Staffing Is More Than a Number: Using Workflow to Determine an Appropriate Nurse Staffing Ratio in a Tertiary Care Neurocritical Care Unit

J Neurosci Nurs. 2018 Oct;50(5):268-272. doi: 10.1097/JNN.0000000000000387.

Abstract

Objective: To enhance nursing staff retention and ensure a consistently high standard of care, a study was conducted to determine an appropriate nurse staffing model for a neurocritical care unit. In addition to being critically ill, these patients often require extensive diagnostic testing to determine treatment. Nurses traveling with patients leave higher nurse-patient ratios remaining on the unit.

Methods: Prospective observation was used to assess relationships between neurologic assessment, documentation, and the amount of time spent traveling with patients. Patient acuity and nursing experience were also measured.

Results: Over the 30-day study period, more than 226 hours were spent traveling, equivalent to approximately 38% of a single nurse's shift. There was no correlation between the experience of nurses and the time necessary to perform a neurologic assessment. When controlling for acuity, a relationship was found between nursing experience and the time needed to chart an assessment.

Conclusions: Significant time was spent every day off the floor, in addition to the documentation and performance of frequent assessments. These results advocate for a staffing position without a dedicated patient assignment but to assist with traveling and high-acuity patients so that safe and attentive care can be consistently given.

MeSH terms

  • Clinical Competence / standards
  • Diagnostic Imaging
  • Diagnostic Techniques, Neurological / instrumentation
  • Diagnostic Techniques, Neurological / nursing
  • Humans
  • Intensive Care Units*
  • Neurology*
  • Nursing Staff, Hospital / standards
  • Nursing Staff, Hospital / statistics & numerical data*
  • Personnel Staffing and Scheduling*
  • Prospective Studies
  • Tertiary Healthcare*
  • Workload / standards*