Staffing decisions

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Does anyone know how/why the CNO decides on a specific nurse:patient ratios on a med/surg unit? I am working on a paper and am awaiting an answer from the CNO of my facility. I live in California where we have mandates, so I am thinking about ratios prior to AB 394.

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Specializes in Surgical, quality,management.

So before I moved to Victoria, Australia it was the ward manager that fought for the ratios on the ward.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

LONG study but some useful information.....http://archive.ahrq.gov/downloads/pub/evidence/pdf/nursestaff/nursestaff.pdf

http://www.ache.org/pubs/hap_companion/gapenski_finance/online%20appendix%20b.pdf

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Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Does anyone know how/why the CNO decides on a specific nurse/patient ratios on a med/surg unit?
It depends on the particular CNO. All CNOs are different.

Some CNOs staff according to patient acuity, where many others are under pressure from hospital administration to staff according to budgetary constraints. Also, look up the term "nursing care hours per patient day." Click on the link below for more information.

quality - nursing - hours per patient day - Northwestern Memorial Hospital - Chicago

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Usually they are using some type of staffing matrix, I have not figured out all the magic either. I would imagine it is some equation that certain number of patients should require a certain number of nurses and how that can be computed to come out with a positive number financially. I do not believe they take into account acuity at all!! I would be very surprised if they did. I think it is a numbers game where so many beds full equal so many staff and then the staff is broken down into managerial and clinical. Usually the managers are included in the clinical staffing even though they may not be on the actual clinical floor. There is the rub. As a manager I can say I had enough to do without also providing patient care. But when I was forced to return to the floor, upper administration still expected me to do certain managerial tasks. My patients came first and that is when I had to leave. No one can stay where they feel they are compromising patient care or they are being put in a position that is not rewarding. You have to be able to lay your head down on your pillow and sleep with a clear conscious no matter what.

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Specializes in Hospital Education Coordinator.

not in CA but the budget has a lot to do with it.

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This is incredible! Thanks!

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That sounds about right and sorry you went through that experience. I have also witnessed supervisors actually change patient's acuity to "even out staffing"; make it seems fair on paper until the subsequent nurse sees the patient. Thanks for your response. I do sense that the staffing at my current facility is based mostly on budget since I do work for a profit driven hospital.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
That sounds about right and sorry you went through that experience. I have also witnessed supervisors actually change patient's acuity to "even out staffing"; make it seems fair on paper until the subsequent nurse sees the patient. Thanks for your response. I do sense that the staffing at my current facility is based mostly on budget since I do work for a profit driven hospital.
ALL staffing for he most part is based on budget.
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Specializes in medical surgical, cardiac.

My guess is the CNO is using an acuity tool. I would love to hear which tool since none are evidence based --YET!

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