1. Donovan, Liz RN, MS

Article Content

Nurse managers endeavor to predict staffing requirements based on increasingly complex patient care needs and state regulatory requirements, all while maintaining a "budget neutral" unit. For several years in California, the Department of Health Services (DHS) has required that nurse staffing be based on a patient classification system that's reliable and valid. Effective January 1, 2004, staffing ratios for all clinical areas were mandated in the state. Staff at Santa Clara Valley Medical Center, a 350-bed, county-owned and -operated, nonprofit facility, looked to existing technology to assist with nurse staffing needs.


Relevant concepts

Patient classification system (PCS): For the past 16 years, staff members have used the facility's existing PCS.


Patients are classified prospectively for the oncoming shift based on the assessment of the RN caring for the patient. The charge nurse then uses a staffing matrix to determine staffing needs for the next shift based on high, medium, or low acuity. Census and known admissions/discharges and transfers are also calculated in. The charge nurse message is then faxed to the nursing staffing office for review, enabling the filling of any staffing needs based on patient care needs, census, or sick calls.


Automated staffing and scheduling system: Since 1991, staff has used an automated staffing and scheduling system. The staffing system is part of the local area network (LAN), which allows nurse managers to centrally accomplish unit scheduling and individual staffing requests. We adjust unit core staffing requirements whenever there's a change in the unit matrix in situations such as the legislatively mandated staffing ratios.


System blending: Once the staffing requirements are received, the staffing clerks add the workload data (acuity) into the staffing and scheduling software. A master staffing sheet is printed, which shows actual staff scheduled to work and target staffing based on the PCS matrices and the variance between the target and actual, if any. In addition, a line on the master staffing sheet shows census target, which indicates the staffing ratio for that particular clinical area. As staffing ratios are only the minimum staffing required, this allows staffers to quickly determine when a unit is adjusting staffing requests due to higher patient acuity.


The staffing clerks use the staffing software "look-up" function to find the nursing staff that fits the patient care needs of a particular unit. This function also checks for qualifications (competency), availability, and overtime candidates. To handle patient unpredictability, staff use floating resource nurses who can be paged to assist with unexpected increases in unit census, patient condition changes, traumas, and treatment/procedures.


Validation: Nurse managers receive quarterly reports regarding each units' average acuity and frequency distribution. They can also use workload data from any date length to add to staffing variance reports or justification. Annually, RNs complete an interrater audit to make sure that PCS remains a valid and reliable tool for workload measurement. The master staffing data for target and actual staff also helps validate and document adequate staffing, as required by the DHS.