Effect of staffing by number compared to equity during a shift
Nursing is a primary need for any health care facility (Aiken et al, 2014). Allocation of duties to the nurses in a hospital is one of the most challenging tasks even for the best run health care institutions. Studies have indicated that assigning more patients to a particular nurse on a shift reduces the chances of survival of the patient. Three models of nurse staffing are being practiced; budget based, patient-nurse ration and patient-acuity model. Each of these models are not sufficient on their own but are used together for better outcome. This paper seeks to assess the effect of staffing by number as compared to patient equity during a shift.
Effects of staffing
According to the American Nurse Association, appropriate staffing is defined as “a match of registered nurse expertise with the needs of the recipient of nursing care services in the context of the practice setting and situation” (Aiken et al, 2014). For effective service provision and quality outcomes in a health care facility, appropriate nurse staffing is necessary. There are managers or people in charge of units who will allocate duties by number or by the patients need for nursing care. The effects of these two models of staffing vary considerably.
Aiken et al, (2002) compared staffing models against patient mortality and rescue services. They found staffing by number to more cost effective. Staffing by number refers to allocation of duties to nurses depending on the number of patients. It is more focused on the nurse-patient ratio. It is based on the number of patients in a unit. It does not consider the patient needs or nature of the complication. With this consideration, a health facility will fail to admit a patient if the nurse patient ratio is exceeded except for emergency cases.
Even though staffing by patient acuity takes into consideration the needs and complexity of the care given to the patient Cho, (2003) argues that it puts a lot of strain on the human resource especially the nurses but does not have commensurate benefits on patient survival. It ensures that when there are patients with more complicated and demanding nursing tasks, the fewer are the patients assigned per nurse. However, it has been observed that sometimes nurses go beyond their scope when this is done making them undermine the nursing practice. When conducting acuity based staffing, it is necessary to take into consideration the scope of nursing as well as patient characteristics.
Studies have indicated that lower staffing levels are linked to adverse effects on the patients. Other studies have suggested that there is higher mortality among the patients if the staffing level is lower. For example, in a study conducted in one of the health facilities, additional surgical patient assigned to a nurse was associated with a 7 percent increase in chances of dying within 30 Days of admission. The same study revealed that there was a likelihood of 7% higher level of failure to rescue (Aiken, Clarke and Sloane, 2002)
A study by Aiken, et al (1999) revealed that there was lower mortality among AIDS patients in a health facility with higher nurse to patient ratio than one with lower one. The study indicated than an increase of 0.25% of the nurse patient ratio resulted in 20% decrease in the mortality of the patients. This suggests that increasing the number of care givers (Registered Nurses) increases significantly the survival rates of the patients. This study was based on the numbers and not patient acuity (Aiken, Sloane and Lake, 1999).
According to a study conducted in Pennsylvania, increased patient acuity increased the pressure on nursing in health facilities as nurses spent more time with other patients leaving others unattended at their points of great need (Cho, Ketefian and Barkauskas, 2003). The study indicated that even though patient acuity based staffing increases the amount of time that the nurse spends with the patient, the overall pressure it creates on the nursing staff is enormous. Allocating more time for a nurse per patient does not necessarily increase the survival rates.
A scrutiny of the above studies indicates that staffing by number is an efficient way of dealing with allocation of duties to nurses. It ensures that each patient is attended to as required, furthermore, nurses have their scope of work. Giving them more time with specific patients is only likely to make them go beyond their scope or concentrate on duties which they were not meant to do. On sticking to the scope of registered nurses, going by the number gives them adequate time and can attend to more patients as compared to when they are assigned duties according to patient acuity.
In conclusion, nurse staffing is an important aspect of management in the health care facilities. There are various models of nurse staffing in the health care facilities. They include; staffing by patient to nurse ratio, budget model and the patient acuity model. Owing to the complexity of the nursing needs and patient variability as well as the scope of nursing, the most appropriate model is to staff by number. This is because it is simple and very effective. Patient acuity strains the health facility resources by creating demand for more registered nurses only to leave the other areas unattended. However, more research needs to be conducted to assess the efficacy of staffing by number model.
Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., Griffiths, P., Busse, R., … & McHugh, M. D. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824- 1830.
Aiken LH, Clarke SP, Sloane DM (2002) Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA 2002; 288(16):1987-93.
Aiken LH, Sloane DM, Lake ET, (1999). Organization and outcomes of inpatient AIDS care. Med Care 37(8):760-72.
Cho SH, Ketefian S, Barkauskas VH (2003). The effects of nurse staffing on adverse outcomes, morbidity, mortality, and medical costs. Nurs Res 2003 Mar-Apr; 52(2):71-9.