Cost of nursing turnover in a Teaching Hospital / Costo de la rotatividad del equipo de enfermería en Hospital de Enseñanza / Custo da rotatividade da equipe de enfermagem em hospital de ensino

Abstract OBJECTIVE To map the sub processes related to turnover of nursing staff and to investigate and measure the nursing turnover cost. METHOD This is a descriptive-exploratory study, classified as case study, conducted in a teaching hospital in the southeastern, Brazil, in the period from May to November 2013. The population was composed by the nursing staff, using Nursing Turnover Cost Calculation Methodology. RESULTS The total cost of turnover was R$314.605,62, and ranged from R$2.221,42 to R$3.073,23 per employee. The costs of pre-hire totaled R$101.004,60 (32,1%), and the hiring process consumed R$92.743,60 (91.8%) The costs of post-hire totaled R$213.601,02 (67,9%), for the sub process decreased productivity, R$199.982,40 (93.6%). CONCLUSION The study identified the importance of managing the cost of staff turnover and the financial impact of the cost of the employee termination, which represented three times the average salary of the nursing staff.

Resumen OBJETIVO Mapear los subprocesos relacionados con la rotatividad del equipo de enfermería y medir el costo de la rotatividad del equipo de enfermería. MÉTODO Estudio exploratorio-descriptivo, en la modalidad de estudio de caso, llevado a cabo en hospital de enseñanza del sudeste de Brasil, en el período de mayo a noviembre de 2013. La población estuvo compuesta del equipo de enfermería, utilizándose la metodología para el cálculo de costo de la rotatividad. RESULTADOS El costo total de la rotatividad fue de R$314.605,62 y, por colaborador, varió de R$2.221,42 a R$3.073,23. Los costos consecuentes de la pre contratación totalizaron R$101.004,60 (32,1%), siendo que el proceso plazas consumió R$92.743,60 (91,8%). Los costos referentes a la post contratación totalizaron R$213.601,02 (67,9%) y, para el subproceso de disminución de la productividad, R$199.982,40 (93,6%). CONCLUSIÓN El estudio permitió identificar la importancia de la gestión del costo de la rotatividad de personal y el impacto financiero del costo del colaborador alejado, que representó tres veces el sueldo medio del equipo de enfermería.

Resumo OBJETIVO Mapear os subprocessos relacionados à rotatividade da equipe de enfermagem e mensurar o custo da rotatividade da equipe de enfermagem. MÉTODO Estudo exploratório-descritivo, na modalidade de estudo de caso, realizado em hospital de ensino do sudeste do Brasil, no período de maio a novembro de 2013. A população foi composta pela equipe de enfermagem, utilizando-se a metodologia para o cálculo de custo da rotatividade. RESULTADOS O custo total da rotatividade foi de R$314.605,62, e por colaborador variou de R$2.221,42 a R$3.073,23. Os custos decorrentes da pré-contratação totalizaram R$101.004,60 (32,1%), sendo que o processo vagas consumiu R$92.743,60 (91,8%). Os custos referentes à pós-contratação totalizaram R$213.601,02 (67,9%), e para o subprocesso de diminuição da produtividade, R$199.982,40 (93,6%). CONCLUSÃO O estudo permitiu identificar a importância do gerenciamento do custo da rotatividade de pessoal e o impacto financeiro do custo do colaborador desligado, que representou três vezes o salário médio da equipe de enfermagem.

Financial impact of nursing professionals staff required in an Intensive Care Unit / Impacto financeiro do quadro de profissionais de enfermagem requerido em Unidade de Terapia Intensiva / Impacto financiero de la dotación de profesionales de enfermería requerida en la unidad de cuidados intensivos

ABSTRACT Objective: to calculate the cost of the average time of nursing care spent and required by patients in the Intensive Care Unit (ICU) and the financial expense for the right dimension of staff of nursing professionals. Method: a descriptive, quantitative research, using the case study method, developed in adult ICU patients. We used the workload index - Nursing Activities Score; the average care time spent and required and the amount of professionals required were calculated using equations and from these data, and from the salary composition of professionals and contractual monthly time values, calculated the cost of direct labor of nursing. Results: the monthly cost of the average quantity of available professionals was US$ 35,763.12, corresponding to 29.6 professionals, and the required staff for 24 hours of care is 42.2 nurses, with a monthly cost of US$ 50,995.44. Conclusion: the numerical gap of nursing professionals was 30% and the monthly financial expense for adaptation of the structure is US$ 15,232.32, which corresponds to an increase of 42.59% in the amounts currently paid by the institution.

