title: Assessing nursing staffing ratios: variability in workload intensity.
abstract: In 2004, California became the first state to implement specific nurse-to-patient ratios for all hospitals. These mandated enactments have caused significant controversy among health care professionals as well as nursing unions and professional organizations. Supporters of minimum nurse-to-patient ratios cite patient care quality, safety, and outcomes, whereas critics point to the lack of solid data and the use of a universally standardized acuity tool. Much more remains to be learned about staffing policies before mature links may be made regarding set staffing ratios and patient outcomes - specifically, how nurses spend their time in terms of variability in their daily work. This study examines two comparable telemetry units with a 1:3 staffing ratio within a California hospital system to determine the relative rates of variability in nursing activities. The results demonstrate significant differences in categorical nursing activities (e.g., direct care, indirect care, etc.) between the two telemetry units (chi(2) = 91.2028; p < or = .0001). No correlation was noted between workload categories with daily staffing ratios and staffing mix between the two units. Although patients were grouped in a similar telemetry classification category and care was mandated at a set ratio, patient needs were variable, creating a significant difference in registered nurse (RN) categorical activities on the two units.
authors.affiliation: School of Nursing, University of California - Los Angeles, Los Angeles, California, USA.
authors.forename: Valda V
authors.initials: VV
authors.lastname: Upenieks
authors.forename: Jenny
authors.initials: J
authors.lastname: Kotlerman
authors.forename: Jaleh
authors.initials: J
authors.lastname: Akhavan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Esser
authors.forename: Myha J
authors.initials: MJ
authors.lastname: Ngo
mesh_terms: D000046:Academic Medical Centers; D019985:Benchmarking / Q000458:organization & administration; D002140:California; D016009:Chi-Square Distribution; D004282:Documentation / Q000706:statistics & numerical data; D017598:Efficiency, Organizational; D006291:Health Policy; D006801:Humans; D007297:Inpatients / Q000145:classification; D016015:Logistic Models; D020380:Needs Assessment / Q000458:organization & administration*; D024802:Nurse's Role; D015401:Nursing Administration Research; D009741:Nursing Staff, Hospital / Q000331:legislation & jurisprudence / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D020415:Personnel Downsizing / Q000458:organization & administration; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D011787:Quality of Health Care / Q000458:organization & administration; D017751:Safety Management / Q000458:organization & administration; D012720:Severity of Illness Index; D013686:Telemetry / Q000451:nursing; D013996:Time and Motion Studies; D000078329:Workforce; D016526:Workload / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*