Hello pill-ga
I tought that the best thing to do to find out the answer to your
question was ask directly to the Oncology Nursing Society
(www.ons.org). They have been so kind to promptly answer me. I am
posting their answer. For any clarification you can contact Laurl
Matey, RN, MSN directly at clinical@ons.org.
I am of course available for any further help
silviares
"
Greetings,
Thank you for your inquiry.
You are correct in that finding data that is as specific as you are
looking for will be difficult. ONS does not have a specific
"recommended staffing ratio". However:
In 1989, ONS conducted and published a staffing survey. It was divided
into separate settings:
The 1989 National Survey of Salary, Staffing & Professional Practice
Patterns in Oncology Nursing: Radiation Therapy-Based Oncology
Nursing, Office Based Oncology Nursing, Oncology Related Infusion
Units, Ambulatory Oncology Clinics, Oncology Related Home care &
Hospice Agencies.
It was accompanied by the following Oncology Nursing Forum piece:
Oncology Nursing Forum 1991 Sep-Oct;18(7):1241-3
Staffing standards: why not? A report from the ONS Administration
Committee.
Lamkin LR, Sleven M.
Queen's Medical Center Cancer Institute, Honolulu, HI.
This report from the Administration Committee of the Oncology Nursing
Society (ONS) follows the publication of the Committee's monograph,
The 1989 National Survey of Salary, Staffing, and Professional
Practice Patterns in Oncology Nursing. Based on the experience of
other professional organizations, the committee explains why it
recommends that staffing standards not be developed at this time. An
example of how to use the survey data to develop ideal staffing is
included. Issues to consider in developing a staffing plan are also
listed.
Another staffing survey is now published in the Vol 28/Number 10
Nov/Dec, 2001 issue of the Oncology Nursing Forum. The article is:
"Oncology Nursing Society Workforce Survey Part 1: Perceptions of the
Nursing Workforce Environment and Adequacy of Nurse Staffing in
Outpatient and Inpatient Oncology Settings",by Luana Lamkin, RN, MPH,
Jean Rosiak, RN, BSN, OCNŽ, Peter Buerhaus, RN, PhD, FAAN, Gail
Mallory, RN, PhD, CNAA, and Mamie Williams, BA, MPH.
If you are an ONS member, you can access the online version of ONF at
this link:
http://www.ons.org/xp6/ONS/Library.xml/ONS_Publications.xml/ONF.xml/ONF2001.xml/November_December_2001.xml
The most recent (Jan/Feb 2002) Oncology Nursing Forum, as "Oncology
Nursing Society Workforce Survey Part II: Perceptions of the Nursing
Workforce Environment and Adequacy of Nurse Staffing in Outpatient and
Inpatient Oncology Settings" includes a section on HPPD (see below):
"Budgeted versus actual staffing: Many nurse executives and managers
budget the number of nurses needed by calculating the total direct
productive "hours of care per patient day" (HPPD) for the number of
patients expected to require nursing care over a given time period.
Calculating the HPPD takes into account the number of minutes and
hours nursing staff directly interact with patients (i.e., the time it
takes to administer treatments and medications, monitor patients, and
provide teaching). It also reflects the time staff takes to document
care, order supplies, prepare medication, and direct other caregivers.
HPPD equals the sum of all direct care time provided by all staff
members (RNs and ancillary staff) who care for one patient in a
24-hour period.
Actual HPPD may differ from the budgeted HPPD for several reasons. For
example, if staffing vacancies exist because they cannot be filled as
a result of staff illness or a shortage of staff to hire, then the
actual HPPD would be lower than budgeted. On the other hand, actual
HPPD would be higher than budgeted if patient acuity was so high that
extra nurses were called in to provide care or if an RN was not
available and had to be replaced by two nursing assistants.
Nurse executives were asked to report both budgeted and actual HPPD
for the settings they supervised. Executives reported a mean of 7.63
HPPD of direct productive care as budgeted on inpatient units, whereas
the actual HPPD was slightly higher at 7.77. Because outpatient areas
typically operate on a less than 24-hour per day basis and patients
usually are present in these settings far less than 24 hours, nurse
executives reported lower budgeted and actual HPPD staffing in
outpatient settings, with a mean budgeted amount of 3.61 HPPD and 3.52
actual staffing. The similarity between budgeted and actual HPPD in
both settings is an unexpected finding. The differences are considered
negligible because of measurement errors."
Please keep in mind, though, that as with the 1989 survey, the results
are not to be followed as standards/guidelines; rather, the data
represents averages, etc.