RESUMO Objetivo: calcular o custo do tempo médio de assistência de enfermagem despendido e requerido pelos pacientes internados em Unidade de Terapia Intensiva (UTI) e o dispêndio financeiro para adequação do quadro de profissionais de enfermagem. Método: pesquisa descritiva, quantitativa, na modalidade de estudo de caso, desenvolvida na UTI de pacientes adultos. Utilizou-se o índice de carga de trabalho - Nursing Activities Score; o tempo médio de assistência despendido, requerido e o quantitativo de profissionais requerido foram calculados por meio de equações e, a partir desses dados, e de valores da composição salarial dos profissionais e tempo mensal contratual, calculou-se o custo da mão de obra direta de enfermagem. Resultados: o custo mensal do quantitativo médio de profissionais disponível foi de US$ 35.763,12, correspondendo a 29,6 profissionais, e o requerido para 24 horas de cuidado é de 42,2 profissionais de enfermagem, com custo mensal de US$ 50.995,44. Conclusão: a defasagem numérica de profissionais da enfermagem foi de 30% e o dispêndio financeiro mensal para adequação do quadro é de US$ 15.232,32, o que corresponde a um acréscimo de 42,59% nos valores atualmente desembolsados pela instituição.

RESUMEN Objetivo: calcular el costo del tiempo promedio de asistencia de enfermería invertido y requerido por los pacientes internados en la unidad de cuidados intensivos (UCI) y el gasto para la adecuación de la dotación de profesionales de enfermería. Método: investigación descriptiva y cuantitativa en la modalidad de estudio de caso desarrollada en la UCI de pacientes adultos. Se utilizó el índice de carga de trabajo Nursing Activities Score; el tiempo promedio de asistencia invertido y requerido y la cantidad de profesionales necesaria se calculó con ecuaciones y, a partir de estos datos y de los valores de la composición de salario de los profesionales y el tiempo de contrato mensual, se calculó el costo de la mano de obra directa de enfermería. Resultados: el costo mensual de la cantidad promedio de profesionales disponible fue de US$ 35,763.12, que corresponde a 29.6 profesionales, mientras que el requerido para 24 horas de atención es de 42.2 profesionales de enfermería, con un costo mensual de US$ 50,995.44. Conclusión: el desfase numérico de profesionales de enfermería fue de 30% y el gasto mensual para la adecuación de la dotación es de US$ 15,232.32, que corresponde a un incremento de 42.59% en los valores que actualmente desembolsa la institución.

Quadro de profissionais de enfermagem em unidades médico-cirúrgicas de hospitais de ensino: composição e custos / Cuadro de los profesionales de enfermería en las unidades médico-quirúrgicas de los hospitales de enseñanza: composición y costos / Nursing staff in the internal medicine and surgical units of teaching hospitals: composition and cost

RESUMO Objetivo Avaliar o quadro quanti-qualitativo médio de profissionais de enfermagem em serviço nas unidades médico-cirúrgicas de três hospitais gerais, públicos e de ensino, do município de São Paulo frente ao quadro médio projetado, segundo parâmetros da Resolução Cofen nº 293/04 e mensurar o custo médio dos quadros em serviço e projetado. Método Estudo quantitativo, exploratório descritivo, com coleta prospectiva de dados. Resultados Na maioria das unidades estudadas o quadro de profissionais de enfermagem está quantitativamente adequado. Em duas Instituições a proporção de enfermeiras é inferior ao preconizado pelo Cofen. O ajuste quali-quantitativo do quadro representaria acréscimo mensal de R$ 141.325,92 para o Hospital A; R$ 138.988,80 para o Hospital B e redução de R$ 99.028,00 para o Hospital C. Conclusão A principal contribuição deste estudo reside na proposição de um método para avaliação quali-quantitativa do quadro de profissionais de enfermagem, bem como para determinação do custo médio de sua adequação.

