To help alleviate the stress of staffing for nurse managers, several different staffing models have been implemented to streamline the process and provide the best care for patients.
There’s no “one size fits all” staffing model, so it is important to know the pros and cons of each one in order to decide which is the best fit for the facility, staff, and patients.
Scheduling & Staffing: What’s the difference?
“Staffing” and “Scheduling” may seem like words that are interchangeable, but they’re actually two very different things. It is important to understand the definitions of both before diving into each nurse staffing model.
The American Nurses Association defines staffing as “a match of registered nurse expertise with the needs of the recipient of nursing care services in the context of the practice setting and situation.” They go on to explain that staffing is “achieved by dynamic, multifaceted decision-making processes that must take into account a wide range of variables” (Hanoski, 2016).
Staffing often focuses on day-of operations to assess and determine the shift-to-shift ratio of nurses to patients. Staffing processes also typically don’t look further than 24 hours in advance of a shift (Mensik, 2014). The complexities that accompany nurse staffing are why there are several hospital staffing models to help facilities create the best patient care possible.
Scheduling, on the other hand, is the process of “determining a set number of staff and type of staff for a future time period based on factors like historical census numbers and anticipated surgical volumes” (Hanoski, 2016). Every organization or facility determines the time frame for which they schedule, often ranging from a 1 month to a 3-month schedule (Mensik, 2014).
The Nurse-Patient Ratio Model
The nurse to patient ratio model is the most common, and often now seen as the most antiquated, way of staffing. The idea of the nurse-patient ratios is to look at patient and staff numbers and decide what ratio will work best for the needs of patients and the professionals that care for them.
There is no exact golden or mandated nurse to patient ratio that fits all facilities. The nurse-patient ratio all depends on the staffs’ skills, patient needs, and the number of patients and staff.
In addition, the nurse-patient ratios by state differ widely as some states have a higher need for medical attention than others.
There’s also a Federal regulation that requires facilities certified in Medicare to “have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed” (American Nurses Association, 2015). The language of this legislation is vague, and so often facilities and nurse managers are left to their own devices to discover the most suitable nurse to patient ratio (as there isn’t a mandatory one).
Some facility staffing models strictly use numbers, such as one nurse for every patient, but this is quickly becoming an outdated practice because of its impracticality. Nurses need breaks, or some patients require more work than others and may even require the attention of 2 or 3 nurses at a time.
The major cons of this model are that a facility can end up understaffed because the law doesn’t define a minimum number of nurses to patients. This leads to nurses being overworked and patients not receiving the level of care that they need, and deserve (American Nurses Association, 2015). There’s also a wide discrepancy in nurse staffing ratios and patient outcomes.
Sure, this staffing model can be the quickest way to make a schedule, but it’s inflexible and greater benefits can be derived from other models that use the nurse-patient ratio as just one factor to consider. Other factors to consider can and should include patient complexity, number of admissions/discharges, staff skill levels, and the physical space in the nursing unit (Sherwood, 2013).
The nurse-patient ratio is very important, but the general consensus has come to be that it’s best used within another facility staffing model, not as a way of staffing on its own.
The Patient Acuity Model
What’s acuity and what does it mean? The definition of acuity is the measurement of the intensity of nursing care required by a patient (The Sentinel Watch, 2014). This medical based definition is often interchangeable with “patient acuity”, which is another way of saying “patient care needs.”
An acuity-based safe staffing model regulates the number of nurses on shift according to patient’s’ needs, not patient numbers.
Patient numbers alone don’t adequately tell the numbers of nurses needed. Some patients may be on their discharge day and require little care, while others may be in a serious condition and need a nurse around the clock. The nursing workload consists of the number of assigned patients per shift along with the required patient care. Creating a balance between patient acuity and the staffing plan is a difficult task for nurse managers.
