20 Responses

  1. iamacielezuzarte at |

    This is an amazing power point presentation. It is very detailed and informative. Viewing the different staffing models presented, the computer staffing model seems to be most accurate. I work in the OR. In the nurse to patient ratio presented in one of the slides it shows 1:1. However, our heart, lung, liver and pancreas transplants do require two nurses for one patient. This is based on the acuity of these patients. However in the general operating rooms our department staffing is prepared on paper, based on cases scheduled each day. Our floors though, use the “one staff” computer program. This program is based on census. The high acuity floors (ICU, SICU, MICU) are closed units.
    Having appropriate nurse to patient ratio is always a challenge. Though evidence illustrates that a lower number of patients per nurse lead to safer patient and quality patient care, the hospital administration looks at finances and profits. It is true that innovative staff scheduling assignments do help by looking ahead at the needs of the unit. Advocacy for safe nurse-patient ratios with our State legislators may help us increase patient and staff quality of care and satisfaction. Good job. I enjoyed your presentation.

    1. Tammy Robinson at |

      Thanks for your feedback! We are glad you enjoyed the presentation.

      I have a question for you- what do you mean the high acuity floors in your hospital are “closed” units?

      As the one of the largest workforces in the country, it’s my hope that we will be able to convince state legislators how important the safe staffing is, and the reaping benefits of such.

      Thanks again!

    2. smulu at |

      Per Bowblis J (2011) Patient death increase when patient nurse ratios are reduced. She ever reports that all care setting from Hospitals to Nursing homes if nurse patient ratio are reduces, increased hospitalization, death become prevalent. From my experience am used to working short and seems some Hospitals are working hard to even bring in agency staff.
      The question is short staffing and nurses role a interwoven phenomenon that represent what nurses have to expect?

      References
      Bowblis, J. (2011). Staffing Ratios and Quality: An Analysis of Minimum Direct Care Staffing Requirements for Nursing Homes. Health Services Research, 46(5), 1495-1516.

  2. Tracey Schoenberger at |

    Great presentation guys! Very thorough and great attention to detail. We have Cerner at our facility but do not utilize the computer based program because of all of the drawbacks you have mentioned. We too use a paper census model similar to the one you pictured in the PowerPoint and the charge nurse uses her judgement based on the acuity on the floor whether or not to call off staff or to get additional staff in.
    It was stated in you presentation that budget is a concerning factor with the proposed Federal RN ratios/safe staffing.
    According to Department for Professional Employees (2016),some critics of safe staffing claim that mandatory nurse-to-patient ratios burden hospitals with high operational costs, the majority of research shows that safe-staffing ratios are cost-effective. High turnover rates and high levels of temporary nurse staffing increase the average costs per discharge (cost of inpatient care, including administration) and overall operating costs. Safe staffing improves nurse performance and patient-mortality rates, reduces turnover rates, staffing costs, and liability. So in a nutshell, it is actually saving money in the long run when you look at the big picture.
    Once again, great job guys!

    Reference: http://dpeaflcio.org/programs-publications/issue-fact-sheets/safe-staffing-ratios-benefiting-nurses-and-patients/

    1. Tammy Robinson at |

      Tracey, Thank you for the kind feedback. I know our presentation was long! But it was so interesting for the team to research, and we thought it was all very pertinent data that the whole class could learn from.

      We must continue to create data for the long-term financial savings by safe staffing! I’m glad you also found supporting data, that shows money can be saved in the long run; and, more importantly, less people will die, staffing won’t turn over as much, and the workplace will be safer for everyone. It’s always a struggle (I think for all of us) when critics of the Federal bill say it’s all about money, money, money. We know, as nurses, it’s hardly about money! It’s about quality of care and saving lives.

