DQ: What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

NUR 621 Topic 7 DQ 1

Knowledge Check

What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

Healthcare workers are the backbone of any healthcare organization. “Staffing is the cornerstone of human resource management” (Theriault et al., 2019). For healthcare organizations to thrive and function at their best, adequate, qualified employees must provide continuous, high-quality, safe patient care. Competent and adequate staffing in healthcare facilities increases and promotes positive patient outcomes, decreases readmissions, decreases errors and safety events, improves the patient experience, and improves facility ratings. “Healthcare is labor-intensive, requiring the expertise and efforts of nurses and other health care providers to assess and manage the care of consumers needing health care services” (Penner, 2017). Staffing and scheduling sometimes present as a complex issue due to the challenges faced by different healthcare organizations, such as short staffing, patient acuity, patient capacity, budgeting, and lack of adequate finances.

Staffing varies between a skilled-nursing facility versus a medical-surgical unit in a hospital. Both units require staffing for twenty-four hours per day for seven days per week, but the medical-surgical unit is an acute setting with more rapid patient turnover while the nursing facility is more chronic and long-term. Based on the acuity and services required, an acute inpatient hospital unit requires more nurses, such as RNs, while a skilled-nursing facility requires fewer nurses and more support staff such as nurses’ aides.

There are three types of staffing models budget base, nurse-patient ratio, and patient acuity (My American Nurse 2014). Some facilities use a combination of staff models depending on the unit’s needs or the facility. Staffing has been and continues to be a considerable challenge for many healthcare facilities and organizations worldwide. Quality patient care and patient safety should be one of the top priorities when staffing is considered. Other factors to be considered when addressing staffing needs are call-offs, sick leave, emergencies, admissions, discharges, patient capacity, and patient acuity.

References

My American Nurse. (2014). What every nurse should know about staffing. https://www.myamericannurse.com/what-every-nurse-should-know-about-staffing/amp/

Penner, S. J. (2017). Economics and Financial Management for Nurses and Nurse Leaders (3rd ed.). Springer Publishing Company. ISBN: 978-0-8261-6001-0

Theriault, M., Dubois, C., Silva, B. and Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6(3). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650648/#_ffn_sectitle

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I enjoyed reading your posts but was wondering what your thoughts are regarding the regulation of nurse-to-patient ratios? This has always been a dicey subject since I have been in nursing. As nurses, we know the type of facility, level of care, and patients determine the nurse-to-patient ratios. However, all patients are not the same. I have been assigned to patients that were so complex that it was very difficult to sufficiently meet all their needs. Although healthcare facilities have nurse-to-patient ratios or some type of staffing plan in place, the pandemic has caused some organizations, including mines, to forgo adhering to these staffing guidelines. Nevertheless, the importance of having optimal staffing levels cannot be underestimated. Research has repeatedly shown the positive relationship that exists between adequate nursing staffing levels and improved patient outcomes. Moreover, Qureshi et al. (2019) highlighted how understaffing can lead to nurse burnout, stress, and other negative effects.

References

Qureshi, S. M., Purdy, N., Mohani, A., & Neumann, W. P. (2019). Predicting the effect of nurse–patient ratio on nurse workload and care quality using discrete event simulation. Journal of Nursing Management, 27(5), 971-980. https://doi.org/10.1111/jonm.12757

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Hi Angela, thank you for your response!

This writer is all in favor of nurse-to-patient ratio regulations. California is one of the only states that has officially established laws and regulations regarding the nurse-to-patient mandate. Because of the lack of federal mandate regarding nurse-to-patient ratios, registered nurses (RNs) are consistently required to care for more patients than is safe, compromising patient care and outcomes (National Nurses United, n.d.). Safe patient care has shown positive outcomes for the patient, the nurse, and healthcare organizations. Patients have a right to receive the best care every time; care should be safe, high-quality, patient-centered, and holistic. How can patient care be all of the above when sometimes a nurse is required to care for up to 8 and more patients in an acute care setting? Presently this writer’s facility’s maximum nurse-to-patient ratio on any shift on a medical/surgical/telemetry floor is seven patients; this can be unsafe for both patient and nurse, especially when there is not enough or no support staff to assist. Short staffage has been a chronic issue in healthcare, and the present pandemic has put an even further strain on the situation. The nurse-to-patient ratio continues to be a concerning topic for nurses across the USA.

Reference

National Nurses United. (n.d.). National campaign for safe RN-to-patient staffing ratios. https://www.nationalnursesunited.org/ratios#:~:text=There%20are%20no%20federal%20mandates,and%20negatively%20impacting%20patient%20outcomes.