The full text of the most recent ONF article can be found at:
http://www.ons.org/xp6/ONS/Library.xml/ONS_Publications.xml/ONF.xml/ONF2002.xml/Jan_Feb_2002.xml/Lamkin_abstract.xml
You will be able to access this directly if you are an ONS member.
Please see below my signature for a list of publications dealing with
staffing standards or staffing and patient outcomes "in general", i.e.
not
specific to ONS or the oncology setting.
I hope that this is useful information to you. If not, please feel
free to email me directly.
To complete our records, I would appreciate knowing if you are indeed
an ONS member, and would greatly appreciate a quick email back to me
with that information; or, if you are not, to allow us to send you
some information about ONS. In that case, if you would provide an
address to which we may send you an informational guide to ONS, I
would also be appreciative
Best regards,
Laurl Matey, RN, MSN
clinical@ons.org
Visit www.ons.org
The following ANA publications are relevant to your inquiry:
Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting
This ANA study qualifies relationships between nurse staffing and
patient outcomes for a large scale cross section of the nation's
hospitals and their inpatients. Today's pressures for hospital cost
control make it imperative to determine whether differences across
acute care hospitals in nurse staffing can be statistically shown to
relate to measurable differences in important patient outcomes.
Pub# NSP-20.
List $24.95/ SNA Member $19.95
Implementing Nursing's Report Card: A Study of RN Staffing, Length of
Stay and Patient Outcomes
This pilot study-an extension of ANA's Nursing Quality Indicators:
Definitions and Implications-explores the relationships between
specific patient outcome indicators and nurse staffing, and assesses
the feasibility of capturing the information necessary to develop
specific nurse staffing and outcome measures. Among the conclusions:
shorter lengths of stay were found to be strongly related to higher
nurse staffing per acuity-adjusted day. Such findings are critical as
nursing is at a crossroads between the increase in demand for health
care services and the push to economize the provision of care.
Quantifying the practice of nursing and its impact on patient care
outcomes and cost may be a prerequisite for the health of the nursing
profession.
1997/32 pp. Pub# Q-1.
List $15.95/ SNA Member $12.75
The following articles:
Journal of Nursing Scholarship 2001;33(2):179-84
A response to California's mandated nursing ratios.
Bolton LB, Jones D, Aydin CE, Donaldson N, Brown DS, Lowe M, McFarland
PL, Harms D.
Cedars-Sinai Health System/Burns & Allen Research Institute, Los
Angeles, CA, USA. Bolton@cshs.org
PURPOSE: To explore the need for evidence-based health policy, as
illustrated by the mandatory staffing bill passed by the California
state legislature in 1999. DESIGN: Prospective data were collected
from a voluntary sample of California acute care hospital
representatives to describe selected patient safety and clinical
outcomes and nurse staffing variables at the patient-care unit level.
METHODS: Data for descriptive analysis were collected on hospital
nurse staffing, patient falls, and pressure ulcers from 257 medical,
surgical, medical-surgical combined, step-down, 24-hour observation
units, and critical care patient care units in 38 California acute
care hospitals from June 1998 to June 1999. FINDINGS: Nursing staffing
ratios varied among the 257 units. RNs provided 91% of the nursing
care in critical care units. Patients in medical-surgical units
received 59% of their care from RNs, 11% from licensed vocational
nurses, and 30% from other caregivers. Preliminary data showed no
relationships between reported staffing ratios in these hospitals and
the incidence of patient falls or hospital-acquired pressure ulcers.
CONCLUSIONS: California Nursing Outcomes Coalition (CalNOC) data
showed wide variations in staffing ratios, patient falls, and
hospital-acquired pressure ulcers among nursing units and hospitals.
These early findings indicate the need for additional research before
determining minimal RN staffing requirements. Analysis of multiple
sources of data may be necessary to determine safe staffing ratios and
to provide evidence-based data for public policy.
PMID: 11419315
Nursing Outlook 1998 Sep-Oct;46(5):199-200
Nurse staffing and patient outcomes.
McCloskey JM
University of Iowa College of Nursing, Iowa City, USA.
OBJECTIVE: This study described the relationship between 6 adverse
patient outcomes (medication errors, patient falls, urinary and
respiratory tract infections, skin breakdown, patient complaints, and
mortality), total hours of nursing care, and the proportion of those
hours of care delivered by registered nurses (RNs). METHODS: With use
of hospital records, data from every unit of a large university
hospital for fiscal year 1993 were analyzed. Correlations among
staffing variables and outcome measures were determined, and
multivariate analyses were completed, controlling for patient acuity.
