1. “It’s All About the Patient” Improving Quality of Care with Engineered Nursing Ratios Prepared by: The HIMSS Nurse Staffing Ratio Work Group February 15, 2008
Copyright 2007 by the Healthcare Information and Management Systems Society (HIMSS)

2. “Patient Safety and Quality Patient Care can be enhanced through the collaborative efforts of all HIMSS communities to provide useful and effective information technology, enhanced processes, and appropriately designed staffing ratios for Nursing Staff”
HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios. Adopted by the HIMSS Board of Directors June 9,2006. Retrieved September 2, 2007.

3. Challenge
Current federal and state legislation exists that would mandate staffing ratios that are fixed and universal.
3 Powerful Nurses Unions have just formed to “organize all non-union direct care RNs” and form a national voice around RN- patient staffing ratios
ANA is underfunded to combat fixed staffing ratios in all states

4. HIMSS Position Statement
HIMSS does not support legislatively-mandated nurse-to-patient ratios that are fixed and universal. HIMSS supports hospitals voluntarily applying flexible evidence-based ratios informed by research and local knowledge.
HIMSS Position Statement: Legislatively Mandated Patient to Nurse Ratios.
Adopted by the HIMSS Board of Directors June 9, 2006.
Retrieved September 2, 2007.

5. In summary, research suggests …
Effective nurse staffing is important to patient outcomes
However, fixed nurse-to-patient ratios cannot address the issues unique to every hospital, such unit layout, support services, technological support, and nurse staffing mix
Legislation to mandate fixed ratios carries a high potential of leading to the economic and political devaluation of the Nursing profession and fails to effectively deal with the issues surrounding nurse staffing
Multi-site research suggests……….

6. In summary, research suggests …
Lower patient-to-nurse ratios may be associated with
Reduced failure-to-rescue
Reduced mortality
Reduced nosocomial septicemia in NICU
Diminished RN burnout
Increased RN job satisfaction
Effective nurse staffing is important to patient outcomes
Mandated fixed nurse-to-patient ratios cannot address the issues unique to every hospital, such as unit layout, support services, technological support, and staffing mix
Multi-site research suggests……….

7. Solution: Engineered Staffing Ratios
Engineered staffing ratios provide:
Objective measures of patient acuity based upon the local patient care delivery model & standards of care
Outcomes that respect unit-based geographic delimiters
Outcomes that respect unique patient populations of the hospital
Outcomes that respect fiscal and community constraints of the hospital
Outcomes & recommendations sensitive to indirect HPPD practices & policies

8. Engineered Staffing Ratios (cont.)
Outcomes that respect the availability of ancillary staff
Hours & days ancillary support is available
Unit-based vs. central pharmacy support
Outcomes that respect availability of support staff on the unit
Outcomes that respect available information systems
Bed management systems
Staffing and scheduling systems
EMR
CPOE – and physician adoption

9. HIMSS and Engineered Standards
Integrating the HIMSS disciplines of IT, Management Engineering and Nursing facilitates the use of properly engineered staffing ratios
Working in tandem with the Nursing profession, management engineers and nurses have created acuity measurement systems which can be used to more precisely determine the workload impact of each individual patient in order to balance safe patient to nurse ratios
Through the effective use of technology and process improvement applications, the life of the nurse can be made easier
The HIMSS disciplines of IT, Management Engineering and Nursing working together facilitate the use of properly engineered staffing ratios.

10. Summary The patient must remain the focus!
Improved patient care outcomes is a shared goal
Optimal nurse staffing can improve patient outcomes
Staffing plans qualified through the metrics of engineered staffing systems will provide the most effective match between available resources and desired patient outcomes