Staffing of nurses within healthcare organizations continues to be one of the most challenging and complex issues facing management today. Research from the last two decades shows there is a link between the importance of adequate nurse staffing in achieving good patient outcomes, safety, and satisfaction. This topic and research is nothing new to hospital administration and management, but it is important that every nurse have a basic understanding of the staffing processes and related terms, know how their unit and organization perform these functions, and be actively involved in the solution. Here are three practical thoughts/solutions for nurses to this ever evolving challenge.
1. Staffing vs. Scheduling
There are several items to consider when dealing with challenges in nurse staffing. First, it is important to understand terms used such as “staffing” vs. “scheduling”.
Staffing and Scheduling are many times used interchangeably; they’re not the same thing. The American Nurses Association (ANA) defines appropriate staffing as “a match of registered nurse expertise with the needs of the recipient of nursing care services in the context of the practice setting and situation. This is necessary to reach safe, quality outcomes; it is achieved by dynamic, multifaceted decision-making processes that must take into account a wide range of variables”. Scheduling, however, entails determining a set number of staff and type of staff for a future time period based on such factors as historical census numbers and anticipated surgical volumes.
2. Staffing Models
Another item to consider when dealing with nurse staffing challenges at your healthcare facility is to understand staffing models. There are three staffing models that are used and typically in combination to fit the unit’s particular dynamics. The three models are:
• Budget Based: nursing staff is allocated according to nursing hours per patient day
• Nurse-Patient Ratio: number of nurses per number of patients or patient days determines staffing levels
• Patient Acuity: patient characteristics are used to determine a shift’s staffing needs
3. State and Federal Regulations
State and Federal staffing requirements is the third thing to consider when developing a solution to nurse staffing shortages. The argument for better nurse staffing has led to Federal and, in some cases, State regulatory requirements. It is important that hospitals comply with these requirements; failure to comply can lead to penalties. Medicare and Medicaid have their requirements yet they are based on having “adequate” numbers of licensed professionals for proper care. This, of course, is open to a wide range of interpretations. So, it is important to know your state’s requirements.
State Laws, according to ANA, the following states have enacted legislation around staffing;
• CA, CT, IL, MA, MN, NV, NJ, NY, NC, OH, OR, RI, TX, VT, WA, and the District of Columbia have enacted legislation of adopted regulations to address nurse staffing.
• CT, IL, NV, OH, OR, TX, and WA require that hospitals have staffing committees responsible for plans and staffing policy.
• IL, NJ, NY, RI, and VT require some form of disclosure or public reporting regarding staffing.
• California is the only state stipulating that nursing units must maintain a minimum nurse-to-patient ratio at all times.
Implement a Staffing Plan
If your state does not require staffing committees and developing plans, it is a great idea to have a strong committee to provide a collaborative approach to your staffing challenges. Your staffing committee can oversee the process and give input on unit scheduling and staffing policies and procedures; this may include development of a staffing plan. The staffing plan is a unit and shift-specific plan that sets nursing staffing levels based on patient acuity and needs at any given time, available support staff, technology , and the care delivery model. These plans help reduce variability and build standardization of care into the unit as well as proper communication about staffing and scheduling.
Staffing Impacts Patient Outcomes
With pressure building to decrease costs, researchers have already shown the impact of staffing on patient outcomes. As a direct care nurse, you should know how your care is being measured and how the combined patient outcomes of your organization’s nursing units are being measured. Check unit outcomes as they relate to nurse staffing; in many cases, such data are used to justify improved staffing levels.
Today, no one should doubt that nurse staffing affects patient outcomes. Staffing and scheduling are complicated processes that need to involve not only managers and staffers but direct-care RNs as well. With their wealth of knowledge about clinical care, these nurses can provide invaluable knowledge that can improve care, processes, and quality. Remember—as a direct-nurse, you’re not “just a nurse.”