When a nurse manager is hiring and scheduling nurses, he follows a unit-specific nurse staffing standard to guide his decisions. Staffing standards are typically specific to the type of patients cared for on a unit. A nurse in an intensive care unit (ICU), for example, may be assigned to one or two patients while her colleague on the pediatric floor may have four to six patients.
History
The Joint Commission, the nationally recognized accrediting body for hospitals, has long identified nursing staffing standards for particular nursing units. In some states, the agency responsible for health care licensing also sets unit-specific standards. In 1996, the Institute of Medicine issued a landmark report recommending that hospitals identify appropriate nurse-patient ratios for specific nursing units to make sure patients received quality health care. In 1999, California was the first state to establish minimum nurse-patient ratios for specific categories of nursing units.
Workload Measurement
When developing a guideline for nurse staffing by hours per patient day (HPPD), a nurse leader will determine how long it takes to provide all of the care for an average patient on a specific nursing unit. He may use an evidence-based commercial system, hire a consultant or do internal studies of actual nursing care. The HPPD will vary significantly depending on the patient population served.
Acuity
To establish an appropriate nurse-patient ratio for a nursing unit, a nurse leader will research accreditation requirements and state-specific staffing standards. In California, for example, the minimum nurse-patient ratio on a telemetry unit caring for cardiac patients is 1:5. She can then look closely at patient acuity, a measurement that reflects how sick the patients are, and come up with a ratio.
Nurse Satisfaction
Lower nurse staffing standards are associated with job dissatisfaction for nurses, as well as nursing burnout. When a nurse is not happy with her work situation and feels her workload is too great to allow her to provide quality care, she is more likely to leave the hospital. This turnover of experienced nurses negatively impacts patient satisfaction and outcomes. The cycle continues unless steps are taken to address nurse staffing standards.
Impact
According to the Agency for Healthcare Research and Quality, hospitals with low staffing levels are more likely to have poor patient outcomes. Studies have shown medical patients in hospitals with high RN staffing levels are 4 to 12 percent less likely to develop urinary tract infections. Another study showed that, for every patient added to a nurse's workload, the risk of a post-operative patient dying within 30 days of admission goes up 7 percent.
Tags: nurse staffing, nursing units, appropriate nurse-patient, health care, hospitals with
