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Why a Guide on Staffing is So Important
Nursing staffing is an issue that has been forefront lately; in the spring, New York nurses battled for months to establish the state’s first-ever minimum staffing guidelines and Illinois introduced a bill to mandate staffing ratios.
As McMillan explains, staffing -- which she calls a “complex issue”-- is a long-standing and important focus for the ANA; in their 2019 membership survey, for example, 93% of the respondents identified staffing as an “important” issue, and 72% identified it as “extremely important.” Additionally, she adds that research demonstrates that appropriate nurse staffing leads to better patient outcomes, reduced costs, fewer adverse events, and fewer complications and readmissions.
She also points out that staffing is a factor in nurse turnover, which costs an average hospital $300,000 for each percent point in RN turnover. If staffing policies don’t adequately meet the needs of nurses, they are more at risk for burnout and as a result, leaving their position, which costs the hospital money for training and recruitment and also leaves patients at higher risk.
Although the ANA had identified a guide to nursing staffing in its original principles, McMillan notes that an update was necessary, as the original principles were first published in 1999 and updated in 2012.
ANA’s 5 Principles For Nurse Staffing
The ANA has created free staffing resources including a free eBook, downloadable infographic and staffing webinar on their site.
Chart via ANA website
According to the ANA, the 5 Principles include,
1. Health Care Consumer: Nurse staffing decisions are based on the number and needs of the patients, families, groups, communities, and populations served.
2. Interprofessional Teams: Optimal care is achieved through individual actions and collaboration with other health care team members. Nurses are full partners in the delivery of safe, quality health care.
3. Workplace Culture: Organizational leaders must create a workplace environment that values nurses as critical members of the health care team.
4. Practice Environment: All nursing care delivery systems must provide the necessary resources to meet each health care consumer's individual needs and the demands of the unit.
5. Evaluation: Organizations must have appropriate nurse staffing plans. All settings need well-developed staffing guidelines with measurable nurse-sensitive outcomes.
Why the ANA Supports Flexible Nursing Staffing
In the updated guidelines on staffing, the ANA supports a flexible approach to nurse staffing, identifying it as beneficial for both patients and nurses.
“Nurse staffing is more than numbers, and one size does not fit all,” McMillan says. “A flexible approach is associated with improved patient outcomes, including reduced mortality rates, shorter stays, lower readmission rates, and reduced hospital-acquired conditions.”
The organization believes that a flexible approach to nurse staffing allows for “nurse-specific factors,” which can include things like a nurse’s level of experience, knowledge, education, and skillset, as well as patient-specific factors such as acuity and intensity.
On a practical level, you can see how this might look like when you consider that a minimum staffing ratio might dictate that two nurses be staffed on the floor--but what if both of those nurses are brand-new grads, fresh off of orientation? Technically, the ratio might be met, but will it be the optimum situation for both those nurses and their patients? The ANA’s view is that more nurses who are appropriately matched to patient assignments equal better patient outcomes and improved quality of work-life that will ultimately result in lower rates of nurse burnout, turnover, fatigue, and fatigue-related errors.
According to McMillan, ANA’s staffing principles support all nurses, like the ones performing direct-care and therefore attuned to what patients actually need -- even as those needs can shift on an hourly level -- having a role in nurse staffing decisions.
With nurses’ input, following the principles would lead to a healthcare organization with the following:
◉ Nurse-driven staffing guidelines with measurable outcomes
◉ Nurses at all levels having a role in staffing decisions
◉ Staffing needs and assignments taking into account factors such as patient status and nurse competencies
◉ Flexibility to reassess and adjust staffing during the course of a shift as patients are admitted and discharged
◉ Sufficient training time and resources for new grads and orientees
◉ Nurse staffing would be referred to as more than numbers, known as “one size does not fit all”
◉ A focus on flexibility and teamwork to effectively meet the ever-changing needs of patients
◉ A workplace culture that values nurses as a vital part of the healthcare team
How All Nurses Can Be Involved
To help establish the staffing policies that ANA believes will benefit both patients and staff alike, ANA explains that the organization has been working hard to not only share the updated principles and encourage “a shift in paradigm,” but has also been working on a federal level as well. For example, ANA has been working with federal officials to push for the Centers for Medicare & Medicaid Services to provide Congress with information about how the agency assesses “adequate” staffing levels as part of its 2020 budget request.
ANA is also working to maintain National Quality Forum endorsement for two nurse staffing measures: skill mix and nursing hours per patient day. McMillan notes that several states already require their hospitals to publicly report these measures, and ANA’s continued advocacy will encourage increased transparency, especially with respect to the Medicare program.
And while federal and state measures are vital for change, the ANA also encourages every nurse who wants to get involved in promoting and implementing flexible nursing staffing policies to take action on a personal level too.
For instance, McMillan suggests that nurses could start by simply having a conversation with nurse managers and other leaders who are responsible for nurse staffing in your workplace as a first step.
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