What is a Hospital Staffing Model?
Research has shown that a nurse’s schedule can directly impact patient care and health. A nurse who is stressed because of low staff levels and overworked due to poor scheduling makes more errors and can become burnt out (Heiser, 2016). With so much at stake, it can be difficult for hospitals and nurse managers to create a suitable schedule based on the needs of the patients. To help alleviate the stress of staffing for nurse managers, several different hospital staffing models have been created to streamline the process and provide the best care for a hospital’s patients. There is no “one size fits all” hospital staffing model, so it is important to know the pros and cons of each one in order to decide which is the best fit for the hospital, staff, and patients.
Difference between Scheduling and Staffing
“Staffing” and “Scheduling” may seem like words that can be used interchangeably in this conversation but they are actually two very different things. It is important to understand the definitions of these two words before diving into each nurse staffing model. The American Nurses Association defines staffings as “a match of registered nurse expertise with the needs of the recipient of nursing care services in the context of the practice setting and situation”. They go on to explain that staffing is “achieved by dynamic, multifaceted decision-making processes that must take into account a wide range of variables” (Hanoski, 2016).
Staffing often focuses on the day-of operations to assess and determine the shift-to-shift ratio of nurses to patients. Staffing processes typically don’t look further than 24 hours in advance of the shift (Mensik, 2014). The complexities that accompany nurse staffing are why there are several hospital staffing models to help hospitals create the best patient care possible.
Scheduling is the process of “determining a set number of staff and type of staff for a future time period based on factors like historical census numbers and anticipated surgical volumes” (Hanoski, 2016). Every organization or hospital determines the time frame for which they schedule, often they range from a 1 month to a 3-month schedule (Mensik, 2014).
Nurse-Patient Ratio Model
The Nurse to Patient Ratio model is the most common and often now seen as the most antiquated way of staffing for hospitals. The idea of the nurse-patient ratios is to look at patient and staff numbers and decide what ratio will work best for the needs of patients and the professionals that care for them. There is no exact golden or mandated nurse to patient ratio that fits all hospitals, the nurse-patient ratio all depends on the staff’s skills, patient needs, and the numbers of patients and staff. In addition, the nurse-patient ratios by state differ widely as some states have a higher need for medical attention than others.
There is no exact golden or mandated nurse to patient ratio that fits all hospitals, the nurse-patient ratio all depends on the staff’s skills, patient needs, and the numbers of patients and staff. In addition, the nurse-patient ratios by state differ widely as some states have a higher need for medical attention than others.
There is a Federal regulation that requires hospitals certified in Medicare to “have adequate numbers of licensed registered nurses, licensed practical nurses, and other personnel to provide nursing care to all patients as needed” (American Nurses Association, 2015). The language of this legislation is vague and so often hospitals and nurse managers are left to their own devices to discover the most suitable nurse-patient ratio (as there is no mandatory nurse to patient ratio).
Some hospital staffing models strictly use numbers, one nurse for every one patient, but this is quickly becoming an outdated practice because of its impracticality. Nurses need breaks or some patients require more work than others and may need 2 or 3 nurses at a time.
The major cons of this model are that a hospital can be understaffed because the law doesn’t define a minimum number of nurses to patients. This leads to nurses being overworked and patients not receiving the level of care that they need (American Nurses Association, 2015).
There is wide discrepancy about nurse staffing ratios and patient outcomes. This model can be the quickest way to make a schedule but it is inflexible and greater benefits can be derived from other staffing models that use the nurse-patient ratio as a factor. alongside other factors like patient complexity, number of admissions/discharges, staff skill levels, and physical space in the nursing unit.
There are other factors like patient complexity, number of admissions/discharges, staff skill levels, and physical space in the nursing unit (Sherwood, 2013). The nurse-patient ratio is very important, but the general consensus has come to be that it is best used within another hospital staffing model and not as a way of staffing on its own.
What is Acuity and the Patient Acuity Model
What is acuity and what does acuity mean? The definition of acuity is the measurement of the intensity of nursing care required by a patient (The Sentinel Watch, 2014). This acuity definition – medical based – is often used interchangeably is “patient acuity”, which is another term for “patient care needs”. An acuity-based safe staffing model regulates the number of nurses on shift according to patient’s’ needs and not patient numbers. Patient numbers alone don’t adequately tell the numbers of nurses needed. Some patients may be on their discharge day and require little care, while others may be in a serious condition and need a nurse around the clock. The nursing workload is comprised of the number of assigned patients per shift along with the required patient care. Creating a balance between patient acuity and the staffing plan is a difficult task for nurse managers.
The acuity-based staffing system helps nurse managers find staffing patterns for every shift based on patient data. This system becomes even easier to use with the specialized software. Nurses enter patient data into a computer and the nurse manager can run a report on it. With this report, the nurse manager can take the data and decide a number of nurses that need to be scheduled or if a “float nurse” is needed. This data also allows shifting the numbers of nurses from area to area or patient to patient. That way patients with the greatest needs are in the care of nurses with the higher skill sets (The Sentinel Watch, 2014).
