3006 — Implementation and Integration of the Veterans Health Administration Nurse Staffing Methodology Directive in Budget Development

Annis AM, VA Ann Arbor Healthcare System; Robinson C, VAAAHS; Yankey N, VAAAHS; Krein S, VAAAHS; Sales A, VAAAHS;

Objectives:
In 2010, the Veterans Health Administration (VHA) issued a Staffing Methodology (SM) Directive to provide an evidence-based, standardized method for determining appropriate nurse staffing for inpatient facilities. SM assists nurse leaders in long-term planning and budget projections of full-time equivalent employees (FTEEs). We aimed to evaluate nurse leaders' experiences of implementing SM and the extent of SM integration in facility budgetary processes.

Methods:
We administered an online survey to Chief Nurse Executives at 148 VHA medical centers nationally. The survey included 38 items spanning four primary domains: integration of SM into the budget process, implementation of elements of the SM Directive, engagement of leadership and staff in the SM process, and use of data to support SM.

Results:
Between October 2014 and March 2015, 109 medical centers electronically submitted completed surveys (response rate = 74%). The majority of respondents (73%) reported that their facility has fully implemented SM. Although 76% of medical centers had initiated SM in fiscal year 2012 or earlier, only 52% had used SM recommendations in their budget development during this period. On a scale of 1-10 (10 = highest success), respondents on average rated the success of their facilities in using SM 6.3. As a result of implementing SM, 15% of respondents indicated they had no change in their budget, 75% had additional nursing FTEEs and 16% had additional non-nursing FTEEs allocated in their budget, 8% had a reduction of nursing FTEEs, and 4% had a reduction of non-nursing FTEEs (multiple selections allowed). Survey respondents indicated their facility leadership had total (36%), partial (62%), or no (2%) confidence in the SM process, while front-line nursing staff had a lot (5%), some (78%), or no (16%) enthusiasm for the SM process.

Implications:
VHA medical centers were in various stages of meeting the Directive. Although most respondents indicated full implementation of SM, fewer reported integration and use in budget development.

Impacts:
The ability to accurately manage and forecast staffing needs is critical for the safety and quality of patient care. Moreover, nurse staffing is a key workforce policy concern for the recruitment, job satisfaction, and retention of nursing personnel.