Optimal Nurse Staffing to Improve Quality of Care and

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ACKNOWLEDGEMENTS, Avalere wishes to acknowledge the following individuals for their participation in the. development of this paper,ANA Staff Reviewers,Mary Jo Assi DNP RN NEA BC FNP BC Lead Reviewer. Michelle Artz MA,Janet Haebler MSN RN,Peter McMenamin PhD. Cheryl Peterson MSN RN,ANA Volunteer Expert Reviewers. Kathy Baker RN PhD NE BC,Terri Haller MSN MBA RN NEA BC.
Matthew D McHugh PhD JD MPH RN CRNP FAAN,Julie Sochalski PhD RN FAAN. Exemplar Contributors,Rita Barry BSN RN CEN,Jim Fenush Jr MS RN. Bob Dent DNP MBA RN NEA BC CENP FACHE,Terri Haller MSN MBA RN NEA BC. Kathleen M Matson MHA MSN RN NE BC,2014 ANA Staffing Summit Participants. Michelle Artz MA,Mary Jo Assi DNP RN NEA BC FNP BC.
Kathy Baker RN PhD NE BC,Renata Bowlden BSN RNC OB C EFMN. Carol Ann Cavouras MSN RN,Pam Cipriano PhD RN NEA BC FAAN. Bob Dent DNP MBA RN NEA BC CENP FACHE,Terri Gaffney MPA RN. Terri Haller MSN MBA RN NEA BC,Debbie Hatmaker PhD RN FAAN. Wendy E Lugo DNP RN PCCN ACNP BC,Peter McMenamin PhD.
Jennifer Mensik PhD MBA RN NEA BC FAAN,Donna M Nickitas PhD RN NEA BC CNE FNAP FAAN. Pat Patton MSN RN,Cheryl Peterson MSN RN,Wm Dan Roberts PhD APN. Marla Weston PhD RN FAAN, This research was sponsored by the American Nurses Association. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 2. EXECUTIVE SUMMARY,Background and Rationale, Expanding access to healthcare improving the quality of care and reducing cost have. long been goals for reform of the U S healthcare system 1 The Affordable Care Act ACA. passed in 2010 has implemented new models of healthcare delivery and payment aimed to. improve quality and reduce cost Central to health reform is the emphasis on value based. healthcare New programs reward or penalize hospitals based on their ability to meet certain. quality outcomes and cost metrics As a result hospitals are exploring many approaches to. improve quality and patient outcomes and contain costs. As nurses comprise the largest clinical subgroup in hospitals a common reaction to cost. containment pressures is to reduce professional nurse labor hours and their associated. costs This strategy however is shortsighted as appropriate nurse staffing levels are essential. to optimizing quality of care and patient outcomes in this era of value based healthcare. In this the first in a series of papers that makes the case for nursing value American Nurses. Association ANA collaborated with Avalere to explore the clinical case for using optimal. nurse staffing models to achieve improvements in patient outcomes Avalere conducted. a targeted review of recent published literature government reports and other publicly. available evaluations of nurse staffing and patient outcomes Avalere also convened a panel. of leading nurse researchers thought leaders managers and those in practice from across. the country to provide additional context and to help identify best practices in nurse staffing. While this analysis focused on nurse staffing in acute care hospitals the principles can be. applied to other settings such as post acute care,Key Findings.
