Best Practice 3 Evidence & Data
The staffing model, policies, and practices are based on and driven by evidence.
There is access to multi-dimensional data supporting informed and effective decision making.
Evidence is the foundation of excellence in staffing and in the development of effective staffing policies and procedures. Thus, good staffing judgments are informed by valid and reliable data. Staffing, scheduling, care delivery, and practice model decisions are based on a sound understanding of safe practices, and the relationship between staffing and positive patient outcomes. Individuals making staffing decisions have ready access to accurate and current data on the condition of patients and their medical/nursing needs; on the resources that are available, including the role competencies of available staff, as well as their skills, experience, work schedule, fatigue level, and other variables that may impact their ability to provide needed care; and information about scheduled procedures, admissions, discharges, transfers, and other planned activities that affect the unit as a whole.
Mechanisms are in place to monitor and adjust staffing practices based on new research findings, current recommendations and ‘best practices’ promulgated by professional groups and associations, and other feedback processes.
Evidence-based staffing is in its infancy. While there is some excellent work upon which to base the design of staffing models and practices, there is also much work ahead. For such efforts to be most helpful to institutions and policy-making bodies, there is a need to standardize staffing metrics and gain agreement on the meaning of common terms and to reach consensus on the data structures that are required to support a robust analysis of staffing practices and their impact on quality and economic viability. It is important for government and private sources to fund further research and disseminate findings to individuals on the front lines of staffing. Adopting evidence-based staffing is critical to patient safety and professional advancement. It is through the collection, analysis, and reporting of staffing impact data that safe and sustainable staffing practices will become the norm.
Best Practice 3review of selected literature
Like their clinical practice colleagues, health care managers are expected to use an evidence-based approach to decision making. (DeGroot, 2005) Calls for using an evidence-based approach to staffing decisions come from multiple quarters, including the American Nurses Association (ANA), which highlights the importance of analyzing patient needs and staff competencies when determining staffing levels (ANA, 1999), and the American Association of Critical Care Nurses, which encourages organizations to routinely evaluate the effect of staffing decisions on patient and system outcomes. (AACN, 2005) The American Organization of Nurse Executives' Policy Statement on Staffing Ratios urges the use of research to identify the components of appropriate levels of nurse staffing in hospitals. (AONE, 2003)
To enhance staffing efficiency, decision makers must have access to information about patients, and about the staff that provide care. (Curtin & Zurlage, 1995) Staffing systems that fail to consider all of the relevant factors risk adverse events and poor patient outcomes. (Hyun, Bakken, Douglas, & Stone, 2008) Specific unit, patient, and nurse characteristics that should be considered when determining required staffing levels and competencies have been identified by the ANA and are listed in the ANA’s Principles for Nurse Staffing. (ANA, 1999) Data to inform staffing decisions can be obtained from multiple sources, including patient classification systems, systems that track patient flow, track patient-caregiver interactions, electronic medication administration and health records, quality and safety databases, and databases with information on workforce qualifications and competencies. (Hyun et al., 2008; Van Slyck & Johnson, 2001) Today’s leading organizations recognize the costs associated with ineffective staffing practices, and routinely measure their “human resource capital” along with financial and other metrics. (Lutz & Root, 2007)
Well-designed organization-based studies can provide baseline measures of nurse-sensitive outcomes and help explain the relationship between outcomes and key nurse staffing variables. (Potter, Barr, McSweeney, & Sledge, 2003) By examining data describing how processes and management methods affect quality, health care organizations can gain insight into resource utilization, prioritization of services, and patient safety. (Dunham-Taylor & Pinezuk, 2006) Tapping into national databases, such as the ANA’s National Database of Nursing Quality Indicators®, and comparing results to those of other organizations can yield an even deeper level of understanding. (Dunton et al., 2007)