  3. Elizabeth McElroy at |

    Great post! Your power point was put together very professional! At the hospital I work at we do our nursing staffing ratio off of patient census. So we also us a paper staffing sheet that has the number of patients then it tells us how many nurses and PCTs we can have. Unfortunately, this can be very difficult for us at time because some of our patients are higher acuity than others and our staffing ratio doesn’t reflect the difficulty of the patients. The management of the hospital refuses to change the way we are staffed due to budgeting issues. This in return creates problems because we you have 4-5 difficult patients you are not providing appropriate care.

    1. csholmes at |

      The staffing matrix is only helpful at determining nurse-patient ratio, but never takes acuity into consideration. Our charge nurse just looks at the numbers too, never at acuity when doing assignments. Most times we require more nurses, but every unit is usually short, so that means taking on more patients, which puts nurse/patient safety at risk. Management is aware, they come out of their office to assess, but usually never help or just tells the charge nurse to make it work the best they can. As a result of the shortage of staffing, increased workload and stress, many nurses have left, making the staffing even more difficult. Magement needs to help their nurses and something needs to be done soon or there will be no staff at the hospital I work at

    2. Tammy Robinson at |

      Thanks for the feedback, Elizabeth! Glad you enjoyed the presentation.

  4. Janden at |

    Great choice of topic! Staffing issues are both a professional and personal concern. It not only impacts patient safety but can lead to a huge effect on the RN and the pressures they face with fatigue, burnout and the ability to provide quality safe patient care. Staff nurses work hard and face many obstacles but should not have to risk their feelings of well-being and sanity to do so. It’s undoubtedly a challenge with many variables in place related to staffing and budget while taking the mandated ratios into consideration.

    1. Tammy Robinson at |

      Janden, Thank you for the feedback!

      I think one aspect we didn’t hit on for the presentation was a more in-depth angle of the psychological impact poor staffing actually has on the nurse. I have seen nurses have panic attacks, anxiety disorders, depression, insomnia, and other negative health outcomes directly related to the conditions of caring for too many high intensity nursing care patients. In addition to the positive benefits of better staffing ratios, staffing to acuity, and staffing to intensity on patient outcomes; it is also beneficial for staff. Here’s to hoping the federal government looks into the long term data, and focuses less on money now versus money saved in the future with those proposed guidelines.

  5. kjdaniels at |

    Nice presentation. Very well thought out and put together. Really enjoyed watching it. Staffing ratio is always a big concern in the medical field and I don’t think it will be going away any time soon. I struggle with this at work, because sometimes I feel like upper management doesn’t care about their employees, heck they go home at 5:00 every day and don’t give it a second thought. I feel like no matter how often we as nurses voice our opinions they tell us what we want to hear to make it by for now.

    1. Tammy Robinson at |

      Kjdaniels, thanks for your response; we are glad you enjoyed watching the presentation.

      You are right, I think a lot of upper managers act like they don’t care about their employees- even though they say they do, their lack of action speaks louder. Managers that don’t give it a second thought really are not leaders. We need to continue to advocate for effective leaders in management who put their words into action. I’m lucky to work on a unit where our clinical managers are on-call, and our senior manager sometimes dresses out for patient care when in a pinch. I think they really do care about our unit- and the attitude starts with them.

  6. jmfrydendall at |

    Great Information! I work in a rural hospital and they do not use any kind of census level to staff. There are usually 3 RN’s on day shift and 2 aids the usual census is between 7 and 10. If there is a high acuity level the DON and the pharmacy nurse take patients as well. On the noc shift there are 3 RN’s and 1 CNA. Again if the acuity level is high the DON makes all efforts to get more staff to come in and work. For us this works pretty good because our hospital is only 15 beds total. I found all the information very interesting. Can you tell me what a SWAT nurse is?

    1. Tammy Robinson at |

      Hi! Thanks for the feedback.
      It’s great your DON and pharmacy nurse can help, and take patients. It’s super interesting though, because I’ve never heard of a DON taking patients! That’s one huge difference between city/urban and rural hospital settings, no doubt. I’m glad your staffing is working for your hospital!

