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Nurse Staffing Effectiveness in 2010: The Interim Standards

Briefings on The Joint Commission, April 13, 2010

For this year, a set ratio for each unit in the hospital must be met at all times, with no exceptions. The patient-to-staff ratios for each unit include:

  • Critical care: 1:2
  • Neonatal ICU: 1:2
  • Postanesthesia care unit: 1:2
  • Labor and delivery: 1:2
  • Postpartum (moms only): 1:6
  • Pediatrics: 1:4
  • Step-down: 1:3
  • Telemetry: 1:4
  • Med-surg: 1:5
  • Specialty care: 1:4
  • ED: 1:4, 1:2, 1:1

"In the ED, the patient census is always changing, so three different ratios are set up," says Cole. "On an hour-by-hour basis, we are checking and making sure we are adequately staffed." To help with the ED's unpredictability, Cole developed two tools over a three-year period, to work together to help ensure that the patient-to-staff ratios are always met.

The first tool is an hourly census that requires the charge nurse to document the patients in the ED and those patients in the emergency room waiting area. By tracking the patients in the ED and those waiting, the tool helps determine when the ED census will be at its highest and helps the facility call more nurses to meet the patient-to-staff ratio.

In addition to the hourly census, facilities utilize an Excel spreadsheet that automatically determines variance in the ratios.

"This gave us a tool to show where our major hours of being under the ratio occurred, and allowed us to present to our fiscal people hard evidence the times when we need more nurses," says Cole.

The importance of staffing effectiveness
Staffing effectiveness is being addressed at a national level, with the possibility of all hospitals one day being required to meet a nurse-to-patient ratio.

"Staffing effectiveness in a hospital, meeting ratios, and meeting acuity plans is a day-by-day process," says Cole. "It is something we have all worked hard to do, but it is still not perfected."

Even with time, Hendrickson believes that it is still important for hospital leaders to look at staffing issues. "We need to understand how staffing affects outcomes, because we are all held accountable for patient safety," she says.

Most importantly though, Hendrickson says, it is necessary for organizations to develop the evidence for their own practices. "We need to work together in order to determine what practices will improve the outcomes. And then we have to spread that information across our profession."


This article was adapted from one that originally appeared in the March 2010 issue of Briefings on The Joint Commission, an HCPro publication.

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