Principles For Nurse Staffing

Nurse staffing decisions are based on the number and needs of the individual healthcare consumer, families, groups, communities, and populations served. In any approach to determining appropriate nurse staffing levels, consideration must be given to the elements affecting care at the level of the individual practice setting. Each setting should have staffing guidelines based on patient safety indicators, and clinical and administrative/operational outcomes specific to that area. Sufficient resources and pathways for care coordination and health education for the patient/healthcare consumer and/or family should be readily available.

The specific needs of the population served should determine the appropriate clinical competencies required of the registered nurses practicing in an area. The organization must specify the appropriate credentials and qualifications of registered nurse staff, while ensuring registered nurses are permitted to practice to the full extent of their education, training, scope of practice, and licensure. Staffing plans should embrace and leverage the skills of experienced nurses and should incorporate dedicated time and resources for mentoring, precepting, and addressing skill development needs of nurses. Regular monitoring of specified indicators such as nurse satisfaction, burnout, turnover and retention, and workplace injuries, can help ensure that staffing outcomes are evaluated and adjusted.

A balance of quality and safety with the overall expenditure of nursing resources and associated costs is needed to achieve best practices and optimal care outcomes. To that end, healthcare leaders and organizations must create a workplace environment that values registered nurses and other employees as critical members of the healthcare team. Policies should support the ability of registered nurses to practice to the full extent of their license, education, scope of practice, and documented competence. To maximize safe patient care and quality outcomes, health system leaders and organizations should recognize that in addition to appropriate nurse staffing, they must provide sufficient interprofessional support and ancillary services and sufficient orientation and preparation of nursing staff. Creation of a culture of values that support respect, trust, collaboration, and interprofessional healthcare team building helps cultivate loyalty and ultimately retention. The increased complexity of today’s healthcare environment requires availability of enhanced support in ethical decision-making for all aspects of care planning and care delivery.

Staffing includes structures and processes that affect the safety of patients and nurses. Institutions employing a culture of safety must recognize appropriate nurse staffing as integral to achieving goals for patient safety and quality. Registered nurses have a professional obligation to report unsafe conditions or inappropriate staffing that adversely impacts safe, quality care, and they have the right to do so without reprisal. Registered nurses should be provided with a professional nursing practice environment in which they have control over nursing practice and have autonomy in their workplace. Policies on length of shifts, management of meals and rest periods, and overtime should be in place to ensure the health, well-being, and stamina of nurses and prevent fatigue-related errors. Mandatory overtime is an unacceptable solution to achieve appropriate nurse staffing.

Staffing plans must be conducive to adjustment to reflect changes in evidence and outcomes, care scenarios, and the needs of the population served, all of which can vary from hour to hour, shift to shift, and day to day. Evaluation of any staffing system should include examination of environmental factors affecting the healthcare consumers’ safety and outcomes, in addition to the evaluation of nurse specific indicators such as work-related staff illness and injury rates, turnover/vacancy/retention rates, and levels of healthcare consumer satisfaction and nurse satisfaction. When evaluating nurse staffing costs, the organization should always take into account the cost of adverse outcomes when staffing is inappropriate, as well as the variability in costs related to staffing and assignment patterns, skill mix, and wages of nurses and nursing personnel related to experience. The allocation of identified costs of nursing care in patient billing records and reimbursement requests makes visible the value of nurses and nursing services.