Long Term Care
How to calculate nursing hours allotted per day per patient/resident (PPD)
If you want more staff for your department, better equipment and higher salaries, you as the Nurse Manager have to show that your department is capable of helping produce revenue and that you are a good steward of the funds you are entrusted with to run your department.
Federal Nursing Personnel Staffing Requirements for Long Term Care
The facility must have sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental and psychosocial well-being of each resident, as determined by resident assessments and individual plans of care.
To assure that sufficient qualified nursing staff are available on a daily basis to meet residents’ needs for nursing care in a manner and in an environment which promotes each resident’s physical, mental and psychosocial well-being, thus enhancing their quality of life.
- 483.30(a) and (b) are to reviewed during the standard survey whenever quality of care problems have been discovered (see Appendix P, Survey Protocol, Task 4, for further information and Task 5C for the investigative protocol to complete this review).In addition, fully review requirements of nursing services during an extended survey or when a waiver of RN and/or licensed nurse (RN/LPN) staffing has been requested or granted. Except as licensed nursing personnel are specifically required by the regulation (e.g. and RN for 8 consecutive hours a day, 7 days a week), the determination of sufficient staff will be made based on the staff’s ability to provide needed care to residents that enable them to reach their highest practicable physical, mental an psychosocial well-being. The ability to meet the requirements of §§483.13, 483.15(a), 483.20, 483.25 and 483.65 determines sufficiency of nurse staffing.
- 483.30(a) Sufficient Staff
- 483.30(a)(1) The facility must provide services by sufficient numbers of each of the following types of personnel on 1 24-hour basis to provide nursing care to all residents in accordance with resident care plans:
(i) Except when waived under paragraph © of this section, licensed nurses; and
(ii) (ii) other nursing personnel.
- 483.30(a)(2) Except when waived under paragraph (c) of this section, the facility must designate a licensed nurse to serve as a charge nurse on each tour of duty.
For interpretive Guidelines and Probes on §483.30(a) see tag F354
PPD is based on an average acuity level of the whole.
This level decides the amount of nursing hours allotted per day in the nursing department.
- Do you know your PPD?
- Do you know on what your acuity level is based?
- Have you seen your nursing budget?
- Do you know who is included in the nursing PPD?
- How much of the PPD is for Direct Care Nursing?
- How many nurses included in your PPD are salaried?
Once you have your direct care PPD, you can figure the amount of hours allotted each day.
Take the PPD and multiply it times the number of residents/patients in the facility.
Once you have a PPD it remains the same until the acuity of the residents/patients change.
The allotted hours may change on a daily basis related to a change in the census.
If the census is 80 you multiply it x 3.2. The nursing department will have 256 hours in nursing allotted in 24 hours. (76 x 3.2 = 243.2, and so on)
With a grand total of 256 hours, you will still need to break those hours into RN, LPN, Restorative Nurses, Restorative Aides, Med Aides, CNA’s, etc.
To figure the PPD for each discipline you can either look at the facility budget or:
- Take a look at how many RNs are allotted for a certain census.
- Then take the number of LPN’s and then CNA’s.
If you are allotted 3 RN’s in a 24-hour time limit, then take how many hours a day they work and divide the census into that amount. 3 x 8 =24, then divide 24 by the census 80 = 0.3, thus the PPD for RN’s for the day is 0.3. If you have 6 LPN’s in a day, 6 x 8 = 48, then 48 divided by census 80 = 0.6, thus the PPD for LPN’s is 0.6.
If you are not certain what the PPD is for your unit or facility, then you can reverse things and figure the PPD by using the hours you have scheduled nursing staff and divide that number by the census. If you have 280 hours scheduled and the census is 82, then the PPD for nursing will be 280 divided by 82 = 3.41. To figure the PPD per discipline, you would do what you did in the previous paragraph.