Capacity planning in hospital nursing: a model for minimum staff calculation

An aging population, emerging technology, heightening patient expectations, rising health care costs, shorter patient stays, and growing pressure to improve quality have made the management of nursing resources even more critical today. While approaching a model for staffing levels, the authors considered factors such as patient acuity, work redesign, and minimum quality standards. The methodology for analysis included estimating the time needed to complete nursing tasks and calculating the average number of tasks per patient. With respect to nursing quality measures, the study examined the adequacy of nursing documentation including admission history, assessments, nursing procedures, and discharge report as well as nursing-driven outcomes such as fall and phlebitis rates. Lastly, the authors determined the theoretical number of staff needed to provide nursing care according to quality standards.     

The implications of nurse staffing information: the real value of reporting nursing data

There is a dearth of information about the relationship between the patient care contributions of nursing and its financial contributions to an organization. As consumers and legislators are becoming more aware of the ramifications of nurse staffing issues, and as they endeavor to address them with legislative solutions, the decision on how best to develop optimal staffing strategies may soon be taken away from nursing leaders. To maintain control of this important issue and develop solutions that will help highlight the economic and patient care contributions of nurses, a thorough understanding of the problem, and a new commitment are needed from nursing leaders to take charge of the issue. To relate nursing care to patient outcomes, meaningful data on the nursing care provided is needed in addition to data on the nursing needs of patients. Staffing and performance monitoring tools should be used to effectively plan, implement, and control financial and operating resources as well as measure the economic value of the nursing profession's contribution to the cost and benefits of patient care.     

Analysis of ambulatory nursing practice

A nursing patient classification system can be used in ambulatory care to facilitate decision making relative to staffing assignments and to begin examining differences in patients' nursing care requirements according to medical diagnosis or other patient characteristics.     

Professional role clarity and competency in health care staffing--the missing pieces

Professional role clarity and role competency are the missing pieces to achieving staffing excellence. The relationships among professional practice models, professional role competency, professional role clarity, patient safety, data, and staffing effectiveness build a solid equation, which supports improved patient outcomes. An essential variable binding these elements is housed in the patient handover conversation. Ensuring this handover is an evidence-based, data-driven conversation which contains both the medical and nursing plans of care provides standardization in nursing practice and improves patient safety. This powerful equation resets the nursing standard of practice and identifies the missing pieces to staffing excellence, namely, the integration of professional role clarity and professional role competency.     

Ambulatory care nursing: growth as a professional specialty

Ambulatory care nursing has emerged as a distinct professional nursing specialty. Many characteristics differentiate ambulatory care nursing from other specialty practices, including the settings, the characteristics of the patient encounters and the focus upon groups, communities, and populations, as well as individual patients and their families. A conceptual framework for ambulatory care nursing was developed in 1998 and recently revised, through consensus of leaders in the specialty. The key elements of the Ambulatory Care Nursing Conceptual Framework are the patient, the environment (both internal and external), and the nurse, practicing in three major roles.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.     

A model for testing the relationship of nursing care and patient outcomes

Studying patient outcomes alone may not provide enough information to determine the associated factors that must be improved when the desired patient outcomes are not achieved. The purpose of this correlational study was to investigate the effects of perceived quality of nursing care and coordination of care on patients' comfort, satisfaction, and length of hospital stay. The overall model-data fit was good according to four indices: the chi-square value, goodness of fit index, adjusted goodness of fit index, and the Steigers root square error of approximation. The proposed model, effects of care quality on patient outcomes, was tested. The relationship between quality of nursing care and the proposed outcomes was tested. The results provide important information to the nursing profession and policymakers in meeting patient care needs.     

Patient intensity in an ambulatory oncology research center: a step forward for the field of ambulatory care

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series the current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify the nursing care will be described.     

Patient intensity in an ambulatory oncology research center: step forward for the field of ambulatory care--part III

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. The day-to-day application of the Ambulatory Intensity System (AIS) is illustrated in this final article of a three-part series that reviewed current literature on acuity/intensity tools, and described the development of an AIS system to objectively quantify the nursing care.     

结核性脓胸围术期护理研究

目的：探讨结核性脓胸围术期护理效果。方法选取我院收治的结核性脓胸患者211例,将其按照随机数字法分为观察组和对照组,对照组患者给予常规护理,观察组患者给予围术期护理,比较两组患者的护理效果。结果观察组患者并发症发生率低,患者满意程度高,明显优于对照组（P＜0.05）。结论对结核性脓胸患者实施围术期护理,可有效减少并发症的发生率,提高患者及家属对护理服务的满意度。     

An economic analysis of patient simulators clinical training in nursing education

Patient simulators have become widely used in medical education including increasing use in nursing education. Research suggests their usefulness in developing nursing competence. Little research to date, however, has examined the financial feasibility of the use of patient simulators as an educational tool. The extent to which a simulation lab comprising six Laerdal SimMan high-fidelity patient simulators and a staff of nurse educators is a financially feasible alternative to classroom-based education is examined.     

