Staffing Ratios
in Times of
Budgetary
Crisis
Amanda Lengerich, Kaitlyn
Burke, Leslee Johnson,
Cydney Chomel, Brooke
Delay, Hannah Crist, Nora
Melvin, Shannon King, Lindsey
Gamrat, Kaylene Linkenheld
PICO Question
 P:
For a nurse manager
 I: does staffing more registered nurses
(RNs) and less unlicensed assistive
personnel (UAPs)
 C: compared to staffing less RNs and and
more UAPs
 O: lead to better patient care and more
monetary savings for the hospital?
Management/Leadership
Theory
 Transformational






leadership
encourage staff involvement
form a shared governance
increase work engagement
encouraging teamwork/peer reviews every 6
months
inspire more nurses to take on leadership roles
mandatory meeting every month
(Sullivan, 2012)
Management/ Leadership
Theory
 Transformational
leadership continued
 We want the nurses to feel confident in
delegation to Nursing techs
 Knowing the scope of practice of the UAPs
 ANA codes of standards of delegating and
assigning tasks
 Knowing the UAPs limitations and skill level
 Continual evaluation of the tasks delegated to
the UAPs
 Praising fellow team members and recognizing
(ATI, 2010)
their achievements
Literature Review
 “Cost
Savings Associated with Increased
RN Staffing in Acute Care Hospitals:
Simulation Exercise”
 Level A: Meta-analysis
 More RNs leads to lower societal costs
 More RNs is a greater cost to the hospital
 Patient safety is a top concern however
cost centers budget must also strongly be
considered
 Weakness of study: all societal costs were
estimated – difficult to truly determine
cost of a life
(Shamliyan, T., A., Kane, R., L., Mueller,
C., Duval, S., and Wilt, T.J., 2009)
Literature Review
 “Unlicensed
assistive personnel: a solution to
dwindling health care resources or the precursor to
the apocalypse of registered nursing?”
 Level of evidence: C Systematic Review
 Using more UAP’s over RN’s results in lower costs for
the hospital
 This supports our view of using more UAP’s and less
RN’s
 Weaknesses of the study: lack of focus on patient
outcomes, cost of education for UAP’s
(Huston, C. L., 1996)
Literature Review
“The Impact of The Nurse Staffing on Hospital Costs
and Patient Length of Stay”
 Level of Evidence C: Systematic Review
 Having a high ratio of Registered Nurses staffed
benefits a unit by reducing:




Patient costs
Length of stay
Resource consumption
Adverse patient events
 Weaknesses:
under representation of all present
research, reporting bias, no meta-analysis
conducted
(Thungjaroenkul, P., Cummings, G. G., & Embleton, A., 2007)
Literature Review
Care in the Balance: UNISON Survey of Staff/Patient
Ratios
 Level of Evidence: Level C, Qualitative study
 Summary: Non-regulated staff ratios are
ineffective, staff feel that current ratios are:
 not adequate for safe care (73%)
 do not allow for adequate time with each
patient (76.8%)
 do not promote adequate staff mix (47.6%)
 Require more overtime (62.2%)
(Bradley, 2012)
Literature Review
“Care in the Balance: UNISON Survey of
Staff/Patient Ratios (cont.)”
 Relates
to our Problem: findings reinforce
that there is a current problem with
staffing, staff members are reporting
dissatisfaction
 Weaknesses: sample size unequal
representation, possible bias,
generalizability
(Bradley, 2012)
Intervention Strategy






Based on the review of literature a strategy is
going to be implemented to increase the
number of UAPs to assist the RNs
We are going to determine RN staffing levels
based on patient acuity first and determine
where UAPs could be utilized
This strategy will be implemented on lower
acuity units initially and then spread
throughout the hospital
Meetings held to educate on scope of
practice and increase nurses confidence to
delegate
Educate nurses on leadership skills
Goal is to motivate staff to be interested and
involved in this change process
Implementation
 Further
research needs to done to determine, by
unit, what the optimum ratio of nurse to patient is
without jeopardizing patient safety and minimizing
hospital costs.
 Once this ratio is determined, each nurse will be
assigned an UAP each shift. Reevaluation will be
done every 3 months of this policy to assure cost
effectiveness, quality of patient care, and avoiding
overstaffing the units.
 Revaluation of the policy will cease after an
effective ratio of UAP to nurse has been determined
 Yearly audit then can determine policy change if
needed.
Stakeholders
 Use
 Nurses
 Unlicensed
Resources
Assistive
Personnel
 Managers of the
floors affected
 Clinical Directors
 Charge Nurses
 Hospital board staff
 Patient Care
Directors
currently
employed UAPs to
help with
education and
orientation of the
newly hired UAPs
 Look at
neighboring
hospitals who are
already using these
methods
Evaluation Method
 Benchmarking

Comparing different organizations who use
transformational leadership as well as other units in the
hospital
 Patient
satisfaction surveys
 Monthly evaluations

NDNQI ex)medical errors, falls, length stay, call light
time response, pressure ulcers
 Monthly


quality meetings
Collaborate with the staff on weaknesses and
strengths of the new staffing change
Implement a survey with the staff to see how effective
the unit is working
(Sullivan, 2012)
In Conclusion….




Hospitals need to determine a way to staff
units that maintains patient safety while
decreasing costs for the hospital.
The research has suggested that increasing
the use of UAPs could be a solution to this
problem.
Patient acuity on each unit will be
determined and UAPs will be added where
they can be utilized
The effectiveness of the intervention will be
evaluated by looking at patient quality care
indicators and staff and patient satisfaction.
References

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


Bradley, P. (2012). Care in the balance: UNISON survey on
staff/patient ratios. British Journal of Healthcare Assistants, 6(5), 252253.
Huston, C. L. (1996). Unlicensed assistive personnel: a solution to
dwindling health care resources or the precursor to the apocalypse
of registered nursing?.Nursing Outlook, 44(2), 67-73.
Nursing Leadership and Management Edition 5.0. (2010).
Assessment Technologies Institute, LLC. Overland Park, Kansas.
Shamliyan, T., A., Kane, R., L., Mueller, C., Duval, S., and Wilt, T.J.
(2009). Cost savings associated with increased rn staffing in acute
care hospitals: simulation exercise. Nursing Economics, 27(5), p. 302331. Retrieved from:
http://content.ebscohost.com.ezproxy.lib.indiana.edu/pdf23_24/p
df/2009/22R/01Sep09/44682115.pdf?T=P&P=AN&K=44682115&S=R&
D=aph&EbscoContent=dGJyMNLe80SeprE4zdnyOLCmr0uep7RSsKy
4TLaWxWXS&ContentCustomer=dGJyMOfr4FPr1%2BeGudvmh%2FH
q
Sullivan, E., J. (2012). Effective leadership and management in
nursing. 8th ed. Boston: Pearson.
Thungjaroenkul, P., Cummings, G. G., & Embleton, A. (2007). The
impact of nurse staffing on hospital costs and patient length of stay:
a systematic review. Nursing Economics, 25(5), 255.