A Flexible Staffing Model Driven by the Bedside Nurse

Purpose:
Faced with escalating patient acuity, rapidly changing patient conditions, nurse dissatisfaction, and an inability to meet our quality and financial targets, the goal was to innovate a patient-centered, direct-care-nurse-driven, efficient and effective staffing model.

Significance:
How nurse leaders use direct-care nurse input to improve the work environment, staffing and patient care is a nursing excellence imperative. The innovation creates the language and decision-making needed to articulate the patient story across patient care units, administration and finance.

Strategy and Implementation:
Interqual criteria were used to identify intensity of service and severity of illness to code patients daily as requiring routine, progressive or critical care for the medical-surgical units. Each level of care is associated with a specific hour per patient day value. Values are established using national benchmarks and testing at the unit level - “does this feel right.” Historical data based on coding over a period of time establishes percentages of patients at each level of care. This data is used to establish the budget from year to year and is linked to the productivity system. Staff use an electronic daily staffing tool to identify resources required by the acuity and volume of patients for each shift. Patient assignments are made by matching patient need to the appropriate nursing resource.

Evaluation:
Success measures include patient quality outcomes, NDNQI RN satisfaction, and efficiency. Staff nurses are engaged in design and implementation of daily staffing and are articulate in describing patient needs. Satisfaction with resources and staffing outperformed the mean on the NDNQI PES.

Implications for Practice:
Drives higher levels of nurse engagement in practice. Achieves patient- centric decision making and a higher level of nursing care that is supported by the system. Implementation has been one variable that has resulted in nationally recognized quality outcomes for this organization.