“The world of healthcare staffing is complex, multi-facetted and the implications of staffing are far reaching, touching almost every aspect of healthcare. If we open our minds, leverage experience and ideas from across disciplines, facilities and geographies we can uncover new approaches to staffing that can better serve our future”
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We not only want comments on this column, but also invite you to share your ideas for future columns. What staffing topics would you like to see explored? What would you like to know more about? What would you like to share with others?
I want to see an ongoing dialogue on best staffing practices across the country and across different types and sizes of organizations. Some of the questions are:
1. Does your organization use a Staffing Committee comprised of 50% direct care staff? If so, are the staff nurses engaged? How is it working? Are you willing to share your charter?
2. Are you using a patient acutity system to guide staffing decisions? If so, are you happy with it? If not, why not?
3. How do you think healthcare reform will impact nursing resources?
Adequate staffing is a necessary but insufficient condition for safe and effective patient care. One other dimension that deserves attention is assignment of nurses to patients. For example, a unit can have the needed number of nurses measured by either ratios or NHPPD, but if staffed by recent graduates or agency/contract nurses may not provide the right skill/experience mix for the patient population. The other discussion we should have is assignment patterns. If the most complex patients are assigned to the least experiened nurse, that could lead to poor outcomes. These patients tend to have longer lenths of stay, multiple comorbidities, and much higher risk for nursing sensitive poor outcomes such as infections, skin breakdown, and falls. These patients tend to be the least appealing ones from an assignment standpoint because they often have multiple problems, family issues, infections with resistant organisms (MRSA for example), as well as other issues that demand a lot of nursing care such as frequent diarrhea from c. diff. etc. This small group of patients consume a disproportionate amount of nursing resources and costs. Who are the nurses actually caring for these patients?
I'm just raising this issue both to open a national dialog as well as suggest a future article.
John, you raise excellent points. I absolutely agree with you that “adequate staffing is a necessary but insufficient condition for safe and effective patient care”. This position is a key concept in the work on Excellence in Staffing (look under the Resources Tab on this site or http://www.staffingexcellence.org/resources/whitepaper ). In achieving excellence we must go beyond adequate. While the literature supports that increased numbers of RNs result in better outcomes, even this does not tell the whole story. It is not about numbers alone. Work environment, educational preparation, experience, fatigue level, etc. and the effective matching of patient needs to nursing resources are all part of the equation. I think we all know this, but in practice, how well do we act on this understanding?
Let’s hear from you out there on the front lines, what’s happening and how can we address this issue?
Also, how can we change the practice John points out in which the complex, long LOS patients who may need the most experienced care are the ones who are least appealing from an assignment perspective?
Does anyone know of a study that looks at who is assigned to these patients and what impact that has?
John, I hope we get people engages in this important dialogue. I agree an article is a good idea to help inspire the conversation and have added your suggestion to the column topics. What do you think of making this a topic in Collaborative Authoring and together we can create an article on this topic?
Great input, Thanks, Kathy
Dear Kathy,
Just a quick note of congratulations on the evolving Institute, opening communication regarding evidenced-based staffing, and a newly dedicated column in Nursing Economics. Thank you for this wonderful work. I cannot wait for each issue to arrive!!
The call for action piece by Rhonda and Karlene is excellent, well timed and we are sharing it with many colleagues to support your spirit of communication.
Hi John, I'm so glad you are in the discussion on this site too!!! Cheers and have a wonderful holiday, Sharon
Hi Sharon,
Thanks for your kind words. We look forward to you sharing your experience and wisdom in some of our discussion groups. We are so pleased to have you join the community!
Warmly, Kathy
Hello Kathy, I have just read your article today and it played the tune I wanted to hear for some time. I currently manage a nursing home in Australia and no one here (to my my best knowledge) adopt an acuity based staffing model. I even had great difficulty convicing aged care providers engage in a study on this topic!! The topic of matching the right staff (numbers, mix, etc.) with residents care needs is in my opinion even of a greater importance in long-term care due to the relationship formed between the nurse/carer and the patient/resident. I would however like to add to the variables you suggested i.i. fatigue levels, satff needs, etc. variables such as lighting, white noise etc.
Regards
Khalil Sukkar RN DBA
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