Optimal nurse staffing leads to clinical and economic improvements: 5 findings

Healthcare employers looking to achieve quality care, better patient outcomes and financial stability should view optimal nurse staffing as a necessity rather than an option — particularly as healthcare reforms and new regulations take hold, according to a new whitepaper commissioned by the American Nurses Association and developed by Washington, D.C.-based consulting firm Avalere Health in collaboration with nurses and policy experts.

The whitepaper, "Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes," highlights studies that show how nurse staffing, if done appropriately, helps to achieve both clinical and economic improvements, from reducing medication errors to shortening patients' stay in the hospital.

It also looks at various forces that have impacted discussions about nurse staffing and healthcare, according to a news release. Those forces include the Affordable Care Act provisions, Institute of Medicine reports and changing patient demographics.

"Nurses on the front lines are in the best position to determine the staffing needed for safe and equitable, quality care, but they consistently tell us they must fight for optimal nurse staffing. This whitepaper is our way of providing evidence to support the need for changes in nurse staffing across all healthcare settings," Pamela Cipriano, PhD, RN, president of the American Nurses Association, said in the release.

Here are five findings from the whitepaper.

1. Optimal staffing is crucial to providing professional nursing value. The whitepaper's authors found existing nurse staffing systems are often antiquated and inflexible. The authors said it is beneficial to have staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to take into account unit and shift level factors.

2. Factors that influence nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; and availability of or proximity to technological support or other resources.

3. Published studies show appropriate nurse staffing helps improve patient satisfaction and health-related quality of life. Appropriate nurse staffing also helps reduce the following:

  • Medical and medication errors
  • Patient mortality, hospital readmissions, and length of stay
  • Preventable events such as patient falls, pressure ulcers,
  • Central line infections, healthcare-associated infections and other
  • Complications related to hospitalizations
  • Care costs through avoidance of unplanned readmissions
  • Nurse fatigue

4. Organizations such as ANA support state and federal regulation and legislation that allows for flexible nurse staffing plans. In addition to promoting flexible staffing plans, ANA and like-minded constituents support public reporting of staffing data to promote transparency and penalizing institutions that don't comply with minimal safe staffing standards, the whitepaper authors said.

5. ANA has introduced a legislative model in which nurses are empowered to create staffing plans. "Optimal staffing is much more than just numbers, and direct care nurses are well equipped to contribute to the development of staffing plans," the whitepaper authors wrote.


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