Key components for optimal staffing

Author(s): Kendra McMillan, MPH, RN

New principles help make this complex goal attainable.

Nurse staffing is essential to the delivery of safe, quality healthcare in every practice setting. Nurses have a unique knowledge and understanding of how to respond to changing patient and unit needs, making them critical stakeholders in staffing decisions and how those decisions play out. Staffing is more than just numbers; it’s an equitable distribution of nursing resources across units and shifts. So, what’s necessary to make optimal staffing a reality?

In 2019, the American Nurses Association (ANA) released an update to its Principles for Nurse Staffing. The principles address the key components needed to achieve optimal staffing and patient outcomes, as described here.

The patient. Staffing decisions should be based on individual patient needs, stability, diagnosis severity, and required care. What’s the level of direct care needed per patient and what are the care and discharge planning needs? Also consider age- and language-specific resources, time spent on transfers off the unit for procedures, patient and family educational needs, and the availability of family and social support. Staffing guidelines should be based on patient safety indicators and accompanied by enough resource allocation for care coordination and patient education.

Nurse and healthcare team. The nurse’s individual characteristics—including experience, knowledge, skill set, educational preparation, and competence with technology and clinical interventions—directly affect care outcomes. After considering the patient’s needs, what’s the skill level of the nurse and healthcare team, and how do you match the two? Does the person in charge of staffing understand the skill level of each healthcare team member to ensure appropriate matching? Are ancillary staff available to carry out non-nursing tasks? Staffing plans require flexibility to adapt to changes in patient status and to accommodate for admissions, transfers, and discharges. Staffing also must account for the allocation of time and resources needed for mentoring and skill development activities.

Organization and workplace culture. Optimal staffing balances safe, quality care with nursing resources and costs. When achieved, nurses are practicing to the full extent of their education and licensure and have the necessary resources to provide care. A healthy work environment with a value-based culture that supports respect, trust, collaboration, and ethical decision-making within the healthcare team is essential to patient care and staffing alignment, and it’s vital for nurse satisfaction.

Practice environment. A culture of safety plays an integral role in achieving appropriate staffing. Unit-by-unit changes within a shift require continuous monitoring and real-time adjustments to provide optimal care. A supportive practice environment with clear policies facilitates nurse well-being and allows adequate time for meal and bathroom breaks, overtime regulation, and limits on shift length to ensure that staff health and safety needs are met. Nurses have a professional obligation to report unsafe conditions and inappropriate staffing levels and the right to do so without the fear of reprisal.

Evaluation. The evaluation plan must be valid and reliable and accurately capture the outcomes, costs, and time needed to provide nursing care. Ongoing assessment of an organization’s overall health with respect to turnover, retention, frequency of overtime, and the need for supplemental staffing also are essential elements to watch.

Appropriate nurse staffing is an asset to our ever-evolving healthcare system. Viable solutions for optimal staffing may be complex, but they are attainable.

Kendra McMillan is senior policy advisor for the American Nurses Association, Nursing Practice and Work Environment department.

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