The acuity-based staffing system helps nurse managers find staffing patterns for every shift based on patient data. This system becomes even easier to use with specialized software. Nurses enter patient data into a computer and the nurse manager can quickly and easily run a report on it. With this report, the nurse manager can take the data and decide a number of nurses that need to be scheduled or if a “float nurse” is needed. This data also allows shifting the numbers of nurses from area to area or patient to patient. That way patients with the greatest needs are in the care of nurses with the most advanced skill sets (The Sentinel Watch, 2014).
Staffing plans within this staffing model serve as a baseline from which managers can make adjustments based on the ever-changing needs of the patients and the abilities of the staff (Henry, 2015).
However, the impact of patient turnover and acuity on the nursing workload is not well studied or understood. While this staffing model looks good on paper, one of the cons is that it’s sometimes difficult to actually execute. The hope for this plan is that enough research can be done to create a predictive staffing plan that can be adjusted and readjusted for patient acuity and turnover.
Another drawback of using this staffing model is that it can also undermine the full scope of nursing practice (Mensik, 2014). This staffing model breaks down patient care needs and the amount of time it takes to do different tasks, like administering medication or taking vitals. When patient care is broken down like this it runs the risk of not involving the full scope of nursing duties and the time needed to maintain high standards of quality care (Mensik, 2014).
The Collaborative Staffing Model
The collaborative staffing model gives nurses the opportunity to work with their managers in order to create a schedule and fill shifts. This type of staffing model helps free up time for nurse managers so they can do less scheduling and more work out on the floor. It also encourages and empowers staff to become more engaged in the scheduling process. Nurses feel that they have more control or input into their schedule and in return, this can prevent nurse burnout and increase the likelihood of better patient care. (Heiser, 2016)
A Harvard Business Review article referenced research that found only 44% of healthcare staff in the U.S. are engaged in their jobs (Sherwood, 2013). When a large majority of a facility’s staff feels this disconnected to their job, it negatively impacts patients and the reputation of the facility. When nurses are engaged, they’re committed to their coworkers, workplace, and delivering the best patient care possible.
The Supplemental Nurse Model
Supplemental nurses can offer a cost-efficient way of staffing nurses during temporary periods of high patient admissions or shortages of permanent nurses (American Staffing Association, 2015). Research shows that temporary or contract nurses are just as qualified as permanent nurses, and this staffing model offers a strategic flexibility that facilities need when workflow increases or staffing shortages occur.
In a Journal of Nursing Care Quality study, “Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center: A Method for Quantifying Supplemental Nurse Cost Efficiency,” the publication analyzed personnel costs and patient stays (American Staffing Association, 2015). The study found that while the hourly cost for supplemental nurses may be higher than permanent ones, if this model is used modestly, in times of need, it can actually be very cost-effective. The study also suggested that supplemental nurses are more cost-effective than a permanent nurse working overtime.
The use of supplemental nursing then could be used not only in times of staffing shortages, but also to help prevent burnout with permanent nurses. It has been well known that permanent nurses that are consistently forced to work overtime can lead to poor nurse and patient satisfaction (American Staffing Association, 2015).
There’s a misconception that finding supplemental nurses that are willing and able to take on temporary positions is challenging and time-consuming. With connectRN’s pool of credentialed clinians, who are eager to work, we can help facilities quickly and seamlessly fill any gaps in their staffing schedules.
Conclusion
Research has shown that time and time again, nurse staffing has a significant impact on patient outcomes. Adequate numbers of RN staffing levels “have been shown to reduce patient mortality, enhance outcomes, and improve nurse satisfaction” (Mensik, 2014). It’s important that everyone within the medical profession, including nurses, is aware of these staffing challenges and the outcomes of patient care because of it.
Facilities and nurse managers will always face major challenges when creating a staff schedule that makes both nurses and patients happy. There’s always a number of factors to weigh and consider, but it’s possible for every facility to find the staffing model that works best for their budget, their staff, and perhaps most importantly, their patients.