(Editor’s note: One of the most common questions we receive at Same-Day Surgery concerns staffing formulas. This month, we explain the staffing formula from the Association of Operating Room Nurses. Don’t miss next month’s issue, when we’ll explore a staffing formula from the American Society of PeriAnesthesia Nurses in Thorofare, NJ.)
When staffing for ambulatory surgery, the rule is 2.5 FTEs for every staffed OR. Or is it? Determine your staffing by starting with two FTEs for every staffed OR, and adjust from there, says Dorothy Fogg, RN, BSN, MA, perioperative nursing specialist at the Center for Nursing Practice, Health Policy, and Research at the Association of Operating Room Nurses (AORN) in Denver.
"Look at your case mix, determine what percentage requires additional or fewer personnel, and adjust the figure accordingly," she says.
For example, if half of your procedures require a third person, use 2.5, she advises. "But that’s something each individual has to determine based on case mix and method of assigning." For example, in outpatient surgery, additional staff often are needed when a nurse is monitoring a patient under local or IV sedation.
AORN has developed Guidelines for Computing OR Staffing Requirements. (See p. 130.) Here is an explanation of how AORN says they work in an OR suite that performs both inpatient and outpatient cases. An OR suite has eight rooms, which are to be staffed and available as follows:
eight rooms, 7 a.m.-3 p.m., Monday-Friday;
two rooms, 3 p.m.-6 p.m., Monday-Friday;
one room, 6 p.m.-7 a.m., seven days a week;
one room, 7 a.m.-6 p.m.. Saturday-Sunday.
• Step 1: Number of rooms multiplied by number of hours per day multiplied by number of days per week = total hours to be staffed per week.
8 x 8 x 5 = 320
2 x 3 x 5 = 30
1 x 13 x 7 = 91
1 x 11 x 2 = 22
463 total hours per week
• Step 2: Total hours per week multiplied by number of people per room = total working hours per week.
463 x 2.5 = 1,157.5 total hours per week
• Step 3: Total working hours/week divided by 40 hours worked/week = basic FTE.
1,157.5/ 40 = 28.9 basic FTEs
• Step 4: Calculate benefit relief per employee.
Average vacation hours/year = 100
Holiday hours/year = 56
Available sick hours/year = 96
15-minute break x 260 days/60 minutes = 65
45-minute lunch x 260 days/60 minutes = 195
512 hours of benefit relief
• Step 5: Basic FTE multiplied by benefit hours/FTE/year divided by 2,080 hours = relief FTE.
28.9 x 512 hours / 2,080 = 7.1 relief FTEs
• Step 6: Basic FTE added to relief FTE = total minimum direct care staff.
28.9 + 7.1 = 36 FTEs
The formula seems straightforward enough. So why is staffing often such a problem? "People outside the OR don’t seem to be able to grasp the concept that if you are open for service, you must have someone there to service," Fogg says. "They will look at the total operative hours and say, You can’t possibly need all these people for 10 cases.’"
People outside the OR don’t realize the figure is not based on operative time or number of cases, Fogg says. "It’s based on the fact that you advertise your hours of service. You say to surgeons, We’re open 7 to 5, and we’re here to do your cases.’ It’s based on the number of rooms you provide to surgeons for the number of hours you provide that service."
Does that mean you have staff there when you aren’t doing cases? "You still have to staff," Fogg says.
