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• W2047826861 abstract "Nurse staffing increasingly has become a topic of research studies. Data currently exist on the relationship between adverse events and nurse staffing.1,2 Data also exist on the relationship between fatigue and patient outcomes.3 Knowing the right number of nurses to have and how to optimally manage their schedules is a goal that all hospitals would like to achieve. The American Association of Critical-Care Nurses (AACN) has listed Appropriate Staffing as an essential standard for a healthy work environment (HWE).4 AACN states that “Staffing must ensure the effective match between patient needs and nurse competency.”4(p28) Many critical elements of this standard relate to the structures and processes necessary for staffing that matches the needs of patients with nurses’ competencies, which ultimately leads to an HWE.Appropriate staffing is necessary to keep patients safe. Numerous staffing bills have been introduced at the state level. Some have passed and become law, such as the Staffing Ratio Assembly Bill 394 in California. Opinions are mixed about whether this bill improved care by identifying a fixed ratio, but an improvement was observed in the overall skill mix, with an increase in the number of registered nurses hired to meet the ratios. Aiken et al2 presented a relationship between higher skill mix in registered nurses and better patient outcomes. Donaldson et al5 found that after reviewing nursing outcome data before and after implementing the ratios in California, a significant difference was not found in the prevalence of hospital-acquired pressure ulcers, restraint use, or reduction of falls at the unit level in medical-surgical units.So, what is the right mix for staffing? Is there a magic number? As mentioned previously, staffing must ensure an effective match between the needs of the patient and the competency of the nurse. To achieve this match, the nursing care delivery model in the hospital needs to address these issues; a method must be in place to determine staffing and patient acuity. The remainder of this article discusses some examples of structures and processes that some hospitals have implemented for determining staffing and acuity based on the AACN Synergy Model for Patient Care.6Many hospitals are searching for an acuity system that will give them the number of nurses needed for staffing on the basis of patient acuity, and that would help the charge nurses and managers know when to decrease staffing as a patient’s acuity becomes lower and the staffing needs are decreased. Acuity programs have improved over the past 10 years, and a few systems are available to help hospitals effectively manage their staffing needs and overall labor management, while also decreasing costs. Cerner Clarvia (Cerner Corporation, Kansas City, Missouri) is an acuity program that can electronically determine patient acuity by pulling data from the electronic health record and determining a nursing acuity score based on identified nursing outcomes. It is an acuity-based system used to move patients to the desired outcomes needed for discharge. As a patient’s condition improves, the number of nursing hours needed for patient care decreases. This system also has a scheduling component that is fully integrated, which assists in matching nursing scheduling needs with patient acuity. When linked electronically with a competency system, it can propose nursing assignments by matching nurse competencies to the needs of the patients. Nursing acuity and staffing systems are moving away from the traditional nursing task-based staffing to effectively match the patient’s needs with the nurse’s competencies, as deemed essential by the Appropriate Staffing standard. The Cerner Clarvia staffing and acuity system is one example that is consistent with the critical elements of the HWE Appropriate Staffing standard. We have come a long way from paper-and-pencil acuity tools that were in place years ago.The AACN Synergy Model was developed on the principle that patient characteristics drive patient acuities. Table 1 lists the 8 patient characteristics of the Synergy Model, and Table 2 lists the 8 nurse characteristics of the Synergy Model. The goal of this model is to match the nurse’s competencies with the patient’s needs/characteristics, resulting in synergy.6 This model was based on the work by Curley7 and created by the AACN Certification Corporation. Curley was the first to publish research on “patient-nurse synergy.” This model has been incorporated at various hospitals for staffing and as a model for professional nursing. Baylor Healthcare in Dallas, Texas, is a hospital that has incorporated the Synergy Model into patient care and has it as the foundation for the Baylor Healthcare System Professional Nursing Practice Model. John Dixon has lectured on this topic at several national conferences, including the AACN National Teaching Institute (NTI). As Dixon said in his 2008 presentation at the American Nurses Credentialing Center Magnet conference, “Professional nursing practice occurs in a healthy work environment where patient needs are assessed and matched to nursing competencies. This synergy results in Safe Passage for patients.”8With the changes occurring in health care and the increasing emphasis on wellness, a strong focus of hospital care is to move the patient through the care continuum as quickly as possible. Structures and processes are needed to achieve ideal patient outcomes. Appropriate staffing continues to be an essential standard to provide the best care while optimally using appropriate resources. Resources are available on the AACN Web site if you are interested in learning more; these resources include journal articles, posters presented at AACN conferences, and statements about what others have done to implement these standards in their work environment." @default.
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• W2047826861 date "2013-01-01" @default.
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• W2047826861 title "Appropriate Staffing for a Healthy Work Environment" @default.
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• W2047826861 doi "https://doi.org/10.1097/nci.0b013e31829937f5" @default.
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