher than expected. However, the manager notes that $49,920 of the variance still remains to be unaccounted for.
3. At this point, the manager compares the flexible budget to the actual budget in order to find the flexible-budget variance. The actual hours-per care, the actual average-price paid-per=nurse,
and the actual number- of-patient-days are used.
Actual Budget Flexible Budget
APi X AQi X AQo BPi X BQi X AQo
$42 X 14.0 X 260 $33 X 12.0 X 260
4. The manager is simply breaking down the total variance into parts. Next, the manager combines the volume variance with the flexible-budget variance to determine the total variance.
Actual Budget Flexible Budget Original Budget
APi X AQi X AQo BPi X BQi X AQo BPi X BQi X BQo
$42 X 14.0 X 260 $33 X 12.0 X 260 $33 X 12.0 X 240
$152,880 $102,960 $95,04
Flexible Budget Volume
$49,920 U $7,920 U
At this point, the total variance has been broken down into a flexible-budget variance and volume variance. The flexible-budget variance is of greater concern to the nurse manager. The volume
variance is from changes in patient days and is usually outside of the manager’s control.
5. In order to find out what is causing the greatest variance in the flexible budget, the manager separates the budget into two pieces: the price variance (average nursing rate per hour) and the
quantity variance (hours per care). First, the manager determined if any part of the variance in the flexible budget was caused by differences in the quantity—or, nursing-care hours. In other
words, did the added patient days have an effect on the quantity of nursing time per patient? To do this, a new budget category is created, called the subcategory. The subcategory is compared to
the flexible budget—which equals the difference between actual patient-care hours compared to the patient-care hours that were budgeted. The AQo is the actual volume for both categories. The BQi is
the budgeted price-per-hour-of-nursing- time. The only difference between the two categories is the AQi, or the patient-care hours.
Subcategory Flexible Budget
BPi X AQi X AQo BPi X BQi X AQo
$33 X 14.0 X 260 $33 X 12.0 X 260
The quantity variance, or hours per care, was related to the patient population being more acuity ill, thus requiring more patient-care hours, and usage of agency personnel who were not as
efficient in caring for patients due to their unfamiliarity with the institution.
Second, the manager determines if some part of the flexible-budget variance was caused by differences in nursing-rate per hour. The Qi, or quantity (patient-care hours), is the actual value for
both. The Qo, or the volume, is the actual value for both. The price is the only difference. Thus, to calculate the price variance, compare the subcategory to the actual budget—this is the
difference between the average hourly rate paid to nurses versus the average hourly rate budgeted.
Actual Budget Subcategory
APi X AQi X AQo BPi X AQi X AQo
$42 X 14.0 X 260 $33 X 14.0 X 260
The price variance of $32,760 results from the fact that, on average, $42 was paid per hour for nursing time instead of the budgeted $33. This was due to an excessive amount of overtime and use of
agency nurses due to a greater workload of patients and a nursing shortage (i.e., several senior nurses retired, several nurses changed units/hospitals/careers due to burn-out, and hospital has a
policy to hire only seasoned critical-care nurses to work in their CCU).
6. Finally, the manager incorporates the price and quantity variance together to note how they compromise the flexible-budget variance:
Actual Budget Subcategory Flexible Budget
APi X AQi X AQo BPi X AQi X AQo BPi X BQi X AQo
$42 X 14.0 X 260 $33 X 14.0 X 260 $33 X 12.0 X 260
$152,880 $120,120 $102,960
Price Variance Quantity Variance
In conclusion, it can be determined that the total variance was caused by only a slight increase in patient volume, yet a higher acuity of patients—causing a greater usage of overtime and agency
nurse utilization resulting in a higher average rate paid to nurses.
Actual Subcategory Flexible Budget Original Budget
APi X AQi X AQo BPi X AQi X AQo BPi X BQi X AQo BPi X BQi X BQo
$42 X 14.0 X 260 $33 X 14.0 X 260 $33 X 12.0 X 260 $33 X 12.0 X 240
$152,880 $120,120 $102,960 $95,040
Price Variance Quantity Variance
Flexible Budget Variance Volume Variance