RESUMEN Objetivo Evaluar el promedio del cuadro cuantitativo y cualitativo de los profesionales de enfermería que prestan servicio en las unidades médico-quirúrgicas de tres hospitales generales, públicos y de enseñanza, del municipio de São Paulo, frente al cuadro medio proyectado según los parámetros de la Resolución Cofen n° 293/04 y mensurar el promedio de costo de los cuadros en servicio y proyectado Método estudio cuantitativo, descriptivo, exploratorio, con recolección prospectiva de datos. Resultados en la mayoría de las unidades estudiadas el cuadro de los profesionales de enfermería está cuantitativamente adecuado. En dos instituciones, la proporción de enfermeras es inferior a la recomendada por el Cofen. El ajuste cualitativo y cuantitativo del cuadro representa un incremento mensual de R$ 141,325.92 para el Hospital A; R$ 138,988.80 al hospital B y la reducción de R$ 99,028.00 al hospital C. Conclusión la principal contribución de este estudio está en proponer un método de evaluación cualitativa y cuantitativa de los profesionales de enfermería, así como para determinar el promedio de costo de su adecuación.

ABSTRACT Objective Evaluate the mean quantitative and qualitative nursing staff working in the internal medicine and surgical units of three public general teaching hospitals in the city of São Paulo, compared to projected mean staff according to the parameters of Cofen Resolution No. 293/04, as well as measure the mean cost of current and projected nursing staff. Method Quantitative, descriptive, exploratory study using prospective data collection. Results In most of the units studied, the number of nursing professionals was adequate. In two of the institutions, the percentage of nurses was lower than that recommended by Cofen. Qualitative and quantitative adjustment of the staff would represent a monthly cost increase of R$141,326 for Hospital A, R$138,989 for Hospital B, and a reduction of R$99,028 for Hospital C. Conclusion The main contribution of this study was the proposed method for qualitative and quantitative evaluation of nursing staff, in addition to determining the average cost for adjustments.

Total staff costs to implement a decision support system in nursing / Custo total com pessoal para implementação de um sistema de apoio à decisão em enfermagem / Costo total con personal para implementación de un sistema de apoyo a la decisión en enfermería

OBJECTIVE: to identify the direct labor (DL) costs to put in practice a decision support system (DSS) in nursing at the University Hospital of the University of São Paulo (HU-USP). METHOD: the development of the DSS was mapped in four sub-processes: Conception, Elaboration, Construction and Transition. To calculate the DL, the baseline salary per professional category was added to the five-year additional remuneration, representation fees and social charges, and then divided by the number of hours contracted, resulting in the hour wage/professional, which was multiplied by the time spend on each activity in the sub-processes. RESULTS: the DL cost corresponded to R$ 752,618.56 (100%), R$ 26,000.00 (3.45%) of which were funded by a funding agency, while R$ 726,618.56 (96,55%) came from Hospital and University resources. CONCLUSION: considering the total DL cost, 72.1% related to staff wages for the informatics consulting company and 27.9% to the DL of professionals at the HU and the School of Nursing. .

OBJETIVO: identificar os custos com mão de obra direta para a implementação de um sistema de apoio a decisão em enfermagem no Hospital Universitário da Universidade de São Paulo. MÉTODO: o desenvolvimento do sistema de apoio à decisão foi mapeado em quatro subprocessos: concepção, elaboração, construção e transição. Calculou-se a mão de obra direta utilizando-se a somatória do salário-base, por categoria profissional, mais os quinquênios, verbas de representação e encargos sociais, dividindo-os pelo número de horas contratuais, obtendo-se o salário-hora/profissional que foi multiplicado pelo tempo despendido em cada atividade dos subprocessos. RESULTADOS: o custo da mão de obra direta correspondeu a R$752.618,56 (100%), sendo R$26.000.00 (3,45%) procedentes de financiamento de órgão de fomento e R$726.618,56 (96,55%) de recursos do Hospital e da Universidade. CONCLUSÃO: do custo total com mão de obra direta, 72,1% referiu-se aos honorários dos profissionais de empresa de consultoria em informática e 27,9% destinou-se à mão de obra direta de profissionais do Hospital Universitário e da Escola de Enfermagem. .

