What Every Nurse Should Know about Staffing

Article excerpt

Continuing Nursing Education (CNE)

1.2 Contact Hours

Learning objectives

1. Differentiate nurse staffing methods and models.

2. Identify the roles of nursing associations, regulations, and legislation in staffing.

3. Describe the direct-care nurse's role in staffing.

The author receives royalties from the sales of her book The Nurse Manager's Guide to Innovative Staffing. The planners of this CNE activity have disclosed no relevant financial relationships with any commercial companies pertaining to this activity. See the last page of the article to learn how to earn CNE credit.

Expiration: 2/10/17

Even in the best-run healthcare organizations, staffing and scheduling are complex issues. Research from the last 2 decades supports the importance of adequate registered nurse (RN) staffing in achieving good patient outcomes, safety, and satisfaction. Better RN staffing levels have been shown to reduce patient mortality, enhance outcomes, and improve nurse satisfaction. One study found that for each additional patient assigned to a given nurse, the patient has a 7% increase in the likelihood of dying within 30 days of admission and a 7% increase of failure to rescue.

Yet despite the abundant research, safe and appropriate nurse staffing remains one of the toughest problems for hospitals to manage. This article discusses the components of staffing and explains how direct-care RNs can affect staffing in their units and organizations. All direct-care RNs should have a basic understanding of staffing processes and related terms, know how their unit and organization perform these functions, and be actively involved in unit staffing.

Professional responsibility

Like many nurses, you may be saying to yourself, "But I'm just a nurse." You may think you lack the knowledge, influence, or formal power to do much about staffing.

In fact, nurses have a professional duty to be knowledgeable about staffing as part of their responsibility to patients. Although nurse managers and other leaders may be accountable to their organization for nurse staffing, all nurses are accountable to their patients and the profession.

The American Nurses Association's (ANA) Nursing's Social Policy Statement speaks to one's commitment as a professional nurse: "Nurses, as members of a knowledge-based health profession and as licensed healthcare professionals, must answer to patients, nursing employers, the board of nursing, and the civil and criminal court system when the quality of patient care provided is compromised or when allegations of unprofessional, unethical, illegal, unacceptable or inappropriate nursing conduct, actions, or responses arise."

Differentiating staffing and scheduling

Although the terms staffing and scheduling frequently are used interchangeably, they're not the same thing. ANA's Principles of Nurse Staffing 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. The provision of appropriate nurse staffing 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."

Staffing typically is a day-of-operations function in which designated persons assess and determine the shift-to-shift ratio of nurses to patients to ensure adequate staffing on each shift and unit. Typically, staffing processes don't look further than 24 hours in advance of the shift, or 48 hours for a weekend or holiday.

Staffing may be centralized or decentralized.

* With centralized staffing, one department is responsible for staffing all units, including call-in staff, call-off staff, and float staff.

* With decentralized staffing, unit leaders (charge nurses or managers/directors) determine the level of staffing needed before and during the shift, based on multiple factors. …