Numerical Staffing vs. Acuity Staffing

Numerical Staffing vs. Acuity Staffing


















Numerical Staffing vs. Acuity Staffing


In the past years, workforce attributes have increasingly transformed into prominent issues in long-term issues for the healthcare sector. Policy formulators and scientists alike, acknowledge that nurses in the healthcare sector are fundamental players in assisting to supply quality care. For instance, several states have permitted the creation of minimum staffing levels for nurses. Staffing levels among nurses can be estimated for an entire organization or a specific department, unit, or division within the organization. Definite periods must be established to make certain standard meanings among data collectors, analysts, and individuals trying to construe results of investigations.

In many instances, staffing measures are estimated for entire institutions on an annual basis. It is practically to average staffing across the common shift, for example, across day, month or annual shifts and occasionally, across all the departments in the hospital. The consequential measures, while offering a vague notion of what precise conditions caregivers and patients go through at particular stages, are universal indicators of institutions’ investments in recruitment. Nonetheless, staffing levels on different departments reflect disparities in patient numbers and the severity of sickness where the most striking is witnessed between critical care units and general care (Ellis & Chapman, 2006). Practically, staffing is administered on a departmental and daily basis with budgeting done for a longer period. For these reasons, some scientists argue that significant studies should be done where recruitment is calculated on a shift and departmental-specific basis rather than on an annual, hospital-wide basis. A diverse, but mounting, collection of studies analyzed employment conditions in organizational microsystems over shorter periods such as monthly or quarterly.

For healthcare provider organizations, staffing created a trial in spite of of the care environment in question, but long-standing care providers experience a mounting number of concerns because of modifications in regulations, authorization and quality proposals, and the patient numbers. After a decade and a half, the numbers of Americans over 65 years will most likely double, and this escalating aging group will place a high amount of stress on healthcare providers and their nursing staff. This growing section of the population exhibit high levels of chronic illnesses and this creates rising acuity levels among patients that need long-term care (Ellis & Chapman, 2006). For healthcare providers, labor presents the highest source of operating costs, and administering these costs while working to recruit nurses in hospitals and consider the best combination of professionals and skills to offer first-class care suitable to the acuity levels remains a problem. These complications make successful workforce management that facilitates providers to acuity levels a vital subject. Simultaneously, the population and the workforce both become old. There exists a shortage of expert, qualified care providers, and employee turnover is high, hastening the need among healthcare organizations to administer their labor force efficiently. Apart from the obvious need to reducing costs, healthcare providers need to deal with the existing personnel better and furnish nurses with devices to enhance employee fulfillment, simplify time and other functions (Wan, 2010).

Contribution to the Future of Healthcare

The increased acuity witnessed among patients admitted for long-term monitoring makes employment, staffing, and setting up facilities more complicated. While repayment for long-term care from insurance companies such as Medicaid may contain an acuity-based aspect, compensation is still mainly dependent on the facility’s expenses. However, facilities must be awarded nurses to watch over sick residents, and staffing and preparation may need to be restructured to align caregiver competence with the explicit demands and medical status of current residents. At the center of waning reimbursement rates, workforce remains the major cost for healthcare organizations, and critically ill patients often call for highly skilled, experienced nursing staffs, which are more expensive to employ and maintain. Actual staffing necessities for the critically acute resident combination may be higher when compared to the least nurse staffing prerequisites prescribed for the institution.

Staff may need specialized instruction for more severe cases, and acuity-based staffing and preparation resolutions should be integrated into a model that would meet the needs of mounting acuity while restricting labor expenses. This will permit long-term care institutions to maintain quality of care under the burden of heightened acuity while controlling costs. With the growing acuity among long-term patients in the future, solutions that target patient categorization and assignment of staff to patients will become gradually more significant for those institutions that need to maintain their quality levels and staff contentment while regulating workforce costs in the new settings. Enrollment for high acuity patients demands vigilant attention to staffing ratios and expenses such as agency staffing and overtime, and the rising acuity make matters worse for the staffing process by demanding attention to supplementary factors, for instance acuity and expert skill sets among the staff that must be objective and balanced across shifts (Wan, 2010). Solutions to workforce management that integrate patient categorization and assignment of staff to patients can assist in creating schedules that report all these factors effortlessly, and the outcome will be an enhanced and safer staff and patient experience.