OBJETIVO: identificar los costos con mano de obra directa (MOD) para la implementación de un sistema de apoyo a la decisión (SAD) en enfermería en el Hospital Universitario de la Universidad de Sao Paulo (HU-USP). MÉTODO: el desarrollo del SAD fue mapeado en cuatro subprocesos: Concepción, Elaboración, Construcción y Transición. Se calculó la MOD utilizando la sumatoria del salario base por categoría profesional más los quinquenios, verbas de representación y encargos sociales, dividiéndola por el número de horas contractuales, obteniéndose el salario hora/profesional que fue multiplicado por el tiempo utilizado en cada actividad de los subprocesos. RESULTADOS: el costo de la MOD correspondió a R$ 752.618,56 (100%), siendo R$ 26.000.00 (3,45%) procedentes de financiamiento de órgano de fomento y R$ 726.618,56 (96,55%) de recursos del Hospital y de la Universidad. CONCLUSIÓN: del costo total con MOD, 72,1% se refirió a los honorarios de los profesionales de empresa de consultoría en informática y 27,9% se destinó a la MOD de profesionales del HU y de la Escuela de Enfermería. .

Structure of Nurse Labor Market and Determinants of Hospital Nurse Staffing Levels

PURPOSE: To analyze the structure of Korean nurse labor market and examine its effect on hospital nurse staffing. METHODS: Secondary data were obtained from Statistics Korea, Education Statistics, and Health Insurance Review & Assessment Service and Patient Survey. Intensity of monopsony in the nurse labor market was measured by Herfindahl Hirshman Index (HHI). Hospital nurse staffing level was divided into high and low. While controlling for confounding factors such as inpatient days and severity mix of patients, effects of characteristics of nurse labor markets on nurse staffing levels were examined using multi-level logistic regressions. RESULTS: For characteristics of nurse labor markets, metropolitan areas had high intensity of monopsony, while the capital area had competitive labor market and the unemployed nurse rate was higher than other areas. Among hospital characteristics, bed occupancy rate was significantly associated with nurse staffing levels. Among characteristics of nurse labor markets, the effect of HHI was indeterminable. CONCLUSION: The Korean nurse labor market has different structure between the capital and other metropolitan areas. But the effect of the structure of nurse labor market on nurse staffing levels is indeterminable. Characteristics such as occupancy rate and number of beds are significantly associated with nurse staffing levels. Further study in support of the effect of nurse labor market is needed.

Effects of Nurses' Social Capital on Turnover Intention: Focused on the Mediating Effects Organizational Commitment and Organizational Cynicism

PURPOSE: The purpose of this study was to investigate the casual relationship between nurses' social capital and turnover intention and to verify the goodness of fit between a hypothetical model and actual data in order to suggest the best model. METHODS: This survey was conducted with 315 nurses working in general hospitals in Seoul. Data were collected from December 1 to December 30, 2011, and analyzed using SPSS Windows 18.0 and AMOS 16.0. RESULTS: Nurses' social capital was found to have a direct effect on reducting organization cynicism and increasing organizational commitment. Nurses' organizational cynicism and organizational commitment were found to have a direct effect on turnover intention, but social capital did not have a direct effect on turnover intention. However, social capital had a partial and indirect effect on turnover intention through mediating organizational cynicism and organizational commitment. CONCLUSION: Results of this study indicate that nurse managers should put increased effort in reducing nurses' organizational cynicism and improving their organizational commitment, two contrary parameters. At the same time managers need to develop plans to establish social capital more efficiently so that nurses have lower turnover intention.

A Proposal to Improve Nursing Fee Differentiation Policy for General Hospitals Using Profitability-Analysis in the National Health Insurance

PURPOSE: The purpose of this study was to propose optimal hospitalization fees for nurse staffing levels and to improve the current nursing fee policy. METHODS: A break-even analysis was used to evaluate the impact of a nursing fee policy on hospital's financial performance. Variables considered included the number of beds, bed occupancy rate, annual total patient days, hospitalization fees for nurse staffing levels, the initial annual nurses' salary, and the ratio of overhead costs to nursing labor costs. Data were collected as secondary data from annual reports of the Hospital Nursing Association and national health insurance. RESULTS: The hospitalization fees according to nurse staffing levels in general hospitals are required to sustain or decrease in grades 1, 2, 3, 4, and 7, and increase in grades 5 and 6. It is suggested that the range between grade 2 and 3 be sustained at the current level, the range between grade 4 and 5 be widen or merged into one, and the range between grade 6 and 7 be divided into several grades. CONCLUSION: Readjusting hospitalization fees for nurse staffing level will improve nurse-patient ratio and enhance the quality of nursing care in hospitals. Follow-up studies including tertiary hospitals and small hospitals are recommended.

