Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach

By Taylor, Beth; Yankey, Nicholas et al. | Nursing Economics, January/February 2015 | Go to article overview

Evaluating the Veterans Health Administration's Staffing Methodology Model: A Reliable Approach


Taylor, Beth, Yankey, Nicholas, Robinson, Claire, Annis, Ann, Haddock, Kathleen S., Alt-White, Anna, Krein, Sarah L., Sales, Anne, Nursing Economics


EXECUTIVE SUMMARY

* All Veterans Health Administration facilities have been mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel.

* A multi-step process was designed to lead to projection of full-time equivalent employees required for safe and effective care across all inpatient units.

* These projections were intended to develop appropriate budgets for each facility.

* While staffing levels can be increased, even in facilities subject to budget and personnel caps, doing so requires considerable commitment at all levels of the facility.

* This commitment must come from front-line nursing personnel to senior leadership, not only in nursing and patient care services, but throughout the hospital.

* Learning to interpret and rely on data requires a considerable shift in thinking for many facilities, which have relied on historical levels to budget for staffing, but which does not take into account the dynamic character of nursing units and patient need.

THE VETERANS HEALTH Administration (VHA) has had a long history of assessing and experimenting with methods of determining appropriate nurse staffing for patient care (Blazey & Williams, 1998; Dunn et ah, 1995). This history extends to the 1970s when a review was commissioned to synthesize and assess the state of the science in staffing methodology (Aydelotte, 1973). Through the 1980s and into the 1990s, VHA attempted to use time and motion studies designed with engineering principles to determine appropriate staffing on inpatient units. In 1991, a task force was convened to assess these approaches, and a radically new approach relying on the expertise of nurses in the field was adopted. This approach, termed the Expert Panel Nurse Staffing and Resource Management Method, was disseminated to the field of over 170 VHA hospitals in 1991-92 (Dunn et ah, 1995). It used an expert panel comprising nurses from all services and disciplines for each facility, and described four steps the panels could use to make appropriate staffing determinations: (a) projecting how much and what type of staff were needed to deliver care to patients; (b) determining what additional staff are needed to allow staff to participate in activities such as administration, education, quality improvement, and research; (c) determining outcomes based on staffing levels; and (d) assessing what nonunit based staff such as educators, clinical nurse specialists, nurse practitioners, and others are needed to support the entire nursing service (Dunn et al., 1995).

Although this approach was radical in its time, by the mid2000s, it was seen as insufficient to fully support the complex, dynamic needs of VHA facilities. The Office of the Inspector General for the Department of Veterans Affairs focused over the course of many years on the adequacy of nurse staffing in VHA, and in several important reports, found problems with staffing adequacy (Office of the Inspector General, Department of Veterans Affairs, 2004). The expert panel method was perceived as overly complex, and with its reliance on facility-level expert panels, insufficiently focused on the determination of staffing at the unit level, where care is actually delivered (Fasoli, Fincke, & Haddock, 2011). A more refined version of the expert panel method, which focused initially on expert panels at the unit level, which then reported to the facility level, was developed and piloted in 2009 in 37 VA medical centers with inpatient units. The pilot study resulted in some changes in the process for staffing methodology, which then led to the creation of a directive (Fasoli et al., 2011).

The Directive

VHA Directive 2010-034, "Staffing Methodology for VHA Nursing Personnel," was promulgated July 19, 2010 (VHA, 2014). Through its provisions, all VHA facilities were mandated to use a standardized method of determining appropriate direct-care staffing by nursing personnel by September 30, 2011. …

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