1. Effects of Staffing Matrix on Clinical outcomes Karen Loden, MN, RN Dr. Linda Corson Jones Memorial Research Day April 11, 2008

2. Learner Objective Discuss the relationship of the current staffing matrix to clinical patient outcomes

3. Staffing Matrix Definition: a mathematical model that shows the number of patients and required staff by skill level for a 24 hour period

4. Development Staffing matrix developed To achieve appropriate skill mix on in patient care units To achieve realistic and reliable staffing within budget parameters and professional standards

5. Staffing Matrix Sample

6. Application in clinical area Does not supersede professional judgment in staffing Matrix facilitates staffing decisions 3 times daily based on available staff, patient acuity and activity and census.

7. Research Question asked Is there a relationship between the staffing matrix to patient outcomes of Length of stay Falls Medication Errors MET calls Code Blue Patient satisfaction (pain control, loyalty, personal needs, care and concern.

8. Data Collection sources Data was collected for a six month period (July 2007- December 2007) from the staffing software, Performance Improvement, Patient Satisfaction questionnaires and Financial services Used HPPD by skill level (hours worked not total hours) (hours per patient day = # hours worked by skill level/patient days or census for time period)

9. Relationship of clinical outcomes There was no relationship between the variables of LOS, MET calls, and Code Blue and the HPPD. There was not a statistical difference when comparing the matrix HPPD and the actual HPPD. There was an inverse relationship between RN HPPD and falls, and medication errors, but it was not statistically significant. There is a relationship between the RN, LPN and UAP HPPD to patient outcomes of pain control, loyalty, personal needs, care and concern.

10. Correlation Skill level HPPD Pain controlLoyaltyPersonal needs Care and Concern RH HPPD.271*.426**.461**.360** LPN HPPD-.228*-.347**-.369**-.280** UAP HPPD.210*** *** r = 0.55, this was put into the regression model ** correlation is significant at the 0.01 level * correlation is significant at the 0.05 level

11. Regression: Pain Perception Skill level HPPD Standardized coefficients Beta tSig. RN HPPD.3871.449.151 LPN HPPD.127.475.636 A great deal of effort has surrounded our communication related to pain management which may be why there is not predictive relationship.

12. Regression: Loyalty Skill level HPPD Standardized coefficients Beta tSig. RN HPPD.6752.706.008 LPN HPPD.2721.089.279

13. Regression: Personal Needs Skill level HPPD Standardized Coefficients Beta tSig. RN HPPD.6972.884.005 LPN HPPD.2561.057.294 UAP HPPD.1962.022.046

14. Regression: Care and Concern Skill level HPPD Standardized coefficients Beta tSig. RN HPPD.6442.506.014 LPN HPPD.3101.206.231

15. Implications for Nursing Administration The matrix offers a guide to help consistency in number of hours provided by skill level. Review and adjust matrix at regular intervals during fiscal year Skill mix needs to be evaluated when staffing, to achieve positive patient outcomes. Value all skill levels in nursing to achieve positive patient outcomes.

16. Recommendations Identification of how to utilize the staff we have on duty to meet patient needs Ask the nursing staff what works, then act on it. Provide adequate support for RNs. Investigate the LPN role in patient care and patient satisfaction. Develop scripting using solution starters. Continue data collection for next 6 months

17. Questions kloden@ololrmc.com kloden@bellsouth.net