Staffing plans within this hospital staffing model serve as a baseline from which managers can make adjustments to by the ever changing needs of the patients to the abilities of the staff (Henry, 2015). However, the impact of patient turnover and acuity on the nursing workload is not well studied or understood. While this hospital staffing model looks good on paper, one of the cons is that it is sometimes difficult to execute. The hopes for this plan is that enough research can be done to create a predictive staffing plan that can be adjusted for patient acuity and turnover.
Another con of this hospital staffing model is that it can undermine the full scope of nursing practice (Mensik, 2014). This particular type of hospital staffing models breaks down patient care needs and the amount of time it takes to do different tasks like administering medication or taking vitals. When patient care is broken down like this it runs the risk of not involving the full scope of nursing duties and the time needed to maintain high standards of care (Mensik, 2014).
Collaborative Staffing Model
The Collaborative Staffing model gives nurses the opportunity to work with their managers in order to create a schedule and fill shifts. This type of hospital staffing models helps free up time for nurse managers so they can do less scheduling and more on floor work. It also encourages and empowers staff to become more engaged in the scheduling process. Nurses feel that they have more control or input with their schedule and in turn, this creates better patient care and less nurse burnout. (Heiser, 2016)
An article for Harvard Business Review said that research found only 44% of hospital staff in the U.S. are engaged in their jobs (Sherwood, 2013). When a large majority of hospital staff feels this disconnected to their jobs, that hurts patients and the hospital. When nurses are engaged they are committed to their coworkers, workplace, and delivering the best patient care.
Supplemental nurses is a staffing model that is a cost-efficient way of staffing nurses during temporary periods high patient admission numbers or shortages of permanent nurses (American Staffing Association, 2015). Research shows that temporary or contract nurses are just as qualified as permanent nurses and this hospital staffing model offers a strategic flexibility that hospitals need when workflow increases or through staffing shortages.
Published in an issue of the Journal of Nursing Care Quality, the study “Cost Outcomes of Supplemental Nurse Staffing in a Large Medical Center: A Method for Quantifying Supplemental Nurse Cost Efficiency,” analyzed hospital personnel costs and patient stays (American Staffing Association, 2015). The study found that while the hourly cost for supplemental nurses may be more than permanent ones if it is used modestly in times of need the hospital staffing model is cost-effective.
The study also suggested that supplemental nurse use was more cost effective than a permanent nurse working overtime. The use of supplemental nursing then could be used not only in times of staffing shortages but also to help prevent burnout with permanent nurses. It has been well known that permanent nurses that consistently have to work overtime can lead to poor nurse and patient satisfaction (American Staffing Association, 2015).
However, a con of supplemental nursing is being able to find nurses willing and able to take on those temporary positions. When those nurses are found, this staffing hospital staffing model works very well for hospitals needing to fill gaps in their staffing schedule.
Hospitals and nurse managers face major challenges when putting together a staff schedule that makes both nurses and patients happy. With a number of factors that have to be taken in for each schedule, it is difficult to find a hospital staffing model that is “one size fits all”. Every hospital has to find a hospital staffing model that works best for their budget, their staff, and most importantly, their patients.
Research has shown that time and time again, nurse staffing has a significant impact on patient outcome. Adequate numbers of RN staffing levels “has been shown to reduce patient mortality, enhance outcomes, and improve nurse satisfaction” (Mensik, 2014). It is important that everyone within the medical profession, including nurses, is aware of these staffing challenges and the outcomes of patient care because of it.
- American Nurses Association. (2015, Dec). Nurse staffing. Retrieved from
- Avalere Health LLC. (2015, Sep). Optimal nurse staffing to improve quality of care and patient outcomes: Executive summary. American Nurses Association. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios/Optimal-Nurse-Staffing-ES-Sep15.pdf
- Hanoski, M. (2016, Feb 18). 3 Key things every nurse should know about staffing. Premier Medical Staffing Services. Retrieved from http://premier.bz/blog/what-to-know-about-staffing/
- Heiser, T. (2016, Dec 7). The key to nurse engagement? A collaborative staffing model. HealthcareSource Blog. Retrieved from http://education.healthcaresource.com/nurse-engagement-collaborative-staffing-model/
- Mensik, J. (2014, Feb). What every nurse should know about staffing. American Nurse Today. Retrieved from https://www.americannursetoday.com/what-every-nurse-should-know-about-staffing/
- Sherwood, R. (2013, Oct 30). Employee engagement drives health care quality and financial returns. Harvard Business Review. Retrieved from https://hbr.org/2013/10/employee-engagement-drives-health-care-quality-and-financial-returns
- Snyder, M. R. (2015, Mar 11). Use of supplemental nurses is cost-effective strategy to address hospital short-term staffing needs. American Staffing Association. Retrieved from https://americanstaffing.net/posts/2015/03/11/supplemental-nursing-cost-effectiveness-study/
- The Sentinel Watch. (2014, Feb 5). How to use the acuity based staffing model in nursing. Retrieved from http://www.americansentinel.edu/blog/2014/02/05/using-patient-acuity-to-determine-nurse-staffing/
- Tierney, S. J. (2010, May 27). Nursing unit staffing: An innovative model incorporating patient acuity and patient turnover: A dissertation. Retrieved from University of Massachusetts Medical School eScholarship@UMMS. Retrieved from