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Grading Your Nurses

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A nurse always checks a patient’s vital signs before administering treatment. And, increasingly, hospital executives are monitoring the vital signs of their nurse staffing plans before they allocate resources—financial or human—to patient care.

A wide array of so-called “report cards” has emerged to inform nurse-staffing decisions. The reports track everything from nurse-to-patient ratios on each unit per shift to a hospital’s overall nursing-intensity level compared to its competitors. Some reports support strategic planning and annual budget allocations while others help determine next week’s staff schedule, but all share one goal: managing the most costly line item of a hospital’s budget.

“You cannot effectively manage what you can’t measure,” says Gina Petrone-Mumolie, R.N., vice president at Aon Consulting’s Life Sciences practice.

At 320-staffed-bed Monmouth Medical Center in Long Branch, N.J., nursing managers developed a report card that monitors performance in four areas: nurse satisfaction, patient satisfaction, quality of care and financial measures. The report cards for medical-surgical units, for example, track turnover among registered nurses, staff overtime, staff sick time, medication errors, patient falls, nursing hours per day, patient pain management and patient satisfaction scores relevant to nursing.

“All of those are very critical to elevating the status of your organization from a competitive standpoint in the market,” says Maureen Swick, Monmouth’s vice president of patient care services. She and other nursing leaders use the report cards to constantly fine-tune staffing patterns for the hospital’s 600 nurses. If patient falls increase on a unit, for example, managers can look for nurse-staffing trends on that unit to help identify and correct the problem.

The report cards are also used to hold nurse leaders—including Swick—accountable for hitting specific performance goals for their units or departments.

“There are very clear measures in place to monitor the success of an executive based on what the organization has decided to achieve,” she says. “It’s pretty black and white.”

One more use: Report cards allow hospitals to benchmark against their peers. For example, Swick can compare the number of pressure ulcers in patients treated on a specific unit with the averages reported in the American Nurses Association's National Database of Nursing Quality Indicators to evaluate the quality of care provided by her staff.

—Lola Butcher



Measuring Staffing, an Hour at a Time

Some hospital executives review nurse-staffing report cards once a year to help put together the annual budget. But nurse managers at OSF Saint Francis Medical Center in Peoria, Ill., use an electronic tool—updated every four hours to track the number of nurses and patients on each unit—to make daily decisions about patient care.

OSF Saint Francis, a 550-staffed-bed tertiary referral center, started using PCMAuditor software from Chicago-based consulting firm The Nash Group nearly four years ago to help meet its goal of staffing one nurse for every five patients. Although charge nurses can adjust that ratio to reflect the acuity of patients on a given unit, Chief Nursing Officer Susan Ehlers wants nurses to be able to expect a five-patient load most of the time.

Because the tool is frequently updated, the hospital’s bed coordinator monitors each unit’s nurse-to-patient ratio to determine the placement of incoming patients. Although medical conditions dictate where some patients must be admitted, OSF Saint Francis’ patient care model allows nurses, rather than physicians, to determine patient placement in most cases.

A unit with five nurses and 22 patients means one nurse has a light load—and the hospital is not using its nursing staff efficiently. By hitting the 5:1 goal most of the time in the medical-surgical unit, OSF Saint Francis saves more than $2 million a year, Ehlers says.

The reporting tool has other uses. While nurses tend to remember the days they cared for too many patients, Ehlers refers to hard data to hold up her end of those conversations.

“I can show the nursing staff how often we meet the nurse-patient ratio target, and it’s a high percentage of time,” she says. “In fact, we use those reports as a recruitment tool.”

—Lola Butcher