Staffing Matrix and Reflection Paper

Staffing Matrix and Reflection Paper

Staffing Matrix and Reflection Paper

Nurse leaders play a critical role in health care settings as far as organizing work and managing resources are concerned. They ensure that patients are adequately served, and nurses are assigned tasks according to their skills and experience. As a result, nurse leaders must be adequately aware of staffing essentials and crucial elements that affect work distribution, such as workload and the flow of patients. Nurse leaders should also be conversant with financial management principles and apply resource management tools like staffing matrices professionally and excellently. The purpose of this paper is to describe the importance of a staffing matrix in a 30-bed medical-surgical unit. Other focus areas include staffing adjustment based on patient census and reallocating resources to make up for variances.

Importance of Using a Staffing Matrix

Each department in a health care organization requires a specific number of employees. The number usually varies according to the workload and skills required to execute a specific task. In a health care setting, a staffing matrix helps leaders determine the levels of staff group needed depending on the patient census (Finkelman, 2021). Hence, a nurse leader uses a staffing matrix as a guideline to allocate duties and shifts primarily based on patient needs and acuity.

A 30-bed medical-surgical unit is a critical area where patients require continuous attention. A staffing matrix is a crucial tool to enable nurses to deliver high-quality care. Always, nurse managers must ensure an effective match between nurse competencies and patient needs (Afshar et al., 2020). A staffing matrix is a valuable tool for appropriate staffing that prevents misuse of organizational resources. It ensures that patients get the attention they deserve, which leads to greater patient satisfaction and improved outcomes overall.

The Staffing Matrix Description

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The staffing matrix for the 30-bed medical-surgical unit illustrates the variation in the levels of staff based on the patient census (Appendix 1). The general assumption is that a 30-bed medical-surgical unit can only hold a maximum of 30 patients at any given time. Since the ideal nurse: patient ratio in such a unit is 1:4/5, eight health care professionals can adequately serve a full unit (30 patients). As further illustrated, the volume of staff reduces as the patient census declines. Here, another assumption is made in that the intensity of work required in the unit reduces as the number of patients reduces. Regarding full-time equivalent (FTE), one FTE denotes 80 worked hours in a 14-day period (Welch & Smith, 2020). This implies that a staff working 40 hours weekly has worked full-time. However, some adjustments can be made based on the setting in the case of 12-hour shifts like in the staffing matrix. In this scenario, 1 FTE is equivalent to three 12-hour shifts per week, or six, twelve-hour shifts per pay period.

Developing a staffing matrix implies assigning roles according to situational demands. The first unit of work measurement considered when developing the staffing matrix is the average daily census (ADC). According to Welch and Smith (2020), the ADC is the number of patients admitted at midnight on any given day. If differently stated, it is the unit’s volume. Using the midnight census helps to reduce wide fluctuations in the staff volume and makes staffing more flexible. The other unit of work measurement is the nurse: patient ratio. No nurse should handle more than four patients at any time in the unit. Doing so avoids overworking nurses, instrumental in preventing workplace stress and nurse burnout. The nurse: patient ratio can also be viewed in terms of nursing workload and skill mix. Griffiths et al. (2020) described nursing workload as the time that nurses spend in direct and indirect care. Since the workload in the staffing matrix (Appendix 1) is based on patient classification, it is crucial to ensure that nurses’ skills match the workload expected.

Effective allocation of duties is critical in preventing the underuse of resources. As a result, the first financial management principle used is efficiency. Penner (2017) described efficiency as maximizing output while using the least resources possible. In health care, efficiency is achieved by avoiding resource wastage, hence matching health care staff with the current patient needs. The other financial management principle considered is the personnel budget. According to Welch and Smith (2020), the personnel budget includes each employee’s productive and unproductive FTEs and salaries. Nurse leaders should avoid overusing or underusing FTEs since they have significant budgetary implications.

