12 more hours ,LAST clinical

Yesterday I spent 12 more hours with my preceptor Rita. The first half of the day was utilization review of a computorized staffing tool called Optilink. It lasted approximatly 5 hours . The tool is used to track the number of patients, their acuity, staffing, and productive employee hours. The program is new to the hospital hence the 5 hour meeting for evaluation of how it is being used and what ways the managers could improve usage. My preceptor was there along with the 4 supervisors of each unit she manages. Managers from other floors were also present. One part of the presentation was a bell curve showing each units low, medium, high, and extreme, acuity. Two of Rita's ICU's were skewed to the right. There was much discussion about patient's(pts) who are on continuous venous hemodyalsis (CVHD)with multisystem failure being medium pts (instead of high to extreme) because that was the units normal population. It didn't seem right to the supervisors, later he said "I just gave up trying to make my point" with the company consultant . In the afternoon Rita showed two of the supervisors in bone marrow transplant (newly managed by Rita)a formula her other supervisors uses to calculate nursing hours with pt. population and how to maintain the target number to stay within a daily budget .Very enlighting for all, myself and both the supervisors .It was a tool to predict the cost of staffing with the # of patients in a given 24 hour shift . She showed us if you sent staff home earliy just by two hours you could stay within the daily target #, if the pt. population went down.Also the formula showed how if the night shift or evening shift stayed over 2 hours how those people were counted into the next 24 hours and it could put you over your target # for that 24 hours. More stuff I have never seen very eye opening.I asked Rita general questions about the buget 80% of each units budget goes to staffing.I also participated in a nursing interview of a new graduate .It was odd to hear Rita's perception and my perception very different.My impression was seemed nice approachable teachable.Rita's was no she didn't have any challanges in school(one of the interview questions).The nursing staff also interviewed the prospective employee most said they weren't impressed either way one other person said she was nice. Rita involves her staff as much as possible in participation of decission making process. Showing the supervisor that formula and tracking system empowered them to make infomed decisions. Also allowing the staff to participate in interviews and actively asking them what they thought gives them empowerment with thier place of employment and who their peers will be. Okay another memorable day lots to think about. Running total hours 62.