|
BACKGROUND/RATIONALE:
Nurse staffing has become a focal point in patient safety and outcome discussions. Appropriate staffing for safe and effective care becomes a challenge without evidence. The system used in VA medical centers, developed over a decade ago, no longer addresses the complexity of providing nursing care in today's health system. The task before us is to provide a systematic, evidence-based approach from existing knowledge with subsequent development of a model linking staffing with outcomes. Thus, the VA Office of Nursing Service requested a methodology for a nationally standardized nurse staffing plan with the foundation coming from a review of patient acuity systems used for nurse staffing.
OBJECTIVE(S):
The purpose of this study is to gather the evidence about nurse staffing systems and develop a model to be tested.
METHODS:
Phase I: The research team will use a series of three conference calls to identify and refine the key concepts and search strings to conduct a systematic review of the literature that will evaluate patient classification systems for general inpatient use. The librarian will work with the research associate (RA) to extract evidence from electronic databases, relevant websites, and other sources as suggested by continuing review by the research team, to include: CINAHL, Medline (PubMed), EBM Reviews - Cochrane Database of Systematic Reviews; websites such as AHRQ (Evidence-based Practice, AHRQ Nursing) and NICE, Google Scholar, and unpublished work, if available. The RA will use DeGroot's (1989) framework for evaluation of PCSs and also include relevant patient factors, nurse workload or intensity and organizational attributes. The RA will summarize data into evidence tables, using the above factors to identify best practices. The research team will use the Oxman & Guyatt (1991) criteria for assessing quality of a review to enhance reliability of output. The expert panel will ensure comprehensiveness, quality and validity of the analysis prior to discussing model development.
Phase II: Develop and test a model: We will convene our investigators, research associate, consultants, statistician and expert panel to identify staffing variables and develop a predictive model that can be linked with patient outcomes. This group will identify gaps between what our research-based model would suggest as appropriate variables to use for staffing and what is currently feasible in the VA system and the VA Nursing Outcomes Data (VANOD). The expert panel will identify barriers and facilitators for a change in the PCS. We will pilot test the model at a Magnet hospital focusing on feasibility (utility, efficiency and acceptability) using existing unit data from administrative and VANOD data bases. We will then examine the factors in the model to determine if there is sufficient variability in the individual measures to be useful in a prediction model.
FINDINGS/RESULTS:
No results at this time.
IMPACT:
The Phase I literature review has already been used by the NNEC Goal Group working on staffing methods for the VA. The variables identified in the literature review and meeting of the expert panel will be used in the next phase of testing them for variability and feasibility across the VA
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems
DRE:
Resource Use and Cost
Keywords:
Nursing, Organizational issues, Staffing
MeSH Terms:
none
|