ptimal staffing is essential to providing professional nursing value Existing nurse. staffing systems are often antiquated and inflexible Greater benefit can be derived. from staffing models that consider the number of nurses and or the nurse to patient. ratios and can be adjusted to account for unit and shift level factors Factors that. influence nurse staffing needs include patient complexity acuity or stability number. of admissions discharges and transfers professional nursing and other staff skill. level and expertise physical space and layout of the nursing unit and availability of or. proximity to technological support or other resources. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 4. ublished studies show that appropriate nurse staffing helps achieve clinical and. economic improvements in patient care including, Improvements in patient satisfaction and health related quality of life. Reduction decrease in,Medical and medication errors. Patient mortality hospital readmissions and length of stay. Number of preventable events such as patient falls pressure ulcers. central line infections healthcare associated infections HAIs and other. complications related to hospitalizations, Patient care costs through avoidance of unplanned readmissions. Nurse fatigue thus promoting nursing safety nurse retention and job. satisfaction which all contribute to safer patient care. rganizations such as ANA support state and federal regulation and legislation. that allows for flexible nurse staffing plans In addition to promoting flexible staffing. plans ANA and like minded constituents support public reporting of staffing data to. promote transparency and penalizing institutions that fail to comply with minimal safe. staffing standards, urther ANA has introduced a legislative model in which nurses themselves are. empowered to create staffing plans Optimal staffing is much more than just. numbers and direct care nurses are well equipped to contribute to the development. of staffing plans, To conclude appropriate nurse staffing is associated with improved patient outcomes With.
the increased focus on value based care optimal nurse staffing will be essential to delivering. high quality cost effective care Implementation of a legislative model will help set basic. staffing standards and encourage transparency of action through public reporting and. imposing penalties on institutions that fail to comply with minimal standards. Note A glossary of nurse staffing terms is provided in Appendix A. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 5. Optimal Nurse Staffing to Improve Quality,of Care and Patient Outcomes. September 2015,Prepared for the,American Nurses Association. Prepared by,Avalere Health LLC, Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 1. ACKNOWLEDGEMENTS, Avalere wishes to acknowledge the following individuals for their participation in the. development of this paper,ANA Staff Reviewers,Mary Jo Assi DNP RN NEA BC FNP BC Lead Reviewer.
Michelle Artz MA,Janet Haebler MSN RN,Peter McMenamin PhD. Cheryl Peterson MSN RN,ANA Volunteer Expert Reviewers. Kathy Baker RN PhD NE BC,Terri Haller MSN MBA RN NEA BC. Matthew D McHugh PhD JD MPH RN CRNP FAAN,Julie Sochalski PhD RN FAAN. Exemplar Contributors,Rita Barry BSN RN CEN,Jim Fenush Jr MS RN.
Bob Dent DNP MBA RN NEA BC CENP FACHE,Terri Haller MSN MBA RN NEA BC. Kathleen M Matson MHA MSN RN NE BC,2014 ANA Staffing Summit Participants. Michelle Artz MA,Mary Jo Assi DNP RN NEA BC FNP BC. Kathy Baker RN PhD NE BC,Renata Bowlden BSN RNC OB C EFMN. Carol Ann Cavouras MSN RN,Pam Cipriano PhD RN NEA BC FAAN.
Bob Dent DNP MBA RN NEA BC CENP FACHE,Terri Gaffney MPA RN. Terri Haller MSN MBA RN NEA BC,Debbie Hatmaker PhD RN FAAN. Wendy E Lugo DNP RN PCCN ACNP BC,Peter McMenamin PhD. Jennifer Mensik PhD MBA RN NEA BC FAAN,Donna M Nickitas PhD RN NEA BC CNE FNAP FAAN. Pat Patton MSN RN,Cheryl Peterson MSN RN,Wm Dan Roberts PhD APN.
Marla Weston PhD RN FAAN, This research was sponsored by the American Nurses Association. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 2. TABLE OF CONTENTS,Executive Summary 4,I Imperative for Change 6. II Value of Appropriate Nurse Staffing 9,III Current Approaches to Nurse Staffing 17. IV Opportunities to Act in an Era of Health Reform 24. V Developing and Implementing an Evidence Based Staffing Framework 28. VI Conclusions 31,Appendices 32,Appendix A Glossary 32. Appendix B ANA Considerations in Building an 33,Evidence Based Staffing Framework.