Change Plan Overview Based on Six Steps

Step 1: Assess Need for Change in Practice

This stage will require the evaluation of the specific groups of labor force that will act as the subject throughout the introduction, implementation and monitoring of the acuity program. Several categories of staff are eligible for this program. However, nursing staff qualify as the category that stands to benefit greatly from the exercise. The rationale behind selecting any group should include urgent issues, financial considerations and other factors. On average, nurses handle the most responsibilities concerning long-term critical patients than any other labor group in the healthcare sector. The main objectives of the acuity plan should be clearly outlined. These objectives need to be realistic and achievable. These include the expected targeted number of nurses, the projected outcomes in terms of person-hours among the nurses as well as other parameters. Checking the existing and proposed policies and priorities relating to the nurses in a particular facility is important since the acuity plan can create new directives that clash with existing ones (Havig, Skogstad, Kjekshus & Romøren, 2011). These factors are important in clarifying the main objective of introducing an acuity-based method of staffing. Determining the professionals that will work on the plan is also necessary at this step. The major players include the project leader, project team and other key stakeholders such as policy makers and senior executives.

Step 2: Link Problem with Interventions and Outcomes

            The main problem is the delivery of quality and specialized care to long-term acuity patients within public and private healthcare institutions. It has been discovered that it is increasingly difficult to provide such necessary care to critical patients for long durations without eating into the budget of the institution or disrupting the schedules for general healthcare, maternity and other units within the same hospital or organization. To that extent, it is necessary to formulate an efficient and workable staffing approach that can factor in the operational costs and flexible schedules. Acuity-based staffing was identified as one of the feasible approaches that use scientific methods to calculate the amount of workload per bed and produce results that can be used by administrators and/or managers to make nurse allocations to critical units and patients without affecting the operational costs and schedules negatively (Barton, 2013). The expected outcomes in such an acuity plan is that the program would efficiently allocated human resources (nurses) throughout the hospital so as to ensure that all critical long-term patients have been allocated an expert nurse at no significant extra cost to the hospital.

Step 3: Synthesize Best Evidence

            In this step, the acuity-based staffing model is refined and reinforced using clinical decisions and contextual information. The most commonly used workload gauge is the ratio of patients to nurses. The nurse-patient ratio can be used to contrast departments and their patient outputs concerning nursing staffing. Earlier research offers compelling evidence that elevated nursing workloads at the departmental level reflect negatively on patient outcomes. The proposals in the studies concerning enhancing patient care were restricted to raising the number of staff in a department or lowering the number of patients allocated to every nurse. Nevertheless, it may unfeasible to implement these proposals due to expenses and the shortages in nursing staff. The main weakness of this category of study is that it perceives nursing workload at a comprehensive level, disregarding the environmental and executive characteristics of specific health care locations that may considerably have an effect on workload (Barton, 2013). Studies should investigate the effect on nursing workload on institution microsystems.


Step 4: Design a Change in Practice

            The important elements when designing such a change include the practice environment, the responses and contributions from stakeholders and the available resources. The basic hospital environment is always busy with patients being handled on a regular basis therefore making it relatively difficult to implement the change gradually. The main stakeholders in this situation include the ministry of health and sanitation service or its relevant substitute, insurance companies (Medicaid etc.), pharmaceutical companies, medical practitioners and the public (Barton, 2013). Car should be taken to simplify the acuity-based approach into simple stages that are easy to comprehend, as this will improve the acceptance levels by the rest of the nursing staff. The evidence collected in the earlier stage should be used to guide medical professionals in recognizing expected discipline-sensitive and intersectional patient outcomes caused by the practice change. Clearly defined and relevant outcomes are an advantage to the project team as it means that the practice will be easily accepted. A pilot demonstration in one department can be initiated to sallow the project managers to promote adjustment to the change to fit the acuity needs of the hospital. This will improve the sense of ownership of the change and facilitate smooth transition and integration of the change.

