1. Exploring the Application of Police Proactive Patrolling Staffing Methodologies to Nurse Rounding and Surveillance Presented by Beth Ann Taylor 1

2. Importance of Nurse Rounding Reduction in patient falls (Meade, Bursell, & Ketelsen, 2006; Weisgram & Raymond, 2008) Decreased call light use (Meade, 2007) Enhanced nurse satisfaction (Generals & Tipton, 2008) Increased patient satisfaction (Bourgalt, et al, 2008) Increased satisfaction with nurse quality of care (Castledine, Granger, & Close, 2005; Culley, 2008; Gardner, Woollett, Daly, & Richardson, 2009) Improve the knowledge and professionalism of nursing staff (Geary, Cole, Quinn, & Whitehall, 2009) 2

3. Importance of Police Prospective Patrolling Proven effective in deterring crime (Nunn, Quinet, Rowe, & Christ, 2006) Reducing injuries associated with motor vehicle accidents (Mock, Kobusingye, Ahn, Afukaar, & Arreola-Risa, 2005) Decreases the number of motor vehicle accidents, crash fatalities, and fatalities related to speed (Davis, Bennick, Pepper, Parks, Lemaster, & Townsend, 2006) 3

4. Staffing Parallels Both must staff for 24/7 operations. Have both proactive and reactive components to work. Have historically used ratios. Measure workload through frequency and duration of activity. Use a replacement factor for vacation, sick leave, and mandatory training when building staffing budgets. Objective: Protect the health and safety of the population for which responsibility is assigned. 4

5. Comparison of Police and Nurse Staffing Methodologies Police Allocation ModelVA Staffing Methodology Historical Workload Leave and Admin Factor Factor for Proactive Work (Unobligated or Free Patrol Time) Historical Workload Leave and Admin Factor Suggests activities to consider but does not provide a specific measure, definition, or calculation method for any proactive work. 5

6. Methodology - Participants Delphi technique: Police and VA Nurse staffing experts were identified. Stratified Random Sampling method used to select 15 VA Nurse Executive participants. Purposive Sampling used to identify the top 2 Police Allocation Model staffing experts. 6

7. Methodology - Procedure All participants interviewed individually by phone using an interview protocol. Each interview was scheduled for 30 minutes. Each interview was digitally audio taped and professionally transcribed. Handwritten notes were also taken by the researcher during each interview. 7

8. Methodology - Data Analysis All of the interview transcripts were reviewed and key terms (rounding, patrolling) were coded for frequency and associated activity. New concepts were identified and defined. Themes were identified and summarized. Tables were developed displaying data summaries and definition of concepts. 8

9. Results – Police and Nurse Executive Staffing Similarities Both report using historical workload data as a foundation for building a staffing budget. Both report adding a leave factor for time off such as vacation and sick leave. Both report adding time for required training, staff meetings, or other organizational business (systems redesign projects, court appearances). Both use comparison staffing data. Both identified funding as a barrier. 9

10. Results – Nurse Executive Key Findings 14 of 15 (93%) of the nurse executive participants reported using some type of nurse rounding in their facility. Only 2 nurse executives reported considering time for rounding when implementing the VA Staffing Methodology. No measure for determining capacity for rounding was reported. 33% (5) of the nurse executives reported inconsistent performance of rounds and issues with staff “buy in”. 10

11. Results – Nurse Executive Key Findings con’t Only 2 nurse executives reported considering time for rounding when implementing the VA Staffing Methodology. No measure for determining capacity for rounding was reported. 33% (5) of the nurse executives reported inconsistent performance of rounds and issues with staff “buy in”. No reported time allotment for other cognitive or proactive work. 11

12. Results – Police Key Concepts for Staffing Unobligated time: the time police officers have between (and in addition to) mandatory or obligatory elements of work. Prospective patrolling and Free Patrol: described as the group of focused activities performed during unobligated time. Availability: police officer’s ability to respond to calls for service. Measured by: Response time: Time interval between a call for service and police arrival on the scene. Cross Beat Dispatching: Frequency of officers called out of their assigned area to help in another geography. Probability of Saturation: Point at which next call for service goes into a queue because all available officers are busy. 12

