Illinois Nurse Staffing Survey
Catherine Stokes BSN, RN, Jalil Johnson PhD, APRN, Ruth Neese PhD, RN, CEN, Doris Carroll BSN, RN-BC, CCRC, Pamela S. Robbins MSN, RN, Deena Sowa McCollum BSN, RN
A national survey was completed from October 1, 2018- October 31, 2018. Survey responses were collected via SurveyMonkey.com. Online outreach occurred through several social media outlets including Allnurses.com, Facebook nursing communities, Medscape Nurses, Show Me Your Stethoscope, and Twitter. The national survey produced 9,498 responses nationwide. These results will show information collected from 508 Illinois nurses. Inclusion criteria for the survey were that nurses should have an active license and be working as a bedside clinician.
Demographic information was obtained from the participants. Units identified in the survey include: ED, ICU, NICU, pediatric ICU, PCU, intermediate step down, telemetry, med-surg, mother/baby, labor/delivery, pediatric floor units, float pools, and psych units. Educational demographics include responses of diploma nurses 4.72%, ADN/ASN 31.10%, BSN 55.12%, MSN 8.46% DNP 0.59%. The clinical settings identified by the respondents include: Tertiary/Academic hospitals 23.62%, community hospitals 57.28%, critical access hospitals 10.83% and 8.27% marked the type of hospital they work at as other. Information obtained as to whether the facility that they work at is a Magnet accredited hospital or not include: 45.08% nurses responding yes and 54.92% responding no.
The intent of this survey was to see if nurses who work in a state with state staffing legislation which mandates utilization of acuity tools and staffing committees comprised of 50% or more RNs, who provide direct patient care at least 50% of the time, is implemented properly and if nurses think staffing is safe. The survey also explored the differences in nurse staffing between Magnet-designated facilities and facilities without that designation.
The state of Illinois has had state legislation for nurse staffing in place since January 1, 2008. The basic premise of that law includes the following:
Facilities must post and implement the staffing plan recommended by a committee of nurses (at least 50% direct-care nurses), with broad representation. The plan must include the complexity of nursing judgment required, patient acuity, number of patients, ongoing assessment, unexpected patient needs, time for documentation, and staffing flexibility. Committee minutes must be stored for five years and must be given significant regard in the adoption and implementation of the plan. The plan must outline the process for submitting the committee’s recommendations to administration; the process for providing feedback to the committee regarding unresolved or ongoing issues, which must be addressed at the next meeting. Nursing Performance and Quality data must be reviewed by the staffing committee semiannually. (Shin, Koh, Kim, Lee, & Song, 2018)
Data
Results for questions pertaining to bedside nurse knowledge of their staffing law are as follows. Nearly 15.87% of Illinois nurses knew their state had acuity based and staffing committee legislation. The rest of the respondents marked “no” or “I don’t know” to the question of having knowledge of the state law that had been in place since January 1, 2008. Over 28% of nurses reported working in a hospital with a staffing committee, 38% of nurses worked in hospitals that do not have staffing committees, and 33.54% of nurses did not know if their hospital has a staffing committee.
Composition makeup of the committees was asked of the respondents to further assess proper implementation. More than 20% of respondents work in facilities that are composed of 50% or more RNs who work direct patient care at least 50% of the time. Seventy-nine percent of the respondents either marked “no”, “I don’t know”, or that their hospital did not have a staffing committee. Sixty-two percent of the participants marked their staffing committee does not encourage feedback from nurses related to staffing issues.
When asked if their staffing committee re-evaluates the effectiveness of the staffing plan semi-annually, 28.97% of respondents marked “no”, 56.90% marked they do not participate in the staffing committee process. Sixty-nine percent of respondents marked that their staffing committee does not re-evaluate variations between the staffing plan and actual daily staffing. We asked the respondents if the staffing recommendations determined by the staffing committee were implemented in the daily staffing census and 25.34% marked “yes.” The other respondents either marked “no” or “I don’t know” to implementation of staffing committee recommendations.
Almost 43% of respondents indicated their hospitals use an acuity tool. When asked if staffing is based on the needs of the patients in the units, 68.26% of respondents said “no”. In response to a survey item asking if adjustments in staffing occur in response to patient acuity on different shifts 65.15% reported “no.” Over 81% of respondents reported their unit does not have a plan for when a patient’s care needs unexpectedly changes and exceeds the direct care nurse resources.
More than 60% of the nurses who responded marked that retaliation is feared for nurses who provide input about staffing.
Nurses were asked if their nurse to patient ratio in their unit is adequate/safe and 82.09% of them reported “no.” Thirty-nine percent experienced unsafe staffing 50% of the time, 31.95% experienced unsafe staffing 75% of the time, 20.23% experienced unsafe staffing 25% of the time, and 8.74% marked that they experienced unsafe staffing 100% of the time.
