ASHLEY BOROWIAK, RN NURSING 450 FERRIS STATE UNIVERSITY Staffing Ratios
Transcript
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ASHLEY BOROWIAK, RN NURSING 450 FERRIS STATE UNIVERSITY
Staffing Ratios
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Introduction Nurse ratios are determined by working hours per
patient per day. Nursing ratios are the number of patients assigned
to a staff member. Nurse staffing can have effects on the quality
of care patients receive, patient safety, and adverse outcomes from
the plan of care.
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Objectives Identify if a correlation exists between nurse to
patient ratios and patient outcomes. Recognize mandated staffing
ratios and the consistency across health care locations. Identify
nursing implications of high and low nurse to patient ratios.
Identify systems used to determine staffing numbers. Discuss
theories related to the subject.
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Theories Related to Nurse Staffing Nursing Services Delivery
Theory Recognizes that many different factors affect the work
demands in the health care system and nurse staffing. Input,
throughput, and output interact to determine staffing needs and
work demands. Staffing research has shown a correlation with key
nurse staffing indicators and patient outcomes. Meyer & OBrien
Pallas, 2010
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Theories Related to Nurse Staffing Maslows Hierarchy of Needs
Nurses need to feel safe in the environment they practice, have a
sense of belonging to their organization, and to feel empowered.
This is achieved through Maslows Hierarchy of Needs. Inadequate
staffing raises a nurses stress level, causing job dissatisfaction.
These stressors can threaten patient safety and negatively affect
the environment in which they practice in. Nurses are advised to
address their basic needs to provide safe and quality care. Groff
Paris & Terhaar, 2011
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Achieving Self Actualization
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Assessment of Health Care Environment Outpatient
Environment-Hospice Guidelines have been in place since 1994.
Varying acuity depending on home care patients or short length of
service patients Often times family present to assist with cares.
Uses an assessment process to estimate staffing levels such as
characteristics of the patient population, level of care, length of
service (LOS), and the environment. National Hospice and Palliative
Care Organization [NHPCO], 2013
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Assessment of Health Care Environment Higher percentage of
short LOS which means acuity could be higher in the first week or
two of care, and the patient s needs are more resource intensive.
Lower percentage of routine patients who partake in home care,
which indicates a higher number of inpatients receiving continuous
care. Issues for nurses to consider when determining staffing:
Psychosocial issues of the complexity of the patients needs Safety
issues for the nurse High intensity of services NHPCO, 2013
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Assessment of Health Care Environment Inpatient
Environment-Acute and Long Term Care Different levels of acuity of
patients Confusion, frequent repositioning and toileting, frequent
prn medications Severity of diagnosis and level of stability
Staffing policies vary between facilities and states Delegation is
often an underutilized tool that can ease the workload of nurses
and CNAs. Ability to pull staff from other units to assist if
needed Census changes throughout the day Discharges,
Admissions
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Management and Education Services for Healthcare (MESH) MESH is
a patient centered acuity system designed to determine staffing by
identifying patients distinctive needs. The Patient Classification
and Staffing System Module (PCSS) is one of four modules used
within MESH to assist with proper staffing. Prior to staffing for
the next shift, a projected census is formulated to determine
staffing needs and patients are categorized into acuity levels.
