Nurse Staffing

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Central to health care reform is the emphasis on value based health delivery. Nurses comprise the largest clinical subgroup in hospitals; a common avenue for cost containment is to reduce nurse labor hours and their associated costs. This strategy is short-sighted, however, as appropriate safe nurse staffing and skill mix levels are essential to optimize quality of care. The determination of appropriate safe nurse staffing challenges the profession to create dynamic and innovative staffing solutions that are adaptable to the evolving nature of the populations cared for and healthcare environment.  This work is essential to save lives, prevent harm, and demonstrate the "business case for nursing", or the return on investment (ROI).

A Federal regulation has been in place for some time, 42 Code of Federal Regulations (42CFR 482.23(b) which requires hospitals certified to participate in Medicare to "have adequate numbers of licensed registered nurses, licensed practical (vocational) nurses, and other personnel to provide nursing care to all patients as needed". This nebulous language and the continued failure of Congress to enact a federal law, The Registered Nurse Staffing Act , has resulted in states taking action to ensure there is optimal nurse staffing appropriate to patients' needs. ANA supports state and federal regulation and legislation that allows for flexible nurse staffing plans.

Transparent Public Reporting – An Effective Policy Lever identified in the National Quality Strategy
In addition, ANA's quality policy advocacy to promote transparency has been successful in key steps to achieve public reporting of staffing and skill mix data through work at the National Quality Forum (NQF). Specifically, reporting these measures publicly will act as an effective quality policy lever to reduce staffing variance in hospital nurse staffing and skill mix that is associated with patient death and harm. In 2014 through 2015, ANA's effective quality policy advocacy led to ANA's staffing and skill mix measures being advanced" for review for public reporting at the Measures Application Partnership. In 2016, ANA's staffing and skill mix measures were endorsed by the NQF at the hospital level of reporting, another key step. This endorsement was essential to pave the way for national quality safety data about hospitals to be available for consumers, purchasers and all stakeholder to view transparently when making healthcare decisions. ANA continues to work with CMS to advance these measures in CMS's hospital public reporting program, Inpatient Quality Reporting, via CMS regulations. See more of ANA's policy advocacy detailed through the ANA Leading Patient Safety link.

For their part, nurses have a responsibility to define, implement, and maintain standards of professional practice. Nurses must plan, establish, implement, and evaluate review mechanisms to safeguard patients, nurses, colleagues, and the work environment. These safeguards include peer review processes, staffing plans, credentialing processes, and quality improvement and research initiatives.

Nurses in management and administration have a particular responsibility to provide a safe environment that supports and facilitates appropriate safe assignment and delegation. A quality work environment includes competency-based orientation and ongoing skill development; licensure, certification, continuing education, and competency verification; adequate and flexible staffing; and policies that protect both the patient and the nurse from inappropriate assignment or delegation of nursing responsibilities, activities, or tasks.