How to calculate FTEs for a nursing unit

Here is how to calculate FTEs for a nursing unit: multiply your census by your target hours per patient day to get the hours the work needs, add the time people are paid but not on the floor, and divide by 2,080 hours, which is one full time year. A unit with a census of 24 at 8.0 HPPD needs about 33.7 FTEs of hours worked, and closer to 39 once vacation, sick and education time are covered. Most of the mistakes happen in that second step, and in counting people instead of hours.

This guide walks through the formula, a full worked budget for a 30 bed unit, how to handle nonproductive time and fixed positions, and how to turn FTEs back into the number of nurses you actually need to hire.

What one FTE means

An FTE is a full time equivalent: a full year of hours, not a person. The standard year is 40 hours a week for 52 weeks, or 2,080 hours. The Government Accountability Office uses exactly that definition when it counts federal employment, and nursing budgets use the same figure. On a two week pay period, one FTE is 80 hours.

This is why your 12 hour nurses are not 1.0. A nurse who works three 12 hour shifts a week works 36 hours, and 36 ÷ 40 is 0.9 FTE. Pamela Hunt makes the point in Nursing Management with ten nurses: counted at 0.9 they cover 720 hours a pay period, counted at 1.0 they appear to cover 800. If you build a staffing plan as if every full time night nurse were 1.0, the plan is short 80 hours every pay period before anyone calls out.

The same math works for anyone. A part timer at 24 hours a week is 0.6. A per diem nurse who worked 624 hours last year was 0.3 FTE of work, even though nobody would call them 0.3 of an employee.

The formula, step by step

Start from the work, not from your current roster.

1. Daily hours needed = census × target HPPD.
2. Annual productive hours = daily hours × 365.
3. Productive FTEs = annual productive hours ÷ 2,080.
4. Paid FTEs = productive FTEs ÷ (1 minus your nonproductive share).
5. Add fixed positions that your HPPD target does not already include.

Two words matter here. Productive hours are time actually worked caring for patients, overtime included. The CDC's national nurse staffing protocol counts it that way, and leaves out vacation, sick and leave time, plus orientation, education and committee time. Nonproductive hours are paid hours that are not productive: the PTO, the class days, most of the orientation. Your budget has to pay for both, but only the productive ones show up at the bedside.

Which census you start from is a real decision. You can start from the average daily census. Hunt's method uses the mode, the midnight census your unit sees most often, because a unit that bounces between 18 and 30 is rarely at its average. Use the one your finance team uses for the budget, and know the other one when you build the schedule.

If you are not sure how your target HPPD was set or which hours it includes, start with our guide on how to calculate HPPD. Every number below depends on it.

A worked budget for a 30 bed unit

Take a 30 bed unit running 12 hour shifts with an average daily census of 24 and a target of 8.0 HPPD in direct care hours. All of these numbers are invented for the example.

Step 1, daily hours. 24 × 8.0 = 192 hours a day. That is 16 twelve hour shifts across days and nights. Say the unit splits them as 12 RN shifts and 4 tech shifts, so 144 RN hours and 48 tech hours a day.

Step 2 and 3, productive FTEs.

Step 4, nonproductive time. Pull last year's payroll for the unit. Say the unit was paid 76,000 hours and 10,640 of them were vacation, sick, holiday, education and orientation. That is 10,640 ÷ 76,000 = 14% nonproductive, so people worked 86% of the hours they were paid. Hunt gets the same kind of figure a different way: total nonproductive hours divided by the number of clinical FTEs who get replaced when they are out, then divided by 2,080.

Divide productive FTEs by 0.86:

Step 5, fixed positions. Say the unit has a charge nurse on every shift without an assignment, and the 8.0 target counts direct care hours only. A position staffed 24 hours a day, every day, is 24 × 365 = 8,760 hours, or 4.2 productive FTEs. Divided by 0.86, that is 4.9 paid FTEs.

Orientation for planned hires. If you expect four new nurses to orient for 12 weeks at 36 hours a week, and orientees are not counted in your staffing plan, that is 4 × 12 × 36 = 1,728 hours, or 0.8 FTE. If last year's nonproductive share already included a similar orientation load, leave this line out so you do not count it twice.