RESULTS: Units with patients who had higher acuity had lower rates of
medication errors and falls and higher rates of the other adverse
outcomes. When patient acuity was controlled, an inverse relationship
between RN hours of care and rates of medication errors, decubiti, and
patient complaints was found. A direct relationship existed between
total hours of care from all nursing personnel and rates of decubiti,
complaints, and mortality. Interestingly, as the RN proportion of care
rose to an 87.5% level, it related to a lower incidence of negative
outcomes; however, when the RN proportion of care went beyond that
level, the adverse outcome rates also increased.
PMID: 9805336
Nursing Research 1998 Jan-Feb;47(1):43-50
Nurse staffing and patient outcomes.
Blegen MA, Goode CJ, Reed L
College of Nursing, University of Iowa, Iowa City, USA.
BACKGROUND: Nursing studies have shown that nursing care delivery
changes affect staff and organizational outcomes, but the effects on
client outcomes have not been studied sufficiently. OBJECTIVE: To
describe, at the level of the nursing care unit, the relationships
among total hours of nursing care, registered nurse (RN) skill mix,
and adverse patient outcomes. METHODS: The adverse outcomes included
unit rates of medication errors, patient falls, skin breakdown,
patient and family complaints, infections, and deaths. The
correlations among staffing variables and outcome variables were
determined, and multivariate analyses, controlling for patient acuity,
were completed. RESULTS: Units with higher average patient acuity had
lower rates of medication errors and patient falls but higher rates of
the other adverse outcomes. With average patient acuity on the unit
controlled, the proportion of hours of care delivered by RNs was
inversely related to the unit rates of medication errors, decubiti,
and patient complaints. Total hours of care from all nursing personnel
were associated directly with the rates of decubiti, complaints, and
mortality. An unexpected finding was that the relationship between RN
proportion of care was curvilinear; as the RN proportion increased,
rates of adverse outcomes decreased up to 87.5%. Above that level, as
RN proportion increased, the adverse outcome rates also increased.
CONCLUSIONS: The higher the RN skill mix, the lower the incidence of
adverse occurrences on inpatient care units.
PMID: 9478183
Nursing Economics 1998 Jul-Aug;16(4):196-203
A multisite study of nurse staffing and patient occurrences.
Blegen MA, Vaughn T
College of Nursing, University of Iowa, Iowa City, USA.
Restructuring of nursing care models has led to more
"non-professional" caregivers, sometimes called unlicensed assistive
personnel (UAPs) who provide more of the basic delegable direct
patient care activities in collaboration with RNs. The purpose of this
study, wherein data were collected from 39 units in 11 hospitals, was
to determine the relationship between different levels of nurse
staffing and patient outcomes (adverse occurrences). Using and
tracking the same indicators of patient quality outcomes over a
significant time period in different institutions with similar patient
groups would greatly enhance the usefulness of such data. Among the
more surprising findings in this study was the "non-linear"
relationship between the proportion of RNs in the staff mix and MAEs.
As the proportion of RNs on a unit increased from 50% to 85% "the rate
of MAEs declined, but as the RN proportion increased from 85% to 100%
the rate of MAEs increased." Further investigations are needed to
explain this finding.
PMID: 9748985
Journal of Nursing Administration 1999 Feb;29(2):25-33
Some impacts of nursing on acute care hospital outcomes.
Lichtig LK, Knauf RA, Milholland DK
NETWORK, Inc., Latham, NY, USA. lichtl@rpi.edu
Measuring nursing-sensitive patient outcomes using publicly available
data provides exciting opportunities for the nursing profession to
quantify the patient care impact of staffing changes at individual
hospitals and to make comparisons among hospitals with differing
staffing patterns. Using data from California and New York, this study
tested the feasibility of measuring such outcomes in acute care
hospitals and examining relationships between these outcomes and nurse
staffing. Nursing intensity weights were used to acuity-adjust the
patient data. Both higher nurse staffing and higher proportion of RNs
were significantly related to shorter lengths of stay. Lower adverse
outcome rates were more consistently related to a higher proportion of
RNs.
PMID: 10029799
Canadian Journal of Nursing Research 1999 Dec;31(3):69-88
Nurse staffing and patient outcomes: evolution of an international
study.
