Nurse Staffing Effectiveness: Outcomes based measurement and analysis within a direct care nurse staffing council model

Purpose:
Texas' new Safe Nurse Staffing Law required the organization to change the way it evaluates nurse staffing. Our goal was to design methods that would meet the new regulatory requirements while providing meaningful data that could be used for effective decision-making related to nurse staffing.

Significance:
Historically, no meaningful relationships have been found using The Joint Commission's staffing effectiveness standards. By expanding the scope of analysis and involving direct care nurses in the evaluation process, this program has gained strength in the organization's decision-making structures.

Strategy and Implementation:
The new law requires that at least 60% of the staffing council membership be held by direct care nurses. The Chief Nursing Officer must also be a member, and serves as the liaison to the governing board. All sixty-eight of our nursing departments are represented in the process of evaluating nurse staffing. Each department selects a nurse-sensitive patient outcome indicator of significance for their patient population, which is compared to the staffing indicator. Actual staffing is also compared to the staffing plan. Quarterly data analysis is performed at the unit level, as well as aggregated by indicator and service line, and includes correlation calculations where appropriate. The staffing council reviews data at all levels quarterly. Recommendations for further analysis and/or action plan steps are also prepared by the council. Examples of data collection methods, data reporting tools, statistical methods utilized and results experienced will be shared within this presentation.

Evaluation:
With eighteen months of data, meaningful relationships have been identified between several patient outcome measures and nurse staffing, particularly at the unit level. When data was aggregated by outcome measure, we continued to see relationships similar to those found at the unit level.

Implications for Practice:
These new analysis processes allow each department to determine the impact staffing levels have on patient outcomes specific to their area. By sharing lessons learned, other nursing organizations can replicate our work of structural empowerment at the bedside.