Appendix C Best Practices from the Field 35,References 42. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 3. EXECUTIVE SUMMARY,Background and Rationale, Expanding access to healthcare improving the quality of care and reducing cost have. long been goals for reform of the U S healthcare system 1 The Affordable Care Act ACA. passed in 2010 has implemented new models of healthcare delivery and payment aimed to. improve quality and reduce cost Central to health reform is the emphasis on value based. healthcare New programs reward or penalize hospitals based on their ability to meet certain. quality outcomes and cost metrics As a result hospitals are exploring many approaches to. improve quality and patient outcomes and contain costs. As nurses comprise the largest clinical subgroup in hospitals a common reaction to cost. containment pressures is to reduce professional nurse labor hours and their associated. costs This strategy however is shortsighted as appropriate nurse staffing levels are essential. to optimizing quality of care and patient outcomes in this era of value based healthcare. In this the first in a series of papers that makes the case for nursing value American Nurses. Association ANA collaborated with Avalere to explore the clinical case for using optimal. nurse staffing models to achieve improvements in patient outcomes Avalere conducted. a targeted review of recent published literature government reports and other publicly. available evaluations of nurse staffing and patient outcomes Avalere also convened a panel. of leading nurse researchers thought leaders managers and those in practice from across. the country to provide additional context and to help identify best practices in nurse staffing. While this analysis focused on nurse staffing in acute care hospitals the principles can be. applied to other settings such as post acute care,Key Findings. ptimal staffing is essential to providing professional nursing value Existing nurse. staffing systems are often antiquated and inflexible Greater benefit can be derived. from staffing models that consider the number of nurses and or the nurse to patient. ratios and can be adjusted to account for unit and shift level factors Factors that. influence nurse staffing needs include patient complexity acuity or stability number. of admissions discharges and transfers professional nursing and other staff skill. level and expertise physical space and layout of the nursing unit and availability of or. proximity to technological support or other resources. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 4. ublished studies show that appropriate nurse staffing helps achieve clinical and. economic improvements in patient care including, Improvements in patient satisfaction and health related quality of life. Reduction decrease in,Medical and medication errors.
Patient mortality hospital readmissions and length of stay. Number of preventable events such as patient falls pressure ulcers. central line infections healthcare associated infections HAIs and other. complications related to hospitalizations, Patient care costs through avoidance of unplanned readmissions. Nurse fatigue thus promoting nursing safety nurse retention and job. satisfaction which all contribute to safer patient care. rganizations such as ANA support state and federal regulation and legislation. that allows for flexible nurse staffing plans In addition to promoting flexible staffing. plans ANA and like minded constituents support public reporting of staffing data to. promote transparency and penalizing institutions that fail to comply with minimal safe. staffing standards, urther ANA has introduced a legislative model in which nurses themselves are. empowered to create staffing plans Optimal staffing is much more than just. numbers and direct care nurses are well equipped to contribute to the development. of staffing plans, To conclude appropriate nurse staffing is associated with improved patient outcomes With. the increased focus on value based care optimal nurse staffing will be essential to delivering. high quality cost effective care Implementation of a legislative model will help set basic. staffing standards and encourage transparency of action through public reporting and. imposing penalties on institutions that fail to comply with minimal standards. Note A glossary of nurse staffing terms is provided in Appendix A. Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 5. I IMPERATIVE FOR CHANGE, The influx of new patients covered under the Affordable Care Act ACA and the. growing elderly population are bringing additional cost containment pressures. to the U S healthcare system These changes are also changing the nature and. complexity of nursing care Reducing professional nurse labor hours and their. associated costs may be viewed as a potential cost containment measure for. hospitals However this strategy has a negative impact on safety for both the. patient and the nurse and ultimately leads to an increase in the cost of care. Expanding access improving the quality of care and reducing the cost of care have long. been goals for reform of the U S healthcare system 1 Much time and effort has been. focused on physician and hospital care but evaluation of other components of professional. services such as nursing has been less emphasized, he 2010 passage of the ACA and other health reform measures have added.
layers of complexity to the U S healthcare system Adding more covered lives. Pat Patton MSN RN Cheryl Peterson MSN RN Wm Dan Roberts PhD APN Marla Weston PhD RN FAAN This research was sponsored by the American Nurses Association Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes 4 EXECUTIVE SUMMARY Background and Rationale Expanding access to healthcare improving the quality of care and reducing cost have long been goals for reform

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