“It’s All About the Patient”
Improving Quality of Care with
Engineered Nursing Ratios
Prepared by:
The HIMSS Nurse Staffing Ratio Work Group
February 15, 2008
Copyright 2007 by the Healthcare Information and Management Systems Society (HIMSS)
“Patient Safety and Quality Patient Care
can be enhanced through the collaborative
efforts of all HIMSS communities to
provide useful and effective information
technology, enhanced processes, and
appropriately designed staffing ratios for
Nursing Staff”
HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios. Adopted by the HIMSS
Board of Directors June 9,2006. Retrieved September 2, 2007.
Challenge
–Current federal and state legislation exists that would mandate
staffing ratios that are fixed and universal.
–3 Powerful Nurses Unions have just formed to “organize all
non-union direct care RNs” and form a national voice around RNpatient staffing ratios
–ANA is underfunded to combat fixed staffing ratios in all states
HIMSS Position Statement
HIMSS does not support legislativelymandated nurse-to-patient ratios that are fixed
and universal. HIMSS supports hospitals
voluntarily applying flexible evidence-based
ratios informed by research and local
knowledge.
HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios.
Adopted by the HIMSS Board of Directors June 9, 2006.
Retrieved September 2, 2007.
In summary, research suggests …
• Effective nurse staffing is important to patient outcomes
• However, fixed nurse-to-patient ratios cannot address the issues
unique to every hospital, such unit layout, support services,
technological support, and nurse staffing mix
• Legislation to mandate fixed ratios carries a high potential of leading
to the economic and political devaluation of the Nursing profession
and fails to effectively deal with the issues surrounding nurse staffing
In summary, research suggests …
• Lower patient-to-nurse ratios may be associated with
– Reduced failure-to-rescue
– Reduced mortality
– Reduced nosocomial septicemia in NICU
– Diminished RN burnout
– Increased RN job satisfaction
• Effective nurse staffing is important to patient outcomes
• Mandated fixed nurse-to-patient ratios cannot address the issues
unique to every hospital, such as unit layout, support services,
technological support, and staffing mix
Solution: Engineered Staffing Ratios
Engineered staffing ratios provide:
• Objective measures of patient acuity based upon the
local patient care delivery model & standards of care
• Outcomes that respect unit-based geographic delimiters
• Outcomes that respect unique patient populations of the
hospital
• Outcomes that respect fiscal and community constraints
of the hospital
• Outcomes & recommendations sensitive to indirect
HPPD practices & policies
Engineered Staffing Ratios (cont.)
• Outcomes that respect the availability of ancillary staff
– Hours & days ancillary support is available
– Unit-based vs. central pharmacy support
• Outcomes that respect availability of support staff on the
unit
• Outcomes that respect available information systems
– Bed management systems
– Staffing and scheduling systems
– EMR
– CPOE – and physician adoption
HIMSS and Engineered Standards
Integrating the HIMSS disciplines of IT,
Management Engineering and Nursing facilitates
the use of properly engineered staffing ratios
• Working in tandem with the Nursing profession, management engineers
and nurses have created acuity measurement systems which can be used
to more precisely determine the workload impact of each individual
patient in order to balance safe patient to nurse ratios
• Through the effective use of technology and process improvement
applications, the life of the nurse can be made easier
• The HIMSS disciplines of IT, Management Engineering and Nursing
working together facilitate the use of properly engineered staffing ratios.
Summary
• The patient must remain the focus!
• Improved patient care outcomes is a shared goal
• Optimal nurse staffing can improve patient outcomes
• Staffing plans qualified through the metrics of
engineered staffing systems will provide the most
effective match between available resources and
desired patient outcomes