Nurse Staffing and Care Quality

Improving healthcare outcomes and increasing the accountability surrounding the provision of care are topics frequently mentioned in the popular press and legislation. Recently, I’ve begun assessing how the system utilizes its primary caregivers – nurses.

Software and device innovation is rapidly changing, but nursing care hasn’t kept pace. With looming doctor shortages, our reliance on nurses for primary care, maintenance of patient records, administration of drugs and therapies and (most importantly) interactions with patients and families is of growing importance in a post reform world measured by HCAHPS (quality) scores.

It’s not surprising that multiple recent studies have concluded that the quality of nursing care has a direct influence on patient’s ultimate health and safety. To address staffing concerns on a macro level, several states have proposed legislation mandating certain nurse-to-patient staffing ratios, which would put in place a “one size fits all” solution to ensure that all patients receive the “required” nurse attention. However, as the many organizations which are opposed to mandatory staffing ratios argue, patient needs are not predicable or consistent. In addition, these ratios would require hospitals to incur significantly higher staffing costs without the potential for increased reimbursement from commercial or governmental payers, as they would be required to maintain high staffing levels regardless of medical needs. To date, California is the only state to mandate nurse-staffing levels, yet many others have adopted other similar staffing requirements.

A more proactive alternative to mandated staffing are patient-acuity (or classification) systems that “flex” nurse positioning and staffing based on patient needs. These systems utilize EHR or nurse-tracked patient data to create acuity levels or patient scores, which dictates organizational or departmental staffing.

These approaches shift the emphasis onto the patient and the complexity of care required, instead of adhering to a fixed nurse to patient ratio. While not widely publicized, acuity based nurse staffing solutions offer many benefits to providers as well as patients, including improvements in:

Patient safety and the avoidance of sentinel events
Care quality
More appropriate levels of care
Nurse expenses and overtime costs
Improve patient satisfaction
Nurse workflow

In addition, because nurses input the patient data that will ultimately provide an acuity score, this model uniquely allows nurses to directly impact staffing and ultimately patient care, which can improve employee satisfaction. As legislative debates continue about states adopting safe staffing laws and the direct correlation between insufficient nurse staffing and adverse patient outcomes, we’ll continue to watch for innovative solutions that might help the cause.

Let us know what you think.

Jamie Lockhart