1
Exploring the Application of Police
Proactive Patrolling Staffing
Methodologies to Nurse Rounding
and Surveillance
Presented by
Beth Ann Taylor
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Importance of Nurse Rounding
• Reduction in patient falls (Meade, Bursell, &
Ketelsen, 2006; Weisgram & Raymond, 2008)
• Decreased call light use (Meade, 2007)
• Enhanced nurse satisfaction (Generals & Tipton,
2008)
• Increased patient satisfaction (Bourgalt, et al, 2008)
• Increased satisfaction with nurse quality of care
(Castledine, Granger, & Close, 2005; Culley, 2008;
Gardner, Woollett, Daly, & Richardson, 2009)
• Improve the knowledge and professionalism of
nursing staff (Geary, Cole, Quinn, & Whitehall,
2009)
3
Importance of Police Prospective
Patrolling
• Proven effective in deterring crime (Nunn,
Quinet, Rowe, & Christ, 2006)
• Reducing injuries associated with motor vehicle
accidents (Mock, Kobusingye, Ahn, Afukaar, &
Arreola-Risa, 2005)
• Decreases the number of motor vehicle
accidents, crash fatalities, and fatalities related
to speed (Davis, Bennick, Pepper, Parks,
Lemaster, & Townsend, 2006)
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Staffing Parallels
•
•
•
•
•
•
Both must staff for 24/7 operations.
Have both proactive and reactive components to
work.
Have historically used ratios.
Measure workload through frequency and
duration of activity.
Use a replacement factor for vacation, sick leave,
and mandatory training when building staffing
budgets.
Objective: Protect the health and safety of the
population for which responsibility is assigned.
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Comparison of Police and Nurse Staffing
Methodologies
Police Allocation Model
VA Staffing Methodology
• Historical Workload
• Historical Workload
• Leave and Admin Factor
• Leave and Admin Factor
• Factor for Proactive Work
(Unobligated or Free Patrol
Time)
• Suggests activities to consider
but does not provide a specific
measure, definition, or
calculation method for any
proactive work.
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Methodology - Participants
Delphi technique: Police and VA Nurse staffing
experts were identified.
Stratified Random Sampling method used to
select 15 VA Nurse Executive participants.
Purposive Sampling used to identify the top 2
Police Allocation Model staffing experts.
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Methodology - Procedure
• All participants interviewed individually by
phone using an interview protocol.
• Each interview was scheduled for 30 minutes.
• Each interview was digitally audio taped and
professionally transcribed.
• Handwritten notes were also taken by the
researcher during each interview.
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Methodology - Data Analysis
• All of the interview transcripts were reviewed
and key terms (rounding, patrolling) were coded
for frequency and associated activity .
• New concepts were identified and defined.
• Themes were identified and summarized.
• Tables were developed displaying data
summaries and definition of concepts.
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Results – Police and Nurse Executive
Staffing Similarities
• Both report using historical workload data as a
foundation for building a staffing budget.
• Both report adding a leave factor for time off
such as vacation and sick leave.
• Both report adding time for required training,
staff meetings, or other organizational business
(systems redesign projects, court appearances).
• Both use comparison staffing data.
• Both identified funding as a barrier.
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Results – Nurse Executive Key Findings
14 of 15 (93%) of the nurse executive participants
reported using some type of nurse rounding in their
facility.
Only 2 nurse executives reported considering time for
rounding when implementing the VA Staffing
Methodology.
No measure for determining capacity for rounding
was reported.
33% (5) of the nurse executives reported inconsistent
performance of rounds and issues with staff “buy
in”.
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Results – Nurse Executive Key Findings
con’t
Only 2 nurse executives reported considering time
for rounding when implementing the VA Staffing
Methodology.
No measure for determining capacity for rounding
was reported.
33% (5) of the nurse executives reported
inconsistent performance of rounds and issues
with staff “buy in”.
No reported time allotment for other cognitive or
proactive work.
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Results – Police Key Concepts for
Staffing
Unobligated time: the time police officers have between (and in addition to)
mandatory or obligatory elements of work.
Prospective patrolling and Free Patrol: described as the group of
focused activities performed during unobligated time.
Availability: police officer’s ability to respond to calls for service.
Measured by:
Response time: Time interval between a call for service and police arrival
on the scene.
Cross Beat Dispatching: Frequency of officers called out of their assigned
area to help in another geography.