      In the NICU, a SWAT nurse is basically a unit float nurse, meaning they do not have an assignment. They must be a very skilled nurse, and a leader. SWAT nurses help with assignments in the unit, help with procedures, and do anything and everything under the sun! They will also be the first nurse to admit patients. If there’s a SWAT nurse, there is no nurse who is first admit on the unit. These nurses also go to deliveries when the delivery nurse is busy or on another delivery.

      In general, SWAT nurses are also utilized in the hospital as nurses who (again) float between units to help with incredibly sick patients. These SWAT nurses will help insert IVs (usually under ultrasound) and they will try to help with patients who are crashing, before rapid responses or codes are called. These floor SWAT nurses look thoroughly through charts to see if the bedside nurse is missing something, and to be a critical eye for the care being received. This is a better “general” picture for the role of a “SWAT” nurse in a hospital setting (which is different than my unit’s “NICU SWAT nurse”).

      Hope that helps!

      1. jmfrydendall at |

        That helped a ton. Thanks for clarifying what a SWAT nurse is.

  7. Nora Nokes at |

    Terrific presentation, very nicely done. Staffing is an issue everywhere in healthcare. Acuity definitely needs to be an important ingredient in the decision process. At this moment, I am sitting next to my husband in the progressive care unit in Salina, KS. Our nurses have had 4 patients every shift. My husband currently has 4 different IV fluids running, including TPN, he has a PCA, telemetry, a chest tube, an NG tube,oxygen running, as well as multiple IV push meds. Today was a difficult day for him, and our nurses probably spent at least 4-5 hours of each of the last 3 shifts with him. I appreciate the amazing care he has been receiving, but it is probably not completely fair to the other patients. It has been an interesting experience to be in a hospital as family to a patient with a serious condition. The last few days have given me a different perspective of hospital care. (FYI- he had an esophageal tear on Valentine’s day. The blessing of a great ER doc saved his life with a quick diagnosis.)

    1. lmrowden at |

      Nora, I’m so sorry to hear about your husband! It’s completely different when you are on the patient side of the healthcare field and you truly do realize how busy the team is and how much care your loved one gets compared to how much they deserve. I hope your husband is healing well! (:

    2. Tammy Robinson at |

      Nora,

      First things first: Praying for your husband and your family! How scary! I’m glad he’s in good hands, and thankful you all had a ER physician who know what he/she was doing. Hope he’s healing well.

      Thank you for your feedback regarding our presentation; and, you are living the role of family member for an intense nursing care patient. I’m glad nursing staff has been able to give your husband great care, and it sound like they must be staffed knowing he is ill, higher acuity, and a higher intensity patient.

      This just goes to show, it doesn’t matter where we land on the health care spectrum, staffing ratios means something to all of us. Whether we are the nurse, we are the patient, or we are the patient’s family member. We all have to fight for fair, safe, staffing ratios which is unique to each patient and each patient/nurse assignment each and every day.

  8. Kenny at |

    I enjoyed seeing the different staffing tools. I work in a 10 bed ICU and feel like our hospital spends a vast amount of time and energy trying to address staffing issues. Our resources are limited because the total bed count is 58 and our census while relatively stable can fluctuate quite a bit. It can be quite stressful during high acuity/census times.

    1. Tammy Robinson at |

      Kenny,

      Thanks for the feedback.

      We also have a census that fluctuates often, and dramatically. Sometimes our unit is short TEN nurses on a shift! We are able to pull resource RNs from our pediatric hospital tower, and also registry or “float” RNs from the main hospital staffing unit- but this is also not good because these nurses don’t know the unit very well, and patient care suffers. We usually sit between 40-50 patients, but sometimes we can hit the 30’s and go upwards to 65 infant patients. I agree, that is the most challenging part. We often offer ESI (extra shift incentive) when our census is so high, to incite nurses to work extra for even more extra pay.

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