Staff cost in direct nursing care at an intensive care unit / Costo de los profesionales en la atención directa de enfermería en la unidad de cuidados intensivos / Custo de pessoal na assistência direta de enfermagem em unidade de terapia intensiva

This quantitative case study aimed to learn and analyze the personnel cost in nursing direct care in the intensive care unit. We opted to use a therapeutic intervention score index, TISS-28, for the analysis of the indirect gravity of patients and the dimension of the nursing staff working time. Evaluating the cost by a gravity score presented to be a logical and relatively simple method to allocate costs per patient in the intensive care unit. In this exploratory and descriptive study, the average TISS-28 per patient was 31 points, requiring a daily expenditure of care hours of R$ 298.69. It was evidenced in this study that personnel costs are variable since there are patients with different complexities. Therefore is possible to estimate the nursing staff cost by assessing its work load.

Con este estudio de caso con aproximación cuantitativa, pretendemos conocer y analizar el costo de los profesionales en la atención directa de enfermería en una unidad de cuidados intensivos. Optamos por la utilización de un índice de intervenciones terapéuticas, TISS-28, para análisis de la gravedad indirecta de los pacientes y dimensionamiento del tiempo de trabajo del equipo de enfermería. Al indagar el costo como un índice de gravedad éste se mostró un método lógico y relativamente sencillo de presupuestar costos por paciente en la unidad de cuidados intensivos. En este estudio, el TISS-28 promedio por paciente fue de 31 puntos, lo que demandó un costo diario de R$ 298,69 de horas de atención de enfermería. En este trabajo, se identificó que el costo de los profesionales es variable, pues existen pacientes con diversas complejidades y muy diferentes, siendo posible, por medio de la evaluación de la carga de trabajo del equipo de enfermería, establecer estimativas individuales de su costo.

Pretendeu-se com este estudo de caso, com abordagem quantitativa, conhecer e analisar o custo de pessoal na assistência direta de enfermagem em unidade de terapia intensiva. Optou-se pela utilização de um índice de intervenções terapêuticas, TISS-28, para análise da gravidade indireta dos pacientes e dimensionamento do tempo de trabalho da equipe de enfermagem. Evidenciou-se, neste trabalho, que o custo com pessoal é variável, pois há pacientes com complexidades bem diferentes, sendo possível, por meio da avaliação da carga de trabalho da equipe de enfermagem, estabelecer estimativas individuais de seu custo. Neste estudo o TISS-28 médio por paciente foi de 31 pontos, demandando custo diário de horas de assistência de enfermagem de R$ 298,69. Apurar o custo por um índice de gravidade mostrou-se método lógico e relativamente simples de alocação de custos por paciente em unidade de terapia intensiva.

Levantamento do custo do processo admissional de técnico de enfermagem de um hospital de ensino / Survey on the cost of the admission process of nursing technicians in a teaching hospital

Este estudo teve como objetivo contribuir para a gestão de custo do processo admissional de técnicos de enfermagem pelo mapeamento e mensuramento do custo direto das principais atividades desse processo. O estudo exploratório, retrospectivo, documental, na modalidade de estudo de caso foi realizado no Serviço de Apoio Educacional do Hospital Universitário da Universidade de São Paulo. O processo admissional foi dividido em cinco subprocessos: planejamento, recrutamento, seleção, contratação e treinamento admissional. Os resultados mostraram que o custo total direto do processo admissional foi de R$ 6.359,90 e o subprocesso seleção foi o que mais consumiu recurso, com R$ 3.416,40, representando R$ 53,72 por cento do total. Cada candidato contratado custou R$ 635,99.

