Joint Commission's Staffing Standards for Hospitals

[hunnybeeRN]

I know that the Board of Nursing's Administrative Code of my state requires that patient condition, nurse experience, and complexity of assignment be taken into consideration with nursing assignments. I'm wondering if anyone has any experience with Joint Commission's standards or input on the following: Is it acceptable to staff your nurses completely based upon patient census without taking the condition of those patients into consideration? If so, what defines the point in which staffing completely based upon numbers becomes unsafe? Seven to eleven medical surgical patients per nurse based solely on the number of patients on the floor without acuity reflected seems an unsafe way to staff a facility. As does five to six pediatric patients without the support of a tech or secretary or any other supportive staff.

Any input on the legality of staffing in such a manner?

[wooh, BSN, RN]

If it's illegal, most hospitals are guilty. And just because Joint Commission would frown upon a practice (in this case, they don't actually frown upon it), that doesn't make it "illegal."

Staffing sucks. It will continue to suck until actual LAWS are passed mandating ratios. The nonsense about "taking into account acuity" or "patient needs" will NEVER actually have anything to do with staffing in reality unless it becomes related to billing. As it is, more nurses costs money. Until there's something to balance that, like acuity that requires more nurses ALSO getting higher reimbursement (like the switch from a general care area to an ICU does), hospitals will ALWAYS say the acuity is low enough to go with a bare minimum of nurses. Until that bare minimum is mandated by law, it's going to be the minimum they can get away with that still gets them customer service scores, enough staff to keep working there, and to keep it safe enough to outweigh the risk of a lawsuit. They can give each nurse a LOT of patients and still keep those things happily in check for themselves.

[HouTx, BSN, MSN, EdD]

JC is concerned more about the process than the specifics. Standards require a process for staffing & assignments that considers quality, safety, employee competence, availability of backup, planning for changes in census, physical characteristics of the environment, etc. They do not dictate any specific staffing ratios.