Evidenced Based Staffing

Pediatric Critical Care Columnist · Apr 13, 2009

I'm interested in the responses to this thread too. Our unit pays lip service to evidence-based practice, but only if it fits in with "no-cost, no-administrative-burden, no-major-changes-to-the-status-quo".

MikeyBSN · Apr 13, 2009

There will probably be nurse-ratio research studies done on california because they are the only ones with a mandate. I've seen different estimates from various organizations. I follow these estimates for ideal staffing:

Heavy Trauma or post-open heart surgery pt: 1:1

CCU and ICU patients: 1:2 or 1:3

Stepdown: 1:4

ED: 1:5

Peds floor: 1:6

RMF: 1:8

I'm interested to see how much of a difference the mandates make in Cali, and how many of their hospitals go out of business.

Mas Catoer · Apr 14, 2009

There will probably be nurse-ratio research studies done on california because they are the only ones with a mandate. I've seen different estimates from various organizations. I follow these estimates for ideal staffing:
Heavy Trauma or post-open heart surgery pt: 1:1
CCU and ICU patients: 1:2 or 1:3
Stepdown: 1:4
ED: 1:5
Peds floor: 1:6
RMF: 1:8
I'm interested to see how much of a difference the mandates make in Cali, and how many of their hospitals go out of business.

My boss can accept number but he will chase me to provide strong rationale as it always has s'thing to do with the budget. I will appreciate your more explanation or references.

I'm from Indonesia, we may have different nursing culture but eager to learn.

allnurses Guide · Apr 14, 2009

Hospital Nurse Staffing

allnurses Guide · Apr 14, 2009

[color=#191919]studies by the nation's most respected scientific and medical researchers affirm the significance [color=#191919]of california's rn-to-patient ratios for patient safety.

[color=#191919]as the institute of medicine's 2003 study [color=#191919]put it, research now documents "what physicians, patients, other health care providers and [color=#191919]nurses themselves have long known: how well we are cared for by nurses affects our health, [color=#191919]and sometimes can be a matter of life or death."

[color=#191919]http://www.calnurses.org/assets/pdf/ratios/ratios_patient_safety.pdf

blondy2061h, MSN, RN · Apr 14, 2009

What is RMF?

sollyhue · Apr 14, 2009

I've seen the Aiken study before but am not aware of any others. Even that study is becoming dated.

Is RMF regular medical/surgical floor?

Chisca, RN · Apr 14, 2009

"The nursing shortage decreases the nurse-to-patient ratio, increasing workload for nurses and decreasing time for infection control precautions. Float and agency nurses temporarily solve the gaps in staffing, but also create the problem of unfamiliarity with specific hospital and unit infection prevention practices. The consequences of the nursing shortage result in an increased nosocomial infection rate and poor patient outcomes."

http://snhs.georgetown.edu/gujhs/vol5no2/nosocomial.html

allnurses Guide · Apr 15, 2009

- Increasing the number of full-time RNs on staff per day by one, there were 9 percent fewer hospital-related deaths in intensive care units, 16 percent fewer in surgical patients, and 6 percent fewer in medical patients -- Healthcare Risk Management, February 2008.

- A study supported by the Health and Human Services Agency for Healthcare Research and Quality(AHRQ) found that more hours of care provided by registered nurses (RNs) were related to fewer postoperative problems among hospitalized children. "Nurse staffing and adverse events in hospitalized children." Policy, Politics, & Nursing Practice 8(2), pp. 83-92. May 2007

- VAP is the most frequent adverse event affecting critically ill patients. Low nurse staffing level increases the risk for late-onset VAP. Adequate staffing is a prerequisite for high-quality care and patient safety. Critical Care. 2007;11(4) ©2007 Hugonnet et al.; licensee BioMed Central Ltd.

- Units with higher staffing had lower incidence of CLBSI, ventilator-associated pneumonia, 30-day mortality, and decubiti. Med Care 2007

- If all hospitals increased RN staffing to match the top 25 percent best-staffed hospitals, more than 6,700 in-hospital patient deaths, and, overall 60,000 adverse outcomes could be avoided.-Health Affairs, January/February 2006

- RN-patient ratios were more cost effective than thrombolytics in reducing deaths after myocardial infarction. Rothberg MB, et al. Improving nurse-to-patient staffing ratios as a cost-effective safety intervention. Med Care, 2005.

- Cutting RN-to-patient ratios to 1:4 nationally could save as many as 72,000 lives annually, and is less costly than many other basic safety interventions common in hospitals, including clot-busting medications for heart attack and PAP tests for cervical cancer-Medical Care, Journal of the American Public Health Association, August 2005.

- Cancer surgery patients are safer in hospitals with better RN-to-patient ratios. A study of 1,300 Texas patients undergoing a common surgery for bladder cancer documented a cut in patient mortality rates of more than 50 percent -- Cancer Journal of the American Cancer Society, September 2005.

- "Based on our findings, we recommend that, if hospitals have goals of minimizing unnecessary patient death for their acute medical patient population, they should maximize the proportion of Registered Nurses in providing direct care, even if this results in lowering total numbers of nursing personnel across all categories." Impact of hospital nursing care on 30-day mortality for acute medical Patients JAN ORIGINAL RESEARCH August 2006