ACUITY AND STAFFING OUTLINE 2
I. Overview
Nurse shortages and unfavorable nurse-patient ratios are among the challenges facing
current global healthcare systems. Professional nurses operate in understaffed
departments, a factor that compromises their ability to provide quality care and satisfy
ever-changing patient expectations. Many health organizations consider
implementing minimum nurse-to-patient ratio policies and acuity-based staffing
despite the need to address such challenges.
A. Patient Acuity: Patient acuity is the categorization of patients as measured by the
intensity of registered nurse (RN) care necessary to meet their safety needs, in
terms of required RN hours per patient day and is a critical factor in achieving
balanced distribution of workloads (Juvé‐Udina et al., 2020). Nurse Managers
and leaders are required to make difficult decisions to ensure a good mix of skill,
education, expertise, and nurses are allocated to each shift. A main flaw in
assessing patient acuity is assuming that at any point in the day can predict
nursing care needs for patients for the following shift or day (Welton, 2017).
Unable to quantify care makes it difficult to calculate the cost of nursing care for
individualized patients (Garcia, 2017).
B. Nurse to Patient Ratios: Evidence has suggested that patient outcomes are more
favorable in hospitals with sufficient nurse staffing. In honor of Florence
Nightingales birth, this year marks the 200th anniversary and has been designated
as the International Year of the Nurse and Midwife (McHugh et al., 2021).
Evidence shows that better hospital nurse staffing is associated with better patient
outcomes, including fewer hospital acquired infections, shorter length of stay
ACUITY AND STAFFING OUTLINE 3
(LOS), fewer readmissions, higher patient satisfaction, and lower nurse burnout.
Yet, within-country variation in hospital nurse staffing persists, giving rise to calls
for public policy interventions to establish minimum safe staffing standards in
hospitals (McHugh et al., 2021).
II. Setting
A. 23 bed medical surgical unit, Joint Base Elmendorf Richardson, 673rd Medical
Group, Alaska.
III. Target Audience
A. This capstone project is targeted towards Nurse Managers, Nurse Leaders, and
Registered Nurses with a Bachelorette degree or higher education that work in an
inpatient, medical surgical unit.
IV. Literature Review
A. A review of literature will be thorough and current with evidence-based practices.
B. Patient acuity and safe nurse patient ratios are current discussions among
Registered Nurses working in the inpatient setting. Nursing care needs to be able
to meet the needs of each patient, individualized care, however is difficult to
achieve due to budget and staffing concerns (Garcia, 2017). Missed nursing care
and adverse patient outcomes have been linked to unsuitable staffing based on
acuity levels, or nurses having a patient load that does not allow for individualized
care (Juvé‐Udina et al., 2020). Few policies to attain nurse to patient ratios have
been implemented in parts of the world however have rarely been evaluated
(McHugh et al., 2021).
ACUITY AND STAFFING OUTLINE 4
C. England has a nationwide guidance but implementation is left to the local level
and there are no direct legal ramifications when the guideline is not followed.
California mandated patient-to-nurse ratios and conducted evaluation studies on
the impact of this approach. Victoria and Queensland implemented mandated
patient-to-nurse ratios but is more flexible compared to California. Ireland has a
safe staffing policy that includes the modification of actual staffing levels based
on required staffing levels as measured by a patient acuity system (Van den
Heede et al., 2020).
V. Nursing Administration: Scope and Standards of Practice
A. According to the American Nurse Association (2016), nurse administrators can
impact positive work environments through evidence-based management and
creating and sustaining a culture of safety and research. Being an organizational
role model, administrators must use this research to evaluate standards of nursing
practice. Standard 2 of the American Nurse Association (ANA) Standards of
Practice for Nurse Administrators states, “The nurse administrator collects
pertinent data and information relative to the situation, issue, problem, or trend”
(American Nurses Association,2016).
B. Standards 9-14 of the American Nurse Association (ANA) Standards of
Professional Performance for Nurse Administrators discusses communication,
collaboration, and leadership (American Nurses Association,2016).
C. Standard 16 of the American Nurse Association (ANA) Scope and Standards of
Professional Performance for Nurse Administrators discusses resource utilization,
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stating that the nurse administrator will use appropriate resources to allocate and
sustain nursing services (American Nurses Association,2016).
VI. Communication Plan
A. After a thorough review of the evidence, a plan to present the information will be
implemented through chain of command. A power point presentation will be
utilized to show leadership the current Multi Service Unit (MSU) patient acuity,
staffing, and current nurse patient ratios. Once approved at the flight leadership
level, it will be addressed at the Medical Group level with the Chief Nurse and
Medical Group Commander for final approval to track patient acuity and make
assignments based on acuity with safe nurse to patient ratios.
VII. Budgetary Needs
A. Funding would be granted from local state and government for additional
manpower, as needed.
VIII. Evaluation
A. Evaluation methods would be ongoing and would be based on patient acuity,
nurse to patient ratios, missed nursing care, overall morale of staff, and patient
outcomes.
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References
American Nurses Association. (2016).HNursing administration: Scope and standards of
practiceH(Second Edition.). Silver Spring, Maryland: American Nurses Association.
Juvé‐Udina, M., González‐Samartino, M., López‐Jiménez, M., Planas‐Canals, M., Rodríguez‐
Fernández, H., & Batuecas Duelt, I. et al. (2020). Acuity, nurse staffing and workforce,
missed care and patient outcomes: A cluster‐unit‐level descriptive comparison.HJournal
Of Nursing Management,H28(8), 2216-2229. https://doi.org/10.1111/jonm.13040
McHugh, M., Aiken, L., Sloane, D., Windsor, C., Douglas, C., & Yates, P. (2021). Effects of
nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions,
and length of stay: a prospective study in a panel of hospitals.HThe Lancet,H397(10288),
1905-1913. https://doi.org/10.1016/s0140-6736(21)00768-6
Van den Heede, K., Cornelis, J., Bouckaert, N., Bruyneel, L., Van de Voorde, C., & Sermeus, W.
(2020). Safe nurse staffing policies for hospitals in England, Ireland, California, Victoria
and Queensland: A discussion paper.HHealth Policy,H124(10), 1064-1073.
https://doi.org/10.1016/j.healthpol.2020.08.003
Welton, J. (2017). Measuring Patient Acuity.HJONA: The Journal of Nursing
Administration,H47(10), 471. https://doi.org/10.1097/nna.0000000000000516
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