This study was aimed at contributing to the cost management of the admission process of nursing technicians by mapping and measuring the direct cost of the main activities in this process. The exploratory, retrospective, documental study on the modality of case study was carried out at the Educational Support Service of the University of São Paulo's Hospital Universitário. The admission process was divided into five sub-processes: planning, recruiting, selection, hiring and admission training. Results showed that the direct total cost of the admission process was R$ 6,359.90, and that, within the sub-processes, selection was the one that consumed most resources - R$ 3,416.40, amounting to 53.72 percent of the total. Each hired candidate cost R$ 635.99.

Este estudio tiene como objetivo contribuir para la gestión de costo del proceso ad misional de técnicos de enfermería por el mapa y medición del costo directo de las principales actividades de ese proceso. El estudio exploratorio, retrospectivo, documental, en la modalidad de estudio de caso fue realizado en el Servicio de Apoyo Educacional del hospital Universitario de la Universidad de São Paulo. El proceso ad misional fue dividido en cinco subprocesos: planeamiento, reclutamiento, selección, contratación y entrenamiento ad misional. Los resultados muestran que el costo total directo del proceso ad misional fue de R$ 6.359,90, el sub-proceso de selección fue el que más consumió recurso con R$ 3.416,40 representando R$ 53,72 por ciento del total. Cada candidato contratado costó R$ 635,99.

Variations in Nurse Staffing in Adult and Neonatal Intensive Care Units / 간호학회지

PURPOSE: This study was done to analyze variations in unit staffing and recommend policies to improve nursing staffing levels in intensive care units (ICUs). METHOD: A cross-sectional study design was used, employing survey data from the Health Insurance Review Agency conducted from June-July, 2003. Unitstaffing was measured using two indicators; bed-to-nurse (B/N) ratio (number of beds per nurse), and patient-to-nurse (P/N)ratio (number of average daily patients per nurse). Staffing levels were compared according to hospital and ICU characteristics. RESULT: A total of 414 institutions were operating 569 adult and 86 neonatal ICUs. Tertiary hospitals (n=42) had the lowest mean B/N (0.82) and P/N (0.76) ratios in adult ICUs, followed by general hospitals (B/N: 1.34, P/N: 0.97). Those ratios indicated that a nurse took care of 3 to 5 patients per shift. Neonatal ICUs had worse staffing and had greater variations in staffing ratios than adult ICUs. About 17% of adult and 26% of neonatal ICUs were staffed only by adjunct nurses who had responsibility for a general ward as well as the ICU. CONCLUSION: Stratification of nurse staffing levels and differentiation of ICU utilization fees based on staffing grades are recommended as a policy tool to improve nurse staffing in ICUs.

Factors Related to Nurse Staffing Levels in Tertiary and General Hospitals / 간호학회지

BACKGROUND: Adequate staffing is necessary to meet patient care needs and provide safe, quality nursing care. In November 1999, the Korean government implemented a new staffing policy that differentiates nursing fees for inpatients based on nurse-to-bed ratios. The purpose was to prevent hospitals from delegating nursing care to family members of patients or paid caregivers, and ultimately deteriorating the quality of nursing care services. PURPOSE: To examine nurse staffing levels and related factors including hospital, nursing and medical staff, and financial characteristics. METHODS: A cross-sectional design was employed using two administrative databases, Medical Care Institution Database and Medical Claims Data for May 1-31, 2002. Nurse staffing was graded from 1 to 6, based on grading criteria of nurse-to-bed ratios provided by the policy. The study sample consisted of 42 tertiary and 186 general acute care hospitals. RESULTS: None of tertiary or general hospitals gained the highest nurse staffing of Grade 1 (i.e., less than 2 beds per nurse in tertiary hospitals; less than 2.5 beds per nurse in general hospitals). Two thirds of the general hospitals had the lowest staffing of Grade 6 (i.e., 4 or more beds per nurse in tertiary hospitals; 4.5 or more beds per nurse in general hospitals). Tertiary hospitals were better staffed than general hospitals, and private hospitals had higher staffing levels compared to public hospitals. Large-sized general hospitals located in metropolitan areas had higher staffing than other general hospitals. Occupancy rate was positively related to nurse staffing. A negative relationship between nursing assistant and nurse staffing was found in general hospitals. A greater number of physician specialists were associated with better nurse staffing. CONCLUSIONS: The staffing policy needs to be evaluated and modified to make it more effective in leading hospitals to increase nurse staffing.