University of Wisconsin, 2014
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MESH System Taking census and acuity information, the system
calculates the number of staff needed. The system will notify the
person making staff assignments if the unit will overstaffed or
understaffed depending on the data entered. University of
Wisconsin, 2014
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MESH System Nurses making staff assignments are able to and
encouraged to documents notes regarding projected and actual
decisions made in regards to staffing. All0ws for nurse explanation
as why staff decisions were made to allow for better decision
making in the future. University of Wisconsin, 2014
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Census Grids Staff is determined solely by number of patients
on the unit. Acuity is normally not a factor in census grids. Black
and white-Nurses do not have ability to make judgments on staffing
decisions Staffing adjustments are made according to the census
grid
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Root Cause Analysis
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California Assembly Bill 394 In 1994, law was passed that
requires acute care hospitals to maintain a minimum nurse to
patient ratio. First state to initiate Facilities are required to
use an acuity classification system Mandated staffing ratios are
unit specific Facilities required to record and report staffing
numbers to ensure compliance with the law. Agency for Healthcare
Research and Quality [AHRQ], 2014
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California Assembly Bill 394 What were the outcomes of the new
legislation? Higher staffing levels Nurse hours per patient day
increased from 6.03 to 7.11 Reduced Nurse Workload Average patients
per shift decreased to 4.1 Fewer patient deaths In California, the
death rate was 10-13 percent lower than 2 other states which do not
have staffing mandates Decrease in nurse burnout and high job
satisfaction 66 percent of nurses in California agreed they are
more likely to remain in their jobs as a result of the legislation
AHRQ, 2014
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Michigans Safe Patient Care Act Proposed by State
Representative Jon Switalski and State Senator Rebekah Warren Would
implement a staffing plan which would have a minimum nurse to
patient ratio. Facilities would create their own staffing plan
Facilities would be banned from using mandatory overtime to
compensate for poor staffing planning Studies show that facilities
would benefit due to shorter lengths of stay, a decrease in
readmissions, decreased legal liability for all complications that
are associated with nurse staffing, and less nurse turnover.
Michigan Nurses Association, 2014
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Mandated Staffing Ratios Positives Ensure safe care if provided
Increased job satisfaction Increased patient outcomes Nurse
recruitment Negatives Reduction in hospital services Increased
emergency room diversions Increased unit closures Increased
expenses Nurses in Minnesota from facilities speak out on why
staffing mandates would have a negative affect on the care their
patients receive. https://www.youtube.com/watch?v=fY-fQ4ewPMM
American Organization of Nurse Executives, 2014
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Inferences and Implications Adequate staffing has been proven
to: Reduce medication errors Decrease complications relating to
patient diagnosis Decrease patient mortality Increase patient
satisfaction Reduce nurse fatigue Decrease nurse burnout Increase
job satisfaction ANA, 2014
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Patient Outcomes High Nurse Staffing Reduces UTIs Pneumonia
Shock Upper GI Bleeding Longer Hospital Stay & Preventable
Readmissions Decreases costs lost by facility for little to no CMS
reimbursement Failure to Rescue Greater patient and family
satisfaction Failures in the plan of care and meeting outcomes
AHRQ, 2014
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Nurse Burnout and Turnover Rates Decreased work conditions and
stressful environments have been proven to have direct negative
effects on a nurses satisfaction with their job. Patient
satisfaction is much less in facilities where nurse burnout and
turnover rates are higher. Nurses working in direct patient care
areas (especially those which are short staffed) have the highest
burnout rates. High burnout and turnover rates have direct negative
affects on patient care. McHugh, Kutney-Lee, Cimiotti, Sloane,
Aiken, 2011
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Budgeting Hospital budgets are one of the main reasons for
staffing issues at facilities. Hospitals spend a large amount of
dollars in overtime pay and incentive pays for outside nurses. Many
nurses do not see unit budgets or are aware the amount of funds
paid out to employees
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Centers for Medicare/Medicaid Services (CMS) Reimbursement
Medicare spends $15 billion a year on preventable hospital
readmissions. Hospital Readmissions Reduction Program Research has
proven that hospitals with adequate staffing have a lower level of
readmissions. Government can assist with decreasing readmissions
by: Mandating minimum staffing levels Using benchmarks and payment
incentives based on nurse staffing Public reporting of nurse to
patient ratios Mitka, 2013
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Recommendations for Quality and Safety Improvements Quality and
Safety Education for Nurses (QSEN) Competencies Patient Centered
Care Recognize the patient as a the main source for providing
compassionate and coordinated care. Proper staffing ratios can
deliver safe and quality care which the patient is entitled to.
Evidence-Based Practice Integrate the best current evidence to
deliver optimal care. Continue to study the positive affects that
staffing mandates and increase staffing have on patient outcomes.
