Article Discusses Evidence-Based Staffing Methodology to Predict Nurse Staffing Needs
VA is the largest employer of nurses in the U.S., with more than 77,000 – 82% of whom are direct-care nurses. Though VA nursing vacancies and turnover had lagged behind the national average since 2000, rates exceeded the national average in 2007; and by 2009, VA had ranked nursing positions as the priority for recruitment and retention efforts. VA’s staffing challenges are not unique, as a national nursing shortfall of 260,000 RNs is projected for 2025. Therefore, throughout the U.S. efforts are underway to address the nursing shortage. In the meantime, methods to determine short- and long-term staffing needs become more critical. It was against this backdrop that the VA Office of Nursing Services (ONS) began efforts to update its current nurse staffing methodology. This article describes the process used to identify indicators of nursing workload and develop an evidence-based nurse-staffing methodology that could be used to predict staffing needs and eventually link to nursing outcomes in the VA healthcare system.
This study utilized an integrative review of the literature on nurse staffing systems and guidance by an expert panel of inter-disciplinary consultants to identify variables and indicators of nursing workload. Investigators then developed a final set of indicators that represented multiple layers of nursing work: patient variables, nursing characteristics, and unit- and hospital-level attributes. The indicators also were considered to be feasible, measurable, and useful to front-line managers as predictors of unit staffing levels. The final set of indicators included: 1) average length of stay (surrogate marker for patient severity of illness); 2) average number of medication doses administered daily; 3) percentage of patients with age >70; 4) percentage of patients with a BMI >25; 5) top three diagnostic categories on the unit (surrogate for complexity/scope of care required); 6) average daily census (patient volume and nursing workload); and 7) daily patient turnover (admissions, transfers, discharges). Tools to facilitate implementation of the staffing methodology were developed, tested in 37 VAMC inpatient units, refined, and finalized.
Following successful evaluation, the ONS introduced a national VA policy that directed all facilities to implement the new evidence-based, nationally standardized staffing methodology by September 2011. A formal evaluation will begin in October 2011. The authors also suggest that this evidence-based approach could be adapted by other healthcare systems.
This study was funded by HSR&D (RRP 07-336). Dr. Fasoli and Dr. Fincke are part of HSR&D’s Center for Health Quality, Outcomes & Economic Research in Bedford, MA.
Fasoli D, Fincke B, and Haddock K. Going Beyond Patient Classification Systems to Create an Evidence-Based Staffing Methodology. Journal of Nursing Administration October 2011;41(10):434-39.