Principles of Nurse Staffing

Principles of nurse staffing require quality patient care with a focus on optimal health care delivery, and consideration for patient and nurse well-being. The Registered Nurse Safe Staffing Act of 2010 proposes to hold hospitals accountable for appropriate staffing levels based on sound principles that ensure optimal staffing levels for high quality patient care. Staffing principles include assessment of management, nursing and patient needs, and final decisions should not rely on the type of payor or only the number of patients. Nurse staffing requires a multi-dimensional approach to assessment and evaluation of staffing needs.

Patient Care

• Nurse staffing principles require sufficient access to staff by all patients based on acuity levels. Appropriate staffing principles consider severity of the overall patient mix and an analysis of individual patient needs. Staffing principles also include consideration of the number of patients, level of intensity, environmental factors, geographic considerations and cultural or linguistic patient needs.

Staff Mix

• Nursing principles requires that staffing levels consider the proper staff mix of experience and knowledge required for patient care. Staffing should include a mix of nursing management support, registered nurses and nursing support staff. Clinical support must be available to support and enhance skills of nurses with less experience, and executive and operational level support should be accessible at all times.

Facility Management

• Staffing levels must consider the type of facility and patient mix to ensure adequate staffing levels. Facility management should promote an organizational structure that supports and values nurses and other staff. The institution must create policies and procedures for nursing staff, and commit to filling open positions timely to ensure effective and efficient patient care.

Nursing Judgment

• Staffing principles establish parameters to assist management in creating staff schedules.These guidelines and tools must be supplemented by professional nursing judgment and management experience. Executive and operations managers must evaluate all aspects of patient care to ensure that the nurse to patient ratios are sufficient based on the actual clinical requirements of the patient load. In addition to the staffing guidelines and tools, the nurse managers must use professional judgment to determine the best mix of registered nurses, licensed practical nurses and nursing support personnel required. (EDITOR ref 4; page 10)