That is the number that goes in the budget. Notice how far it sits from the 33.7 FTEs of work the patients actually see. More than a quarter of what the unit is paid for happens away from the assignment board, and that is normal, not waste.

Turning FTEs into people

FTEs are hours. You hire people. Divide each role's paid FTEs by the FTE of the positions you actually post.

If every RN on the unit were a full time 12 hour nurse at 0.9, then 29.4 RN FTEs ÷ 0.9 = 32.7, so about 33 nurses before the charge nurses. Add the charge line the same way: 4.9 ÷ 0.9 is about 5.4 more. Mix in part timers at 0.6 and the headcount goes up while the FTEs stay the same.

Then check it against the schedule. 8.0 HPPD at a census of 24 for one 14 day pay period is 2,688 hours, which is 33.6 productive FTEs at 80 hours each. That should match the annual figure within rounding. If your posted schedule for a normal pay period does not add up to roughly that many hours of direct care, the problem is in the schedule, not the budget. Our guide to nurse self scheduling covers how to build a schedule that actually lands on the hours you need.

Where FTE math goes wrong

1. Counting a 0.9 as 1.0. Already covered, and still the most common one. It makes a fully staffed roster look like it has a cushion it does not have.

2. Multiplying by 1.14 instead of dividing by 0.86. If 14% of paid hours are nonproductive, you need productive FTEs ÷ 0.86, which is a factor of about 1.163. Multiplying by 1.14 gives 38.4 instead of 39.2 in the example above. That 0.77 FTE is about 1,600 hours a year, or roughly 133 twelve hour shifts you will end up covering with overtime.

3. Counting the charge nurse twice, or not at all. If your HPPD target was built with the charge nurse inside it, adding a separate charge line double counts. If it was built on direct care only, leaving the line out leaves you short every shift. Ask finance which it is before you defend the budget.

4. Using last year's nonproductive share in a year that will not look like last year. A unit about to hire eight new grads, or one where half the staff are near retirement with deep PTO banks, will run a different share than the year before. Adjust it, and write down why.

5. Confusing budgeted, filled and worked FTEs. Budgeted FTEs are what you are allowed. Filled FTEs are the positions you have people in. Worked FTEs are the hours that actually happened, divided by 2,080, and they include overtime, agency and float hours. A unit can be 4 FTEs vacant and still run at its full worked FTEs, because the gap is being filled with overtime. That is expensive, and our guide to the 8/80 overtime rule explains how those hours turn into overtime pay.

Keeping the number honest during the year

The budget is set once a year. The census is not. Check worked FTEs against budget every pay period: productive hours worked ÷ 80 for the period, compared with census × HPPD × 14 ÷ 80 for the same period. When the two drift apart for more than a pay period or two, find out whether it is census, acuity, turnover or vacancies before someone else decides it for you.

If your unit runs on Adelo Workforce, the manager side puts hours, overtime and HPPD in its analytics, and Capacity turns the census forecast into nurses needed for the week ahead, so the gap shows up before the pay period closes instead of after.

Questions people ask

How many hours is 1 FTE in nursing?

2,080 hours a year, which is 40 hours a week for 52 weeks, or 80 hours in a two week pay period. Ask finance how your own organization defines it, because the hours behind every budget line rest on it.

How many FTEs does it take to staff one nurse around the clock?

One position covered 24 hours a day, every day, is 8,760 hours a year, or 4.2 productive FTEs. Once vacation, sick and education time are covered at a 14% nonproductive share, it is about 4.9 paid FTEs. That is why one more nurse on every shift costs about five FTEs, not one.

Is a nurse who works three 12 hour shifts full time?

They may have full time benefits, but in FTE math they are 0.9, because 36 hours ÷ 40 hours is 0.9. Count them at 0.9 when you build a staffing plan or you will come up short every pay period.

What is the difference between productive and paid FTEs?

Productive FTEs are hours actually worked caring for patients, including overtime. Paid FTEs add the hours people are paid for but not on the floor, like vacation, sick time, education and orientation. Your budget pays for paid FTEs; your patients only see productive ones.

What is a replacement factor in nurse staffing?

It is the multiplier that covers nonproductive time. If 14% of paid hours are nonproductive, the factor is 1 ÷ 0.86, about 1.16. Multiply productive FTEs by it, or divide by 0.86, which is the same thing.