Probability of Saturation: Point at which next call for service goes into a
queue because all available officers are busy.
Police Allocation Model
Reactive
Admin
Proactive
Police Total
Workload
Leave
Time factors
considered
in staffing
budget.
Visibility
Availability
Calculations are
specifically defined.
Historical
Workload
Factor
Administrative
Factor
VA Staffing Methodology
Reactive
Admin
Proactive
Nursing
Total
Workload
Leave
Time factors
considered
in staffing
budget.
Suggested activities for
consideration. No definitions or
recommended calculations.
Historical
Workload
Factor
Administrative
Factor
Sustainability of Proactive Work
Historical
Workload
Factor
Administrative
Factor
Without the support of time allocated in a
staffing model, proactive work is not sustainable.
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Conclusions
Nurse rounding and surveillance contributes to
improved patient outcomes.
Using ratios alone to build nurse staffing budgets is a
crude and inadequate method to determine staffing
adequacy.
Using standardized methods for budget development
and testing efficacy is important to determine
adequacy of nurse staffing.
Quantifying nursing’s capacity for cognitive work is an
important consideration in developing nurse
staffing budgets.
17
References
Bourgault, A., King, M., Hart, P., Campbell, M., Swartz, S., & Lou, M.
(2008). Circle of excellence: Does regular rounding by nursing
associates boost patient satisfaction? Nursing Management. Nov.
18-24.
Bulechek, G., Butcher, H., & Dochterman, J. (2008) Nursing
Interventions Classification (NIC). (5th Edition). St. Louis: Mosby
Elsevier.
Castledine, G., Grainger, M., & Close, A. (2005). Clinical nursing
rounds part 3: patient comfort rounds. British Journal of Nursing,
14(17): 928-930.
Culley, T. (2008). Reduce call light frequency with hourly rounds.
Nursing Management. Mar. 50-52.
Davis, J., Bennink, L., Pepper, D., Parks, S., Lemaster, D., &
Townsend, R. (2006). Aggressive traffic enforcement: a simple and
effective injury prevention program. The Journal of Trauma. 60(5),
972-977.
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References con’t
Department of Veterans Affairs, Veterans Health Administration
(2010). Staffing methodology for VHA nursing personnel. VHA
Directive 2010-034
Douglas, K. (2010). Ratios – if it were only that easy. Nursing
Economic$, 28(2), 119-125.
Flynn, M., & McKeown, M. (2009). Nurse staffing levels revisited: a
consideration of key issues in nurse staffing levels and skill mix
research. Journal of Nursing Management, 17(6), 759-766.
Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009).
Measuring the effect of patient comfort rounds on practice
environment and patient satisfaction: A pilot study. International
Journal of Nursing Practice, 15(4), 287-293.
Geary, S., Cole, D., Quinn, B., Winehall, J. (2009). Daily rapid rounds:
Decreasing length of stay and improving professionalism. Journal
of Nursing Administration, 39(6), 293-298.
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References con’t
Generals, J. & Tipton, P. (2008). Recruitment & retention
report. Rounding to increase retention. Nursing
Management, 39(5), 10-12.
Kane, R., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T.
(2007). The association of registered nurse staffing levels
and patient outcomes. Systematic review and metaanalysis. Medical Care, 45(12), 1195-1204.
Meade, C. (2007). Round bounty. MHS. Spring, 23-27.
Meade, C., Bursell, A., & Ketelsen, L. (2006). Effects of
nursing rounds on patients’ call light use, satisfaction,
and safety. American Journal of Nursing. 106(9), 5869.
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References con’t
Mock, C., Kobusingye, O., Ahn, L., Afukaar, F., &
Arreola- Risa, C. (2005). Human Resources for the
control of road traffic injury. Bulliten of the World
Health Organization. April 2005, 83(4): 294-300.
Nunn, S., Quinet, K., Rowe, K., & Christ, D. (2006).
Interdiction day: Covert surveillance operations,
drugs, and serious crime in an inner-city
neighborhood. Police Quarterly, 9(1), 73-99.
Van den Heede, K., Diya, L., Lesaffre, E., Vleugels, A.,
& Sermeus, W. (2008). Benchmarking nurse staffing
levels: the development of a nationwide feedback
tool. Journal of Advanced Nursing, 63(6), 607-618.