QSEN Institute, 2014
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QSEN Competencies Quality Improvement Use improvement methods
to design changes to improve the quality and safety of health
systems. Discover and test new staffing grids to optimize patient
care Seek out information and formulate a root cause analysis to
determine the cause of staffing issues. QSEN Institute, 2014
Recommendations for Quality and Safety Improvements
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American Nurses Association (ANA) Standards Standard Nine:
Evidence Based Practice The nurse will incorporate research into
everyday practice. With this, nurses can discover ways to improve
upon staffing issues to deliver quality care and reduce nurse
stress. Standard 10: Quality of Practice The nurse delivers quality
care in his or her nursing practice. Regardless of staffing issues
and/or patient ratios, nurses should deliver safe, quality care,
without taking shortcuts to get tasks accomplished that could
sacrifice the safety of the patient (i.e. leave catheters in too
long, disregard dressing changes) Standard 16: Environmental Health
The nurse practices in an environmentally safe and healthy manner.
Nurses reach Maslows hierarchy of needs and promotes a health
environment so patient care can be optimized. Ferris State
University, 2014
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Summary Nurse to patient ratios vary between environments
Research and studies can improve the way facilities staff their
units and improve patient care Staffing can have both positive and
negative affects on patients and the facility Government mandates
are not widely accepted by those in the health care field Using the
standards set by the ANA and QSEN, nurses can continue to deliver
optimal patient care.
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References Agency for Healthcare Research and Quality (2014).
Hospital nurse staffing and quality of care. Retrieved from
http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.html#Staffing
http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.html#Staffing
Agency for Healthcare Research and Quality (2014). State-mandated
nurse staffing levels alleviate workloads, leading to lower patient
mortality and high nurse satisfaction. Retrieved from
http://innovations.ahrq.gov/content.aspx?id=3708http://innovations.ahrq.gov/content.aspx?id=3708
American Organization of Nurse Executives (2014). Mandated staffing
ratios. Retrieved from
http://www.aone.org/resources/leadership%20tools/staffingratios.shtml
Barton, N. (2013). Acuity-based staffing: Balance cost,
satisfaction, quality, and outcomes. Nurse Leader, 11(6), 47-50.
Centers for Medicare and Medicaid Services (2012). Design for
nursing home compare five-star quality rating system. Retrieved
from https://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/CertificationandComplianc/downloads/usersguide.pdfhttps://www.cms.gov/Medicare/Provider-Enrollment-and-
Certification/CertificationandComplianc/downloads/usersguide.pdf
Ferris State University (2014). Standards of professional nursing
practice (ANA). Retrieved from
http://www.ferris.edu/HTMLS/colleges/alliedhe/Nursing/Standards-of-Professional-Nursing-Practice.htm
Groff Paris, L., & Terhaar, M. (2011). Using Maslows pyramid
and the national database of nursing quality indicators to attain a
healthier work environment. The Online Journal of Issues in
Nursing, 16(1).
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References McHugh, M.D., Kutney-Lee, A., Cimiotti, J.P.,
Sloane, D.M., & Aiken, L.H. (2011). Nurses widespread job
dissatisfaction, burnout, and frustration with health benefits
signal problems for patient care. Health Affairs, 30(2), 202-210.
doi: 10.1377/hlthaff.2010.0100 Meyer, R.M., & OBrien-Pallas,
L.L. (2010). Nursing services delivery theory. Journal of Advanced
Nursing, 66(12), 2828-2838. doi: 10.1111/j.1365-2648.2010.05449.x
Michigan Nurses Association (2014). MI needs a safe staffing law
now! Retrieved from
http://www.minurses.org/legislation/safepatientcare
http://www.minurses.org/legislation/safepatientcare Mitka, M.
(2013). Greater nurse staffing may lower hospital readmissions. The
Journal of the American Medical Association, 310(18). National
Hospice and Palliative Care Organization (2013). Staffing
guidelines for Hospice home care teams. Retrieved from
http://www.nhpco.org/sites/default/files/public/quality/Staffing_Guidelines.pdf
http://www.nhpco.org/sites/default/files/public/quality/Staffing_Guidelines.pdf
QSEN Institute (2014). Pre-licensure KSAS. Retrieved from
University of Wisconsin (2014). Management and education services
for healthcare (MESH). Retreieved from
http://www.uwhealth.org/misc/mesh/management-and-education-services-for-healthcare-
mesh-patient-classification-and-staffing-system/35619http://www.uwhealth.org/misc/mesh/management-and-education-services-for-healthcare-
mesh-patient-classification-and-staffing-system/35619