More than 93% of responses indicated charge nurses were providing direct patient care on their unit. When asked if the charge nurses had a patient assignment, 34.01% of respondents marked “yes”, 28.31 marked “no”, 27.70% marked “sometimes but less than 50% of the time”, and 9.98% marked “sometimes more than 50% of the time.”
Nurse staffing based on Magnet hospital status vs non-Magnet status was assessed to determine if there was a significant difference in the relationship between the designated facilities vs non-designated facilities.
Over 37% of nurses in Magnet hospitals reported having a staffing committee in contrast to 20.97% of non-Magnet hospital nurses. A significant difference was noted between nurses at Magnet-designated hospitals and non-Magnet facilities, with more nurses at Magnet hospitals 37.33% being aware of the existence of a staffing committee, than nurses at non-Magnet facilities 20.97%. Additionally, nearly 30% of Magnet facility nurses reported “no” to having a staffing committee in comparison to 45.32% of nurses at non-Magnet facilities. A significantly higher difference in non-Magnet hospital nurses saying no at 45.32% vs 29.33% was determined. Respectfully 33%, of nurses in both magnet and non-Magnet did not know if a staffing committee was used.
Thirty-three percent of nurses in both Magnet and non-Magnet designated hospitals did not know if a staffing committee were used. In Magnet accredited hospitals, 26.29% of nurses reported that the staffing committee was composed of 50% or more RNs who work in direct patient care 50% of the time. In contrast, in non-Magnet hospitals, 15.31% of nurses reported that the staffing committee was composed of 50% or more RNs who work in direct patient care 50% of the time. Slightly more than 51% of Magnet hospital nurses did not know if the hospital staffing committee was composed of 50% or more RNs who work in direct patient care; compared to 36.73% of non-Magnet hospital nurses.
There were no significant differences found between Magnet hospital nurses and non-Magnet hospital nurses in regards to staffing based on the needs of the patients in the unit. Seventy percent of non-Magnet hospital nurses reported that staffing is not based on the needs of the patients. In Magnet accredited hospitals, 66.08% of nurses reported that staffing is not based on the needs of the patient.
Magnet hospital nurse response: 82.97% report that their nurse to patient ratio is not safe. Non-Magnet hospital nurse response: 81.36% report that their nurse to patient ratio is not safe.
Almost 60% of nurses who work in a Magnet accredited hospital feared retaliation for providing input for staffing. Over 62% of nurses that fear retaliation for providing input on staffing work in non magnet-designated hospitals. There is no significant difference found between Magnet and non-Magnet nurse responses and fear of retaliation.
Of the total 508 responses, 496 respondents marked they do have ancillary services including certified nursing assistants (CNAs), patient care technicians (PCTs), unit secretaries, phlebotomy, electrocardiogram technicians, and respiratory therapists. When asked if licensed vocational nurses (LVN) or licensed practical nurses (LPN) were used to provide team nursing, 92.13% of participants reported “no”. Seventy-three percent of respondents indicated that they do not have to stay over their shifts as “mandatory overtime” to cover scheduling gaps.
Conclusions
Slightly more than 85% of nurses responding to this survey did not know Illinois had legislation in place requiring hospitals to develop staffing committees for safe staffing. Over 68% of nurses reported patient needs were not used to determine staffing in Illinois. There was no significant difference between how nurses perceived Magnet and non-Magnet hospital nurse staffing; and nurses did not believe staffing was based on actual patient needs.
Almost two-thirds of nurses in Illinois feared retaliation if they provided input about staffing. Magnet accreditation did not make a significant difference regarding fear of retaliation. Magnet hospitals utilized staffing committees more than non-Magnet hospitals, with 26.29% of nurses in Magnet-designated facilities reporting the staffing committee is comprised of 50% or more RNs as compared to 15.31% of nurses in non-Magnet hospitals. Despite this finding, 82% of nurses felt their assignments were unsafe; and Magnet designation did not make a significant difference in this perception.
A law mandating hospitals to utilize a staffing committee to determine nurse staffing has been in place in Illinois for 11 years. Magnet status is considered an important benchmark for the quality of nursing care. However, findings from this survey study show nurses report unsafe staffing consistently occurring in both Magnet and non-Magnet hospitals in the state of Illinois.
Reference:
Juh Hyun Shin, Jung Eun Koh, Ha Eun Kim, et al. (2018) Analysis of professional health provider need in East Nusa Tenggara until 2019. Health Syst Policy Res Vol. 5 No.1:67
