Adequate nurse staffing is critical for quality patient care, patient outcomes, and staff and patient satisfaction (Butler et al., 2019; Dubois et al., 2013; Havaei, MacPhee, & Dahinten, 2019; McGillis Hall et al., 2003; Theriault, Dubois, Borges da Silva, & Prud'homme, 2019; Tran, Johnson, Fernandez, & Jones, 2010; Winslow et al., 2019).
Typically nurse staffing in acute care settings follow one of two models: total patient care or team nursing, although some literature has referred to four staffing models: functional, team, geographic, and primary (Winslow et al., 2019). During nursing shortages, it is crucial for institutions to critically manage their workforce to ensure patient and staff needs are met. COVID-19 is challenging the health care system on many fronts, not the least of which is the availability of staff to provide care for medical-surgical patients, whose condition can worsen quickly.
There are areas around the world, and many growing in the United States, that are "hot-spots", meaning they are seeing extremely high volumes of patients diagnosed with, or presumed to have, COVID-19. These states, counties, and cities are dealing with incredibly high patient loads and staff that are at risk of contracting the virus. Many facilities are using contingent staff, for example retired health care providers, i.e. nurses, and senior medical and nursing students, to augment their existing staff to manage the increased workload.
A Staffing Model Can Help with Managing Your Workload & Workforce
AMSN has compiled a staffing plan, based on the team nursing model, to assist facilities in ensuring patient care can safely be provided, while also balancing the staffing needs of individual units and hospitals. This resource is based on the evidence available for team nursing, and is offered to institutions free of charge from AMSN during the COVID-19 pandemic.
This staffing model can be best utilized following an assessment of the competencies of the contingent staff, via the AMSN Self-Assessment Survey, which was also included as a link in your recent email from AMSN. This self-assessment is comprehensive, and was tailored to represent the most important competencies staff need during this pandemic.
“Descriptive accounts of innovative RN team partnership models, or dyads, maximizing the skills and competencies of each nurse are promising. These partnership models require effective communication skills and delegation abilities to sustain due to patient proximity challenges, differing levels of RN experience and competencies, scope of practice knowledge and use of unlicensed personnel support where overlap in tasks exist.”
The nursing care staffing plan describes five stages of intervention based on what the organization is experiencing during the pandemic. The following terms are used:
Moderate staffing shortages – In this state, the organization is experiencing higher than usual absences of nursing staff due to illness and/or vacancies but is still able to provide safe care using the usual model of care delivery (patient centered care, total care, or primary nursing) by floating staff and using available resources.
Critical staffing shortages – In this state, the organization is no longer able to provide adequate nursing care staffing due to overwhelming staff absences and/or increased patient census leading to unsafe conditions for both nursing staff and patients.
Recommended Implementation Strategies:
• Review the staged interventions and adapt to organization specific language and structure. Ensure alignment with current policies and procedures.
• Determine scope of implementation. Originally designed as an organization level tool, the geographic and operational design of an organization may allow implementation at the department or service line level.
• Introduce to nurse leaders, identifying the stage the organization is currently in and what interventions have already been accomplished. Determine who will make decision to move to the next stage (i.e., staffing office, nursing director, senior nurse leader).
• Identify metrics to monitor effectiveness of staffing and nursing care delivery model (i.e., nursing sensitive indicators, adverse events, etc.).
• Develop plan to communicate anticipated changes to clinical nursing staff. If possible, involve clinical nurses in developing roll out plan and scripting messages.
Butler, M., Schultz, T. J., Halligan, P., Sheridan, A., Kinsman, L., Rotter, T., . . . Drennan, J. (2019). Hospital nurse-staffing models and patient- and staff-related outcomes. Cochrane Database Syst Rev, 4, CD007019. doi:10.1002/14651858.CD007019.pub3
Dubois, C. A., D'Amour, D., Tchouaket, E., Clarke, S., Rivard, M., & Blais, R. (2013). Associations of patient safety outcomes with models of nursing care organization at unit levels in hospitals. International Journal for Quality in Health Care, 25(2), 110-117.
Havaei, F., MacPhee, M., & Dahinten, V. S. (2019). The effect of nursing care delivery models on quality and safety outcomes of care: A cross-sectional survey study of medical-surgical nurses. J Adv Nurs, 75(10), 2144-2155. doi:10.1111/jan.13997
McGillis Hall, L., Doran, D., Baker, G. R., Pink, G. H., Sidani, S., O'Brien-Pallas, L., & Donner, G. J. (2003). Nurse staffing models as predictors of patient outcomes. Medical Care, 41(9), 1096-1109.
Theriault, M., Dubois, C. A., Borges da Silva, R., & Prud'homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nurs Open, 6(3), 1218-1229. doi:10.1002/nop2.321
Tran, D. T., Johnson, M., Fernandez, R., & Jones, S. (2010). A shared care model vs. a patient allocation model of nursing care delivery: comparing nursing staff satisfaction and stress outcomes. Int J Nurs Pract, 16(2), 148-158. doi:10.1111/j.1440-172X.2010.01823.x
Winslow, S., Cook, C., Eisner, W., Hahn, D., Maduro, R., & Morgan, K. (2019). Care delivery models: Challenge to change. J Nurs Manag, 27(7), 1438-1444. doi:10.1111/jonm.12827