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Do you currently use staffing ratios to assess staffing needs? If so, new standards will call for you to switch to a different method. New standards being pilot tested by the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations require the use of performance indicators to assess the effectiveness of staffing. They are expected to become effective in 2002.
The standards require you to assign staffing based upon outcomes, says Diana Contino, RN, MBA, CEN, CCRN, president of Emergency Management Systems, a Monarch Beach, CA-based consulting firm which specializes in staffing issues. "The key to your success with these clinical/service and human resource screening indicators’ is which ones you decide to use," she notes.
The clinical service indicators include adverse drug events, patient falls, patient and family complaints, pneumonia after major surgery, injuries to patients, skin breakdown, IV-related infections, and wound infection. The human resource screening indicators are overtime, closed beds, floating of staff, sick time, on-call/per diem use, staff injuries, nursing care hours, understaffing as compared to an organization’s staff plan, staff turnover, staff satisfaction, and vacancy rate.
You’ll need to choose at least two indicators in each category to monitor, says Contino. "Surveyors will be looking at the relevancy and sensitivity of the indicators," she says. "If the facility has chosen indicators that are not relevant and sensitive to their situation, the facility may be cited and asked to develop an action plan."
Contino notes that assessment of staffing using patient outcomes is the focus of a new study, which concludes that the number and mix of nurses in a hospital make a difference in the quality of care patients receive. (See "Resources," at the end of this article, to learn how to obtain a copy of the study.)
The study is based on 1997 data from more than 5 million patient discharges. It found a strong relationship between nurse staffing and five outcomes: urinary tract infection, pneumonia, shock, upper gastrointestinal bleeding, and length of stay. A higher number of nurses was linked to a 3-12% decrease in adverse outcomes.
The researchers recommend that universal definitions of nursing categories be adopted, along with procedures to calculate full and part-time equivalent employees, report nurse staffing data by inpatient and outpatient categories, and report data by specific nursing unit and nursing practice pattern such as primary, team, and functional, notes Contino.
Contino urges nurses to use these strategies to monitor outcomes and act on any adverse findings. "This new standard should help nurses and human resources departments validate and correct ineffective staffing patterns, and practices," she predicts.
To learn about the new standards to assess, contact:
• Diana Contino, RN, MBA, CEN, CCRN, Emergency Management Systems, 24040 Camino Del Avion, Suite 123, Monarch Beach, CA 92629. Telephone: (949) 493-0039. Fax: (949) 493-7568. E-mail: diana@ConsultingEMS.com.
The complete draft standards and indicators are posted on the Joint Commission’s web site, www.jcaho.org. Click on "Standards" and scroll down to "Draft Standards."
A study released in April 2001 on nurse staffing and patient outcomes can be downloaded for free on the Health Resources and Services Administration Bureau of Health Professionals web site (bhpr.hrsa.gov). Click consecutively on "Overview of Programs," "Nursing," and "Nurse Staffing and Patient Outcomes in Hospitals."