Safe Staffing

On my honor, I have neither given nor received aid on this assignment or test, and I pledge that I
am in compliance with the BSMCON Honor System.

For the practicing RN, staffing is an issue of both professional and personal concern.
Inappropriate staffing levels can not only threaten patient health and safety, and lead to greater
complexity of care, but also impact on RNs' health and safety by increasing nurse pressure,
fatigue, injury rate, and ability to provide safe care (ANA, 2015). Patient outcomes are linked to
nurse staffing in both acute and sub-acute settings. Per Amer, research clearly shows that care is
safer when nurse to patient ratios are reasonable (2013).
Registered nurses have long acknowledged and continue to emphasize that staffing issues
are an ongoing concern, one that influences the safety of both the patient and the nurse. There is
a strong relationship between adequate nurse-to-patient ratios and safe patient outcomes. Rising
patient acuity and shortened hospital stays has contributed to challenges (ANA, 2015). Staff is
now more than ever responsible for providing care that will aid in decreasing a patients length of
stay and there are also more demands on providing a high level of care in order to receive reimbursement from governmental payors. Finding an optimal nurse-to-patient ratio has been a
national challenge. However, rising patient acuity and shortened hospital stays have contributed
to recent challenges. Ensuring adequate staffing levels has been shown to reduce medical and
medication errors, decrease patient complications, decrease mortality, improve patient
satisfaction, reduce nurse fatigue, decrease nurse burnout, and improves nurse retention and job
satisfaction (ANA, 2015). Optimal staffing is essential in order to provide optimal patient care.
Innovative and collaborative strategies that focus on developing long-term solutions will
improve the quality of patient care outcomes (ANA, 2015).The best quality care can be
accomplished when nurses design their own best practice situations (Amer, pg. 217, 2013).

Quality improvement (QI) consists of systematic and continuous actions that lead to
measurable improvement in health care services and the health status of targeted patient groups
(HRSA, 2015). The Institute of Medicine's (IOM) which is a recognized leader and advisor on
improving the Nation's health care, defines quality in health care as a direct correlation between
the level of improved health services and the desired health outcomes of individuals and
populations (IOM, 2015). In order to improve nursing shortages and make for safer staffing
ratios, facilities will first need to implement a quality improvement project. The first step is for a
team to be formed and to determine which quality methodology will be used. The team will need
to include supervisors, administrators and most importantly staff nurses who are currently
working the shifts. Once a team has been formed it is time to work. We will use the 4 stages of
an improvement project as our example. Stage 1 is Innovation; in this stage teams brainstorm
good ideas for changes to test (what will we accomplish) (IHI, 2009). Stage 2 is Pilot; in this
stage the team is testing the change on a small scale, maybe they are starting with only one unit
to see how effective the new plan is. Stage 3 is Implementation; this stage is responsible in
making the change the new standard process in a defined setting. Stage 4 is Spread; this is where
the team has accomplished their goals and will now implement the changes in several settings
(IHI, 2009). A Quality Improvement project could be implemented in any hospital setting to Sub
acute setting simply by Health care leaders offering support and recognition. If a staff member is
not part of leadership, it is important to understand your organizations current status regarding
quality improvement. An assessment of current activities in your organization will help you
identify strengths and weaknesses as well as barriers to sustain Quality Improvement (QI) efforts
(HRSA, 2015). Common barriers to sustaining a project can be lack of an adequate Quality
Management (QM) organizational structure to support improvements over time, lack of

resources, lack of ongoing communication and feedback to providers and staff, lack of periodic
re-monitoring and feedback to providers and staff, staffing changes without sufficient training of
new staff, and changing priorities and lack of interest (HRSA, 2015). In order to have an
effective QI plan, the team needs to include the organization mission and goals. The QI will need
to define their concept; there will need to be training and support for all staff involved, evaluate
all measurements that have been analyzed, and receive input from all staff (HRSA, 2015).
Once a QI project has been started it is important to review how it is affecting nursing.
Nurses can be active participants in each of the trends and bring the nursing mindset and the
quality imperative to these new endeavors (Amer, 2013). Staffing models and staff planning
processes need to reflect the complexity of patient acuity and should include patient turnover
(admissions, discharges, and transfers) and be flexible to allow nurse managers to meet staffing
needs within their allocated resources. Using a weight factor added to worked hours per patient
day (WHPPD) may be useful when nurse managers plans for accurate staffing (Tierney, 2013).
Studies have shown that increases in RN staffing levels in general hospital units have resulted in a
reduction of 5.7% in patient days. The trend toward higher RN staffing levels has been shown to
decrease avoidable never events such as inpatient falls and hospital-acquired pressure ulcers (Staggs,
2013). By working to improve staffing shortages, it will allow for a better nurse patient ratio,

which can allow nurses to provide the necessary hands on care to their patients thus leading to
better patient outcomes and higher re-imbursement rates.
Health care leaders have an opportunity to build a safer environment for patients and
registered nurses. Staffing solutions require leadership support and recognition to assure an
appropriate number and skill mix of registered nurses who are able to deliver safe quality patient
care (HRSA, 2015).

Objective: April 2015 Nurse Safe Staffing to allow for RN to patient ratio of 1:5
For 20
bed unit

Amoun
t of
HAIs

Patien
t falls

Sentin
el
events

Advers
e drug
events

Nursing
turnover/vacan
cy

Staff
shortag
es

<5
episode
s
monthl
y

<3%

6 call
outs

Hospita
l
acquire
d
Pressur
e
Ulcers
4
inciden
ts
<stage
2
1
inciden
t
<stage
3
0

Full
time
RN/LP
N Staff
40
hours
a
week

Nursing
skill mix
of 85%
RN or
higher
(12
Nurses
daily)

<5
episode
s
monthl
y

10

Part
time
RN/LP
N Staff
20
hours
a
week
CNA
Full
time
40
hours
a
week
CNA
part
time
20
hours
a
week

Nursing
skill mix
of 85%
RN or
higher

<5
episode
s
monthl
y

<5
episode
s
monthl
y

Need 6
certified
nursing
assistan
ts

N/a

1 call
out

Need 2
certified
nursing
assistan
ts

N/a

1 call
out

References:
Amer, K. S. (2013).Quality and Safety for Transformational Nursing Core Competencies. Upper
Saddle River, NJ: Pearson
American Nursing Association. 2015. Nurse Staffing. Retrieved from
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NurseStaf
fing
Butts, Sue. 12-23-2009. The Life Cycle of Quality Improvement Project. Institute for
Healthcare Improvement. Retrieved from http://app.ihi.org/lms/lessondetailview.aspx?
LessonGUID=2adf747a-862f-4862-ab0c-561318f05b67&CourseGUID=ea07c796-a771-47138bd8-520188b6c793&CatalogGUID=4cc435f0-d43b-4381-84b8-899b35082938

The Institute of Medicine of the National Academics. 2015. About the IOM. Retrieved from
http://www.iom.edu/About-IOM.aspx
Staggs, V., & He, J. (2013). Recent trends in hospital nurse staffing in the United States. The Journal
of Nursing Administration, 43(7/8), 388393.

Tierney, S., Seymour-Route, P., Crawford, S. (2013).Weighted staffing plans for better prediction
of staffing needs. The Journal of Nursing Administration, 43(9), 461467.

U.S. Department of Health and Human Services, Health Resources and Services Administration.
2015. Quality Improvement. Retrieved from
http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/