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RRP 07-336 – HSR&D Study

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RRP 07-336
Assessing Evidence for Nurse Staffing to Improve Patient/Organizational Outcomes
Kathlyn Sue Haddock PhD RN
Wm. Jennings Bryan Dorn VA Medical Center, Columbia, SC
Columbia, SC
Funding Period: October 2007 - March 2008

BACKGROUND/RATIONALE:
Nurse staffing has become a focal point in patient safety and outcome discussions. Appropriate staffing for safe and effective care becomes a challenge without evidence. The task before us was to provide a systematic, evidence-based approach from existing knowledge with subsequent development of a model linking staffing with outcomes. Thus, the VA Office of Nursing Service requested a methodology for a nationally standardized nurse staffing plan with the foundation coming from a review of patient acuity systems used for nurse staffing.

OBJECTIVE(S):
The purpose of this study was to gather the evidence about nurse staffing systems and develop a model to be tested:
1.Complete a systematic literature review to analyze the evidence about staffing models and the factors that should be considered in a staffing model.
2.Engage an Expert Panel to review the evidence and determine which variables were appropriate to consider for use in a staffing model.
3.Test the feasibility of identified variables and of electronically accessing those variables at two VA facilities.

METHODS:
The researchers conducted a systematic review of the literature for evidence of validated staffing models and variables that should be considered in a staffing model. Using a panel of experts and a statistical consultant, the evidence was used to develop a list of staffing variables. The variables were tested using both electronic administrative data and interviews with nurse managers from a Magnet hospital to determine variability and feasibility of measures.

FINDINGS/RESULTS:
Variable testing helped identify gaps in existing electronic data repositories and has been instrumental in developing the process for the Expert Panel Methodology to be piloted in five VA networks. The electronic data available include: hours per patient day, average length of patient stay per nursing unit, number of admissions, transfers, discharges per day, and average patient age. Other variables related to physical layout, number of students, residents, and services rotating on the unit, average number of orders written and average number of medication passes were considered significant but we were not easily able to capture the data electronically and chose not to use it for this evaluation.

IMPACT:
The Phase I literature review has already been used by the NNEC Goal Group working on staffing methods for the VA. The variables identified in the literature review and meeting of the expert panel have been used in the next phase of testing them for variability and feasibility across the VA. A five (5) VISN pilot study is underway and reaching completion. This investigator will do the evaluation of the staffing pilot.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: none
Keywords: Nursing, Organizational issues, Staffing
MeSH Terms: none

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