The Nurse Executive Or Designated Qualified Nurse Leaders Approve for Each Area Providing

Policy Title: Staffing Guidelines / Policy No.: POC-02-103
Category: Provision of Care/Clinical / Policy No. POC-02-104
Policy Owner: Chief Nursing Officer / Origination Date: June 20, 2012
Last Revision Date: April 18, 2016
Policy Title: Staffing Guidelines
Supersedes: / July 16, 2013 /

POLICY

The Nurse Executive or designated qualified nurse leaders approve for each area providing nursing care:

1. Criteria for employment as a staff member.
2. The process for assigning patient care responsibilities to a staff member.
3. Criteria for deployment of staff members considering:
4. Patient care needs
5. Numbers and mix of personnel needed for patients in each unit
6. The mode of delivery
7. The number of qualified RN’s for delivering nursing care and directing the care provided by other staff members.
8. The competency of each staff member delivering care to patients

Established staffing guidelines are consistent with the Centers for Medicare & Medicaid (CMS) Condition of Participation: Nursing Services (482.23), Ohio Revised Code 3727.50 – 3727.57, HB346, the American Nurses Association’s Principles for Nurse Staffing, and other standards established by private accreditation organizations or governmental entities to ensure safe, quality, nursing care. They are developed with consideration of patient needs, established work hour standards, the functionality of the unit, clinical competencies of the staff, expertise of the nursing staff, RN ratios, projections, and /or procedural volume projections. Also considered is the ability to provide support to the staff by the management team on both an operational and executive level. Documented competencies are completed on each nurse to promote quality care for all patients.

STAFFING STANDARDS

Staffing standards established by private accreditation organizations, governmental entities or published evidence are used to develop staffing plans for each nursing unit. The following guidelines and benchmarks are considered when developing staffing plans that address the acuity and population based needs of individual patients:

Guidelines / Benchmarks / Nursing Service Area(s)
Linda Aiken et all / Med/Surg and Clinical Decision Unit
Guidelines for Professional Registered Staffing for Perinatal Units- Association of Women’s Health, Obstetrics and Neonatal Nursing (AWHONN) / Maternity
American Association of Critical Care Nurses (AACN) / Step/Down, Critical Care
Association of Perioperative Registered Nurses (AORN) / Operating Rooms
Emergency Nurses Association Guidelines (ENA) / Emergency Department
American Society of PeriAnesthesia Nurses (ASPAN) / Recovery Room
Ohio Department of Mental Health / Mental Health Unit

REVIEW PROCESS

In accordance with Ohio’s Safe Nurse Staffing Legislation, Fairfield Medical Center has added to the responsibilities of its Nursing Executive Council (NEC), its hospital-wide nursing care committee comprised of a majority of staff nurses and the Chief Nurse, a nursing services staffing plan that is, at a minimum, consistent with current standards established by private accreditation organizations or governmental entities and shall annually devote part of its agenda, pursuant to section 3727.51 of the Ohio Revised Code, to review and address all of the following:

(1)The selection, implementation, and evaluation of minimum staffing levels for all inpatient care units that ensure that the hospital has a staff of competent nurses with the specialized skills needed to meet patient needs in accordance with evidence-based safe nurse staffing standards;

(2)The complexity of complete care, assessment on patient admission, volume of patient admissions, discharges and transfers, evaluation of the progress of a patient’s problems, the amount of time needed for patient education, ongoing physical assessments, planning for a patient’s discharge, assessment after a change in patient condition, and assessment of the need for patient referrals;

(3)Patient acuity and the number of patients for whom care is being provided;

(4)The need for ongoing assessments of a unit’s patients and its nursing staff levels;

(5)The hospital’s policy for identifying additional nurses who can provide direct patient care when patients’ unexpected needs exceed the planned workload for direct care staff.

Pursuant to section 3727.54 of the Ohio Revised Code, the nursing care committee conducts a review of the staffing plan at least once a year to evaluate how the nursing services staffing plan does all of the following:

(1)Affects inpatient care outcomes;

(2)Affects clinical management;

(3)Facilitates a delivery system that provides, on a cost-effective basis, quality nursing care consistent with acceptable and prevailing standards of safe nursing care and evidenced-based guidelines established by national nursing organizations.

Additionally, the NEC makes recommendations, based on the most recent review conducted, regarding how the most current nursing services staffing plan should be revised, if at all.

In addition to an annual review by the NEC, the staffing plan is monitored on an ongoing basis by using quality studies, period position control reports, period turnover reports, and budget variance reports. Mechanisms are in place to adjust staffing on a daily basis and more frequently as needed up to every 4 hours. If staff exceed the required levels the following options are considered: reassign personnel, call off contingent staff, call off personnel scheduled extra, or other options according to decentralized scheduling guidelines. If less than required staffing, the following options are considered: assign appropriately trained float personnel, call for extra shifts, call in contingent staff, utilize Team Leaders, Supervisors, and Managers, utilize overtime, reschedule shifts, or other options according to staffing guidelines.

Hiring decisions are based on the annual staffing plan, actual/projected turnover, and projected changes in volume and activity. An ongoing effort is in place to ensure all budgeted positions are filled in a timely manner so patient care is not interrupted.

MECHANISM FOR REQUESTING ADDITIONAL RESOURCES

1. Staff nurses are to use the nursing chain of command to give input at anytime to any staffing concerns they believe will impact the safety of patients or the department.
2. Bed-huddles, conducted by the House Supervisor, occur at regularly scheduled intervals throughout each twenty-four hour period, convening the charge staff of all patient care areas for the purposes of communication and collaboration between colleagues of patient care issues including staffing needs.
3. The department’s leader at the time of the concern will assess the staffing concern and determine the need to alter staffing
4. The department’s Nursing Executive Council representative will participate in the annual evaluation of staffing recommendations.

CHAIN OF COMMAND

Staff RN to Team Leader to Manager/House Supervisor to CNO/VP on Call

AVAILABILITY OF THESTAFFING PLAN

1. The availability of the plan to the public is posted and is available upon request from the Nursing Office.
2. The plan is available to staff as are all policy and procedures on FMC’s
3. Intranet.

References: / American Nurses Association (2010). ANA Principles on Safe Nurse Staffing. Retrieved September 19, 2010 from
The Centers for Medicare & Medicaid (2010). State Operations Manual: Appendix A – Survey Protocol, Regulations and Interpretative Guidelines for Hospitals. Retrieved September 19, 2010 from
Aiken. L.H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J. H. Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction. JAMA, 2002;288:1987-1993.
Ohio Revised Code (2009). /
Distribution: / Click here to enter text. /
Related Forms: / Click here to enter text. /
Related Standards/Legislation: / Safe Nurse Staffing Legislation, Ohio Revised Code /

APPROVAL AND REVIEW

Approval / Helen Harding, Chief Nursing Officer / Date:April 18, 2016
Approval (if applicable) / Date:Click here to enter text.
Approval (if applicable) / Date:Click here to enter text.
Committee Review Recommend: ( if applicable) / Policy & Procedure Committee / Date:
Author: / Helen Harding, CNO /
Review Schedule: / Every Year /
Review Dates: / Click here to enter text. /
Retired Date: / n/a /

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