Staffing Principles from the Patient’s Perspective
The common staffing formula of “nursing hours per patient day” is not adequate to determine sufficient staffing levels. Patients with more intense needs may require greater concentration of nursing services. Merely establishing the “average” patient’s needs is inadequate. Staffing plans are most appropriate when they account for:
- Number of patients
- Patients’ intensity levels
- Layout of the floor, available technology and other physical or systemic factors
- Nurse skill and experience level
Appropriate staffing levels should account for individual patient needs as well as total care needs on a unit. These patient considerations should be taken into account:
- Age and functional ability
- Communication skills
- Culture and language
- Severity and urgency of admitting condition
- Scheduled procedure(s)
- Availability of social supports
Staffing plans also depend on hospital unit functions necessary to support and improve the quality of patient care:
- Management decision-making process
- Involvement in quality measurement activities
- Development of treatment and progress plans for patients
- Evaluation of practice outcomes
| TABLE I |
| Matrix for Staffing Decision-Making |
| Items |
Elements/Definitions |
| Patients |
Patient characteristics and number of patients for whom care is being provided |
| Intensity of unit and care |
Individual patient intensity; across the unit intensity (taking into account the heterogeneity of settings); variability of care; admissions, discharges and transfers; volume |
| Context |
Architecture (geographic dispersion of patients, size and layout of individual patient rooms, arrangement of entire patient care unit(s), and so forth); technology (beepers, cellular phones, computers); same unit or cluster of patients |
| Expertise |
Learning curve for individuals and groups of nurses; staff consistency, continuity and cohesion; cross-training; control of practice; involvment in quality improvement activities; professional expectations; preparation and experience |