Sochalski J, Estabrooks CA, Humphrey CK
Center for Health Outcomes and Policy Research, University of
Pennsylvania, Philadelphia, USA. julieas@pobox,upenn.edu
Industry-wide health sector reforms in the United States, Canada, and
Europe have provided a unique opportunity to examine the effects of
hospital restructuring on inpatient nursing care and patient outcomes
across an array of settings. Seven interdisciplinary research teams--1
each in Alberta, British Columbia, England, Germany, Ontario,
Scotland, and the United States--have formed an international
consortium whose aim is to study the effects of such restructuring.
Each site has enrolled large numbers of hospitals and nurses to
explicate the role that organization of nursing care, a target of
hospital restructuring, plays in differential patient outcomes. The
study seeks to understand more fully the influence of both nurse
staffing and the nursing practice environment on patient outcomes.
Discussion of the theoretical foundation, study design, and process of
developing the study instruments and measures illustrates the process
to date, as well as the feasibility of and opportunities inherent in
such an international endeavour.
PMID: 10696170
Citation <1>
Accession Number
2001062865.
Authors
Anonymous.
Title
Ask AACN. Where can I find information on a national standard for
nurse-patient ratios in ICU and step-down and telemetry units?
Source
RN, 64(6 Acute Care Decisions):24ac3, 2001 Jun.
Citation <2>
Accession Number
2001053803.
Authors
Anonymous.
Title
Proposed nurse-to-patient staffing ratios from CNA.
Source
Hospital Home Health, 18(5):58, 50, 60, 2001 May.
Citation <3>
Accession Number
2001024231.
Special Fields Contained
Fields available in this record: cited references.
Authors
Anonymous.
Title
AMSN position statement: staffing standards for patient care.
Source
Amsn News, 9(5):2, 2000 Sep-Oct. (3 ref)
Citation <4>
Accession Number
2001024010.
Special Fields Contained
Fields available in this record: cited references.
Authors
Gallagher RM. Kany KA. Rowell PA. Peterson C.
Title
Workplace advocacy. ANA's nurse staffing principles.
Source
Kentucky Nurse, 48(4):16-8, 2000 Oct-Dec. (11 ref)
Citation <5>
Accession Number
2001002997.
Special Fields Contained
Fields available in this record: abstract, cited references.
Authors
Kovner CT.
Institution
Professor, Division of Nursing, School of Nursing, New York
University.
Title
Policy perspectives. State regulation of RN-to-patient ratios.
Source
American Journal of Nursing, 100(11):61, 63, 65, 2000 Nov. (15
ref)
Citation <6>
Accession Number
2000029328.
Special Fields Contained
Fields available in this record: Cinahl full text.
Authors
Bunch C.
Title
New hospital regulations require acuity-based nurse staffing levels.
Source
Nevada Rnformation, 9(1):1, 3, 2000 Feb.
Citation <7>
Accession Number
2000010579 NLM Unique Identifier: 20003692.
Special Fields Contained
Fields available in this record: abstract.
Authors
Mayo AM. Van Slyck A.
Institution
Consultant, Nursing Consultant Services, San Diego, California,
e-mail: annmrn@aol.com.
Title
Developing staffing standards: statistical considerations for
patient care administrators.
Source
Journal of Nursing Administration, 29(10):43-8, 1999 Oct. (4 ref)
Abstract
To demonstrate accountability and responsibility for patient care
operations, patient care leaders are re-evaluating staffing standards.
Typically, activity studies are conducted and statistical methods
correlate patient acuity levels to hours per patient day (HPPD). The
authors discuss statistical considerations that allow patient care
leaders to evaluate the appropriateness of HPPD generated by activity
study data. (4 ref)
Citation <8>
Accession Number
1999031514 NLM Unique Identifier: 99250584.
Special Fields Contained
Fields available in this record: cited references.
Authors
Gallagher RM. Kany KA. Rowell PA. Peterson C.
Title
Issues update. ANA's nurse staffing principles.
Source
American Journal of Nursing, 99(4):50, 52-3, 1999 Apr. (11 ref)
Citation <9>
Accession Number
1999001740.
Special Fields Contained
Fields available in this record: cited references.
Authors
Mamaril M.
Title
ASPAN's position statement on minimum staffing.
Source
Breathline, 18(4):4, 1998 Jul-Aug. (2 ref)
Citation <10>
Accession Number
1998042708 NLM Unique Identifier: 98362822.
Authors
Curtin LL.
Title
One nurse, two nurse... red nurse, blue nurse.
Source
Nursing Management, 29(4):5-6, 1998 Apr.
"
silviares |
