Rational staffing of hospital nursing services by functional activity budgeting

Nursing services are a costly item in the hospital budget, yet their justification is usually based on precedent and anecdote. Patient classification systems enable quantification of the nursing load on a daily basis. This methodology for determining the size of the nursing staff, however, has not gained widespread use because it tends to formalize existing staffing patterns. At the Johns Hopkins Hospital, physicians and nurses drew up a list of activities that should be performed for patients and that need to be considered in budgeting for nursing services. The largest and most variable components of the nursing workload are the tasks specified by physicians' orders and the nursing care plan. A computerized information system which communicates these orders can also be used to quantify these components of the nursing workload, since standard times to perform these tasks have been documented. The variability of these tasks from day to day and from patient to patient is the source of most of the problems of staffing. Other components of the workload, such as patient education, depend on the nursing program desired and must be added separately. Budget decisions can then be based upon the specific nursing functions which the hospital desires to perform. The technique of functional activity budgeting can also be used for the utilization review of physicians' use of nursing services.