Improving Patient, Nursing and Organizational Outcomes Utilizing Formal Nurse-Patient Ratios

Saskatchewan

Healthcare stakeholders in Saskatchewan recognize that a positive work environment is crucial to the retention and recruitment of nurses. If the conditions for the bedside nurse improve it will have a positive impact on the retention and recruitment of nurses. Outdated staffing systems are one source of inefficiency and discontent. Many such systems were established years ago under different circumstances. Studies have shown that patients experience fewer and less adverse events and shorter lengths of stay when the nursing resources are adjusted to meet their needs.

The Saskatchewan Union of Nurses, the Saskatoon Health Region and the Saskatchewan Ministry of Health have partnered to adapt a “Synergy Model” staffing plan for a unit at St Paul’s Hospital, a 200-bed acute care facility in Saskatoon.

  • Developed by Martha Curley, the Synergy model considers eight universal patient characteristics: stability, predictability, complexity, vulnerability, resiliency, participation in care, participation in decision making, and resource availability.
  • These indicators allow nurses to articulate patient characteristics and needs, to consider the impact on workload, and to determine the health care professional best suited to meet those needs.
  • The model classifies patient needs and resulting workload impacts, creating a real-time communication tool for handovers and shift-to-shift reports and can be integrated into care plans, practice notes, and patient rounds.
Project Objectives: 
  • Maximize patient outcomes, including safety and satisfaction.
  • Maximize nursing and organizational outcomes, including enhancing retention and recruitment.
  • Be able to assess the day to day adequacy of staffing within an individual unit.
  • Let nurses utilize their professional judgement to determine appropriate nurse-patient ratios for their unit.
  • Allow nurses to work to their full competence, maximizing their scope of practice.
  • Establish a mechanism and process to ensure ratios based on the patient characteristics are established, maintained or adjusted according to patient needs.
  • Add to the body of knowledge on the impact of nurse-patient ratios.
Project Description: 

Using patient characteristics as described in the Synergy Model to inform a staffing plan, the project is exploring the effect of formal nurse-patient ratios on patient, nursing and organizational outcomes within 6th Medicine, a unit of about 40 nurses.

  • The project helps identify the formal nurse-patient ratios that are needed within the unit to ensure optimal patient outcomes.
  • The Synergy based tool helps outline the questions staff and managers need to ask when assessing whether the ratios require an adjustment according to changes in patient needs or other factors.
  • The tool will allow the bedside nurse, in consultation with management, to adjust nurse-patient ratios to reflect changes in the number or acuity of patients.
  • All RNs on the unit have the opportunity to use the staffing tool and all will be able to participate in web-based surveys designed to evaluate it.
  • RNs are the decision makers on the staffing model, though efforts are being made to include the input of other healthcare workers.
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