13. Police Allocation Model Proactive Reactive Admin VisibilityAvailabilityHistorical Workload Factor Administrative Factor Time factors considered in staffing budget. Calculations are specifically defined. Police Total Workload Leave

14. VA Staffing Methodology Proactive Reactive Admin Historical Workload Factor Administrative Factor Time factors considered in staffing budget. Suggested activities for consideration. No definitions or recommended calculations. Nursing Total Workload Leave

15. Without the support of time allocated in a staffing model, proactive work is not sustainable. Historical Workload Factor Administrative Factor Sustainability of Proactive Work

16. Conclusions Nurse rounding and surveillance contributes to improved patient outcomes. Using ratios alone to build nurse staffing budgets is a crude and inadequate method to determine staffing adequacy. Using standardized methods for budget development and testing efficacy is important to determine adequacy of nurse staffing. Quantifying nursing’s capacity for cognitive work is an important consideration in developing nurse staffing budgets. 16

17. References Bourgault, A., King, M., Hart, P., Campbell, M., Swartz, S., & Lou, M. (2008). Circle of excellence: Does regular rounding by nursing associates boost patient satisfaction? Nursing Management. Nov. 18-24. Bulechek, G., Butcher, H., & Dochterman, J. (2008) Nursing Interventions Classification (NIC). (5 th Edition). St. Louis: Mosby Elsevier. Castledine, G., Grainger, M., & Close, A. (2005). Clinical nursing rounds part 3: patient comfort rounds. British Journal of Nursing, 14(17): 928-930. Culley, T. (2008). Reduce call light frequency with hourly rounds. Nursing Management. Mar. 50-52. Davis, J., Bennink, L., Pepper, D., Parks, S., Lemaster, D., & Townsend, R. (2006). Aggressive traffic enforcement: a simple and effective injury prevention program. The Journal of Trauma. 60(5), 972-977. 17

18. References con’t Department of Veterans Affairs, Veterans Health Administration (2010). Staffing methodology for VHA nursing personnel. VHA Directive 2010-034 Douglas, K. (2010). Ratios – if it were only that easy. Nursing Economic$, 28(2), 119-125. Flynn, M., & McKeown, M. (2009). Nurse staffing levels revisited: a consideration of key issues in nurse staffing levels and skill mix research. Journal of Nursing Management, 17(6), 759-766. Gardner, G., Woollett, K., Daly, N., & Richardson, B. (2009). Measuring the effect of patient comfort rounds on practice environment and patient satisfaction: A pilot study. International Journal of Nursing Practice, 15(4), 287-293. Geary, S., Cole, D., Quinn, B., Winehall, J. (2009). Daily rapid rounds: Decreasing length of stay and improving professionalism. Journal of Nursing Administration, 39(6), 293-298. 18

19. References con’t Generals, J. & Tipton, P. (2008). Recruitment & retention report. Rounding to increase retention. Nursing Management, 39(5), 10-12. Kane, R., Shamliyan, T., Mueller, C., Duval, S., & Wilt, T. (2007). The association of registered nurse staffing levels and patient outcomes. Systematic review and meta- analysis. Medical Care, 45(12), 1195-1204. Meade, C. (2007). Round bounty. MHS. Spring, 23-27. Meade, C., Bursell, A., & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use, satisfaction, and safety. American Journal of Nursing. 106(9), 58- 69. 19

20. References con’t Mock, C., Kobusingye, O., Ahn, L., Afukaar, F., & Arreola- Risa, C. (2005). Human Resources for the control of road traffic injury. Bulliten of the World Health Organization. April 2005, 83(4): 294-300. Nunn, S., Quinet, K., Rowe, K., & Christ, D. (2006). Interdiction day: Covert surveillance operations, drugs, and serious crime in an inner-city neighborhood. Police Quarterly, 9(1), 73-99. Van den Heede, K., Diya, L., Lesaffre, E., Vleugels, A., & Sermeus, W. (2008). Benchmarking nurse staffing levels: the development of a nationwide feedback tool. Journal of Advanced Nursing, 63(6), 607-618. 20