Learning Objective #1: Provide strategies for nurse leaders in implementing a staffing effectiveness

Learning Objective #2: Discuss the evaluation and challenges in evaluating indicator correlations of JCAHO staffing effectiveness standards

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The nursing shortage is attributed to increased acuity level of patients and aging nurses (Buerhaus, 2000) ANA 2000 study linked RN staffing with improved patient outcomes. JCAHO developed an evaluation of staffing effectiveness (SE) to address the ever-evolving health care changes and acute nursing shortage. Several factors relate to JCAHO's decision to implement SE standards including shortage of health care providers; decrease in health professional program enrollment and aging RN workforce. Miami Children's Hospital (MCH) participated, the only pediatric hospital in the southeastern U.S. MCH selected indicators based on JCAHO screening indicators. Indicator decision matrix developed usied a 4-point priority grid. Historical performance, external benchmark data and current process improvement data were utilized to develop expectations. Objectives: identify HR indicators that provide the most pertinent information; assess data acquisition; identify Clinical Service (CS) indicators relevant to pediatric care, and those that have high impact on safety and quality. RNs were identified as “direct caregivers” for the SE review. HR and CS indicators were plotted to evaluate inter-relationships and ascertain potential or real correlations. Identifying concerns regarding safety and quality of patient care is impacted by staffing. An inverse/negative relationship between RN Hours per patient visit (HPPV) and variables in ED: left without being seen; average LOS; average daily visits; patient complaints, unplanned returns with admission. Positive relationship existed between patient satisfaction and RN HPPV. Increase in average daily volume correlated with less RN HPPV. New JCAHO standards should motivate hospitals to gather vital information, evaluate the hospital's level of performance based on data. Departmental staffing is not viewed in isolation but in relationship with other key departments. Results and action plans are presented quarterly to SE Team, and bi-annually to the CQI and Board of Directors QI Committee.