Step 5: Implementing and Evaluating Change in Practice

            This stage requires the constant and detailed supervision by the project leader to ensure that all elements of the acuity-based staffing are implemented correctly. After the change is fully adopted, the project leader will use scientific data collection methods to compare the effect before and after the introduction of the acuity-based approach (Roussel & Swansburg, 2009). These values include the new patient-nurse ratios, number of emergencies concerning long-term critical patients and other variables.

Step 6. Integrate and Maintain Change in Practice

            This last step in the Rosswurm and Larrabee Model is best initiated after the results of the pilot and actual implementation have been analyzed. Positive results of the pilot and actual implementation guide change strategies. However, most hospitals and healthcare institutions have a top-down system making them highly vulnerable to poor implementation (Brown & Gallant, 2006). The change can be highly successful if implemented on a departmental level throughout all the units.

Evaluation Plan

The evaluation seeks to achieve the main objective of determining the success of the acuity –based approach using different indicators. The findings from the evaluation will be used to refined the approach and make it more effective for future use. The evaluation plan will contain a research on quality improvement (QI) with procedure and results indicators and examinations of patient contentment and staff reactions to the modifications in practice. Some pointers will be similar to those in previous QI statistics to provide for comparison data before and after the implementation process. The resources available to support the evaluation process are limited as they are mainly provided by the church. The expected outputs from the evaluation include a drop in the number of unattended critical patients and an efficient distribution of nurses according to need (acuity).

Next Steps to Maintain

The maintenance section of the program is relatively easy. It involves constant monitoring and review of all aspects of the acuity-based staffing method such as opinions form all stakeholders and statistics on the operations from different departments. The search strategy used in the study used text on nurse staffing and patient wellbeing exposed the fact that literature in the field was quickly evolving, very diverse in terms of approaches and measures, and oblique in terms of its outcomes concerning precise measures. The objective of the search was to elaborate on extensive trends in the literature, and for this purpose, the search was based on four methodical, integrated evaluations that contained comprehensive search criteria and coherently articulated inclusion criteria and offered meticulous analysis of results. Most of these reviews were obtained from AHRQ publications, the recent being identified in personalized searches of CINAHL and PubMed databases since 2009 and 2011 using the terms “outcomes” “patient safety,” and “nurse staffing”.


Researchers have commonly discovered that lower nurse recruitment levels are linked to increased risks of poor patient results. Levels of nursing staff particularly those concerned with nurse workload, also emerge related to professional health complications such as back injuries and psychological conditions such as burnouts that might stand for antecedents for nurse turnover from explicit jobs as well as the occupation. Other elements of hospital working conditions beyond recruitment, as well as personal nurse and patient traits, affect results since negative products are comparatively infrequent even at the limits of employment and do not happen in every situation where recruitment is little. A decisive collection of studies determined that nurse recruitment is one of several variables entitled attention in research and safety practice. There is little argument that nursing recruitment influences a significant section of patient outcomes under special situations. Prospective research will elucidate finer issues, such as the ideal approaches for calculating staffing and the specific devices through which the relationship between staffing and outcomes work practically.



Barton, N. (2013). Acuity-Based Staffing: Balance Cost, Satisfaction, Quality, and Outcomes. Nurse Leader, 11, 6, 47-64.

Brown, K. K., & Gallant, D. (2006). Impacting patient outcomes through design: acuity adaptable care/universal room design. Critical Care Nursing Quarterly, 29, 4.

Ellis, J., & Chapman, S. (2006). Applied leadership – Nurse staffing requirements. Nursing Management, 13, 4, 30.

Havig, Anders, Skogstad, Anders, Kjekshus, Lars, & Romøren, Tor. (2011). Leadership, staffing and quality of care in nursing homes. BioMed Central Ltd.

Roussel, L., & Swansburg, R. C. (2009). Management and leadership for nurse administrators. Sudbury, Mass: Jones and Bartlett Publishers.

Wan, T. T. H. (2010). Improving the quality of care in nursing homes: An evidence-based approach. Baltimore: Johns Hopkins University Press.

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