Estimating the time involved in managing the 'unoccupied bed:' a time and motion study

Occupied bed days are often used as a demand indicator when calculating the number of nurses required to provide safe care. However, such calculations fail to take into account the amount of nursing time consumed by the "unoccupied bed." This study used direct observation time-and-motion methods to estimate the time and costs associated with a bed that is unoccupied. The average time taken to complete all of the activities associated with a bed that was unoccupied due to an internal transfer was 8.65 minutes, for a patient discharge 26.27 minutes, and for a patient admission 37.7 minutes. An average daily cost for activities surrounding these patient movements was approximately $386/day (AUD) in registered/enrolled nursing salaries alone. The unoccupied bed is not resource neutral and time associated with its maintenance should be considered when calculating nursing requirements to provide safe care.     

The nursing care technologist: an interview with Linda Sims Matessino

To better promote nursing, provide quality patient care, and address long-term problems posed by the nursing shortage, Ochsner Foundation Hospital of New Orleans developed and implemented the role of nursing care technician. In this interview, Linda Sims Matessino, Associate Hospital Director and Director of Nursing Services, details this position and how it has benefitted Ochsner Foundation Hospital.     

Nursing overtime: why, how much, and under what working conditions?

To provide the best care to patients, the physical wellness of nursing staff is essential. Current evidence indicates long work hours can lead to adverse nurse and patient outcomes. To provide quality and safe patient care, both staff nurses and nurse managers need to recognize the adverse effects of overtime, whether it is mandatory or voluntary. Results of this study showed overtime was not used more when there was an increase in nursing shortages. Further, overtime was not used to control shortages; rather, understaffing was an underlying condition of the nursing practice, at least in the study sample. Thus, efforts must be made not only to prevent nurses from working long hours, but also to resolve the problem of understaffing in order to retain qualified nurses in hospitals.     

Patient intensity in an ambulatory oncology research center: A step forward for the field of ambulatory care--Part II

Nursing leaders in ambulatory care need to objectively quantify patient intensity to balance patient care needs and nursing resources. In this three-part series, current literature on acuity/intensity tools will be reviewed, and the development of an Ambulatory Intensity System (AIS) to objectively quantify nursing care will be described. In this article, the ongoing implementation of the system, its incorporation into the organization's established computerized appointment system, reliability measures, and related performance improvement activities will be discussed.     

Relationship of direct nursing care hours to DRG and severity of illness

Great variation in nursing resource use is documented within DRGs. Much of this variation may be explained by patient severity of illness. Variance in nursing resource use within DRGs can be reduced by using a severity of illness instrument to score patients.     

试析人文关怀在病患输液过程中的作用

目的 探讨人文关怀在病患输液过程中的临床应用价值.方法 选取2010年7月至2012年9月来我院接受静脉输液治疗的患者89例,44例患者采用常规护理方法进行护理,作为对照组,45例患者在常规护理的基础上采用人文关怀模式进行护理,作为观察组,分别以两组患者的护理满意程度作为临床观察指标,并使用SPSS软件包进行统计学分析.结果 观察组患者的护理满意度明显高于对照组患者,P＜0.01.结论 在常规护理的基础上采用人文关怀模式可有效提高患者输液过程中的护理满意度,对于提高患者的治疗效果具有重要的意义.     

Using technology to support the CLAS Standards

Effective communication is essential for ensuring effective patient education to support patient acquisition of self-care knowledge and behaviors. National standards have been developed suggesting methods for meeting this need and systems changes are either mandated or recommended within health care delivery organizations to assure movement toward the goal of effective patient-provider communication. By availing themselves of the opportunity to assign these nationally standardized cultural competency modules as part of institutional requirements, nursing administrators and managers can implement a cost-effective method for improving the cultural knowledge base of nursing personnel.     

Don't forget our charge nurses

In response to the nursing shortage, many health care organizations are utilizing a team approach to nursing care delivery. Although, the role of the charge nurse in these changing nursing care delivery models is a pivotal one to the effective and safe management of patient care units, many receive no leadership training. An educational program that hundreds of charge nurses have attended over the past 2 years is described. Strategies that organizations should consider when planning their own training are shared.