Staffing Adjustment Based on Changes in the Patient Census

As reflected in the staffing matrix, the staff levels match the patient census. In this case, the nurse: patient ratio is maintained throughout the week. The basic assumption is that the day’s workload matches the night’s workload. Accordingly, eight health care professionals can effectively handle a full unit, whether during the day or night. The other assumption was that patient acuity is directly proportional to the patients’ volume. This implies that nurses require the same amount of time to handle a specific number of patients irrespective of the severity of their conditions. Based on these considerations, the number of RNs, NAs, and unit health coordinators can be reduced as the patient volume declines without significantly affecting the workload, nurse satisfaction, and teamwork.


Making Up the Variance and Resource Allocation

FTEs are an essential resource that must be used prudently. Overuse of FTEs can adversely affect financial resources and patient care quality. Time lost cannot also be recovered unless some adjustments are made in future staffing matrices to compensate for it. It is crucial to reevaluate the staffing matrix and check whether everything was scheduled as initially intended to prevent such scenarios and make up the variance. Nurse leaders should reexamine the staffing model applied and check whether adjustments can be made. In the current staffing matrix (Appendix 1), acuity-based staffing has been used. In the case of FTEs’ overuse, the variance can be addressed by shifting to a different model.


The primary role of nurses is to serve patients and address their needs comprehensively. As a result, nurse leaders must ensure adequate staff to address patient needs as situations oblige. As explained in this paper, a staffing matrix is crucial to ensure that the staff volume matches patient acuity. Various units of work measurement and financial management principles were considered when developing the staffing matrix. They include patient acuity, nursing workload and skills, and average daily census. In case of FTEs’ overuse, a nurse leader should reexamine the staffing matrix and check whether everything was scheduled as initially intended. Other interventions include changing the staffing model.


Afshar, M., Sadeghi‑Gandomani, H., & Masoudi Alavi, N. (2020). A study on improving nursing clinical competencies in a surgical department: A participatory action research. Nursing Open7(4), 1052-1059.

Finkelman, A. (2021). Professional nursing concepts: Competencies for quality leadership. Burlington, MA: Jones & Bartlett Learning.

Griffiths, P., Saville, C., Ball, J., Jones, J., Pattison, N., Monks, T., & Safer Nursing Care Study Group. (2020). Nursing workload, nurse staffing methodologies and tools: A systematic scoping review and discussion. International Journal of Nursing Studies103, 103487.

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). Springer Publishing.

Welch, T. D., & Smith, T. (2020). Understanding FTEs and nursing hours per patient day. Nurse Leader18(2), 157-162.


Appendix I: NUR-621 Topic 8- Staffing Matrix

Census 30 29 28 27 26 25 24
Direct Caregivers Scheduled Hours Shift Length Number of Staff
Day Shift
RN 08.00 am- 08.00 pm 12 hours 5 5 5 4 4 4 4
NA 08.00 am- 08.00 pm 12 hours 3 3 3 2 2 2 2
Health Unit Coordinator 08.00 am- 08.00 pm 12 hours 1 1 1 1 1 1 1
Night Shift
RN 08.00 pm- 08.00 am 12 hours 5 5 5 4 4 4 4
NA 08.00 pm- 08.00 am 12 hours 3 3 3 2 2 2 2
Health Unit Coordinator 08.00 pm- 08.00 am 12 hours 1 1 1 1 1 1 1


Scenario: You are the nurse leader of a 30-bed medical surgical unit and have to account for all staffing, including any discrepancies. Using sound financial management principles, complete the “NUR-621 Topic 8: Staffing Matrix” in the provided Excel template.

After completing the matrix, compose an 1,000-1,250-word reflection answering the following questions:

1. Why is it important to use a staffing matrix in your health care setting?
2. Briefly describe your staffing matrix. How many FTEs (full-time equivalent) on the staffing roster are required to cover daily needs? What units of services or work measurement did you use and why? What financial management principles did you use to determine your staffing matrix?
3. Explain how you adjusted your staffing based on changes in the patient census.
4. You receive your financial report for the month. You have used more FTEs than what was budgeted for your census. How will you make up the variance? How would you reallocate resources to make up for the variance and still comply with guidelines?

Include two to four peer-reviewed references in your essay, including the textbook.

Textbook for reference: Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders (3rd ed.). New York, NY: Springer Publishing. ISBN-13: 9780826160010

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