Nurse Staffing 101: A Decision-making Guide for the RN

By Lauri Lineweaver

Nurse Staffing 101 is a resource for RNs in developing effective and facility-specific approaches to optimal staffing decisions and plans. It covers the essential topics:
Historical and political setting of safe staffing
Workplace, safety, and quality considerations
Examples of professional nursing practice models
Staffing at the organizational level in terms of workload variances
Current practices and possible solutions for determining and achieving the requisite staffing levels and measureable quality outcomes
To further assist RNs in staffing decision-making: a checklist based on ANA’s Principles for Nurse Staffing and extensive references on the substantive body of evidence on the link between adequate nurse staffing and better patient outcomes.

• Language: English
• Publisher: Nursesbooks
• Release date: May 16, 2013
• ISBN: 9781558104884

Book preview

Nurse Staffing: A Framework for Safe, Quality Care

ANA’s Principles for Nurse Staffing

The ANA Principles for Nurse Staffing, updated in 2012, were developed to support optimal nurse staffing that enhances the delivery of safe, quality care. These principles were designed to accommodate the dynamics of any given healthcare and practice situations and address the elements of these dynamics that must be considered when developing staffing plans. Grounded in the substantive and growing body of evidence that demonstrates the link between adequate nurse staffing and better patient outcomes, these principles, like this 2013 publication, address the complexities of the decision-making and development of processes and policies needed to improve nurse staffing. The checklist at the end of this publication, which will assist any RN involved in nurse staffing decision-making, is based on those principles.

Appropriate nurse staffing is critical to the delivery of safe, quality care. The time that the nurse spends with patients in direct and indirect care is different at every level of practice and in each practice setting. Because nursing care is varied and diverse, the determination of safe nurse staffing levels is complex and multifaceted, and the solutions are not always straightforward.

In 2012, the American Nurses Association updated its Principles for Nurse Staffing. These principles define the dynamics that must be considered when developing staffing plans to achieve optimal patient outcomes, and are organized according to these five factors:

(American Nurses Association, 2012a, p. 4)

This publication explores the historical context of nurse staffing in the United States and the political and related influences that have shaped the current state of staffing. It reviews the importance of a professional nursing practice model and a purposeful advancement toward a staffing plan that produces optimal patient outcomes. The publication also outlines the current practices in determining staffing levels, details the measurable quality outcomes that must be achieved with safe staffing levels, and explores examines possible solutions.

Historical and Political Context of Nurse Staffing

Florence Nightingale

Historical Perspectives

The evolution of nurse staffing within hospitals is closely linked with the evolution of health care in the United States. Florence Nightingale began modern nursing education in the St. Thomas hospital in London, using it as a training ground for new nurses. Under this model, unpaid nursing students staffed hospital wards and left after graduation for community work or private duty for wealthy clients. Hospital work was considered menial and to be performed only by those less skilled. The early 20th