A hospital’s medical-surgical unit is more resourced than a skilled nursing facility. The auxiliary nurses and nurse aides are essential in a medical-surgical unit because of the acuteness of the patient’s problems (Thériault et al., 2019). The number of care providers present in a nursing facility meets the patient’s needs because the patients do not need extra care unless their health deteriorates. Therefore, it is more appropriate to schedule all the nurses in a nursing facility according to their shifts. Furthermore, a skilled nursing facility will likely take more graduate nurses to meet the rising demand for patient care (Harrington et al., 2020). On the other hand, a medical-surgical unit in a hospital may take most of the experienced care providers to meet the critical care needs of patients. This move ensures that patients receive quality care in the surgical units. Each unit has other care providers to help if they need help or their conditions exacerbate.

References

Harrington, C., Dellefield, M. E., Halifax, E., Fleming, M. L., & Bakerjian, D. (2020). Appropriate Nurse Staffing Levels for U.S. Nursing Homes. Health services insights, 13, 1178632920934785. https://doi.org/10.1177/1178632920934785

Thériault, M., Dubois, C. A., Borgès da Silva, R., & Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing open, 6(3), 1218-1229. https://doi.org/10.1002/nop2.321

There are so many factors that go into staffing. We need to understand environmental factors (technology use, environment framework (long hallways, use of WOWs), nurse factors (experience, teamwork), and patient factors, which usually involves looking at acuity. This is a tough one! If anyone could come up with a reliable way of measuring all of these factors, staffing would be so much easier!

Patient acuity can change; stable patient become unstable. Patients are discharged and readmitted. Staying ahead of needs becomes critical. What acuities looked like last shift changes for the next shift. From a leadership perspective, it is critical that patient assignments are consistent, objective and quantifiable (Ingram & Powell, 2018). Nurses become dissatisfied and frustrated when this does not occur (Ingram & Powell). “Scoring” patient on their needs (number of medications, number of treatments, level of complexity) plus scoring nurse tasks (admission/discharges, educational requirements, wounds, isolation, safety) can help in balancing assignments and increasing satisfaction.

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The American Hospital Association (AHA) recommends for hospital administration and members of the organizations to be successful in a value-based healthcare environment there are 10 “must-do” financial strategies (Leger, 2021). All members of the organizations are equal partners to identify strategies and support the basic value of giving patients what they desire (Leger, 2021). Out of these 10 strategies, I see five vital strategies I could implement in my current work environment.

Aligning providers and other hospitals across the continuum of care (Leger, 2021). This is important to have multidisciplinary rounds daily to decrease delays in care and decrease patient frustration. This does take a lot of time out of the providers and care team day, but implementing MDRs increases patient satisfaction and improves care. We currently use MDRs in our facility. Families speak highly about this process and how important these rounds are to them on a daily basis as they feel valued, and heard from the care team.
Using evidence-based practices to improve quality and patient care (Leger, 2021). When organizations use and implement EBP in their organizations, the quality of care is improved, allowing the metrics organizations to have implemented based on quality of care given to help lead to reimbursement for the organization. As a nursing leader the biggest impact to financial strategy is using EBP to improve quality and patient safety (Leger, 2021).
Improving efficiency through hospitals productivity and financial management (Leger, 2021). Nurses enjoy spending valuable time with patients and families and understanding what is important to their patients. Practice councils are important in an organization because when areas are identified and change needs to occur at the bedside, while providing what patients value, and providing high quality care and safety improves the overall vision of the organization to meet financial goals (Leger, 2021). It is important to flex staff from their shift or offer a delay start to their shift when census decreases to meet the productivity of the department.
Educating employees to engage to become leaders (Leger, 2021). When staff are mentored and educated to be the advocates for their patients, and strive to be leaders within the organization, the quality and culture of the organization shifts to improvement and increased patient satisfaction results. Keeping staff members informed of organizational and departmental updates and providing educational resources is a win in my facility, saving overall money.
Seeking population health improvements (Leger, 2021). Our facility offers for all county schools in our region free service for physicals to be completed on student athletes prior to the school year. These services are provided by a trauma provider, trauma nurse, and a physical trainer. This is a preventive service to diagnose health concerns or conditions for students allowing follow up treatment if needed.

When implementing strategies nursing can identify areas and strategies that not only help the financial side of the organization but will better serve the patients within the organization (Leger, 2021). With healthcare moving into a value-based environment, it is important to be aware if quality measures are not being met, organizational ratings will decline decreasing reimbursement to the organization (Leger, 2021).

Reference:

Leger, J. M. (2021). Financial management for nurse managers: Merging the heart with the dollar (5th ed.). Jones & Bartlett Learning.