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- Massachusetts hospitals are among the best in the world. Doctors, nurses and other
caregivers share a common mission – delivering safe, high-quality care to patients.
- Here in Massachusetts, we are leading the nation in developing new standards of
transparency and accountability.
- In January 2005, Massachusetts hospitals, in partnership with the Massachusetts
Organization of Nurse Executives, launched Patients First – a bold, comprehensive initiative
to further the longstanding commitment to quality and safety second to none.
- MHA and the Massachusetts Coalition for the Prevention of Medical Errors tackled two
complex problems in patient safety – reconciling medications and communicating critical
test results – which became the model for JCAHO’s 2005 National Patient Safety Goals.
- All of the 68 acute care hospitals in Massachusetts have signed onto the Institute for
Healthcare Improvement (IHI) “Campaign to Save 100,000 Lives,” which includes adopting
six interventions to improve patient care and prevent avoidable deaths.
- Through Patients First, Massachusetts hospitals are embracing innovative, new strategies
to reduce medical errors, craft and publicly report staffing plans that meet patient needs,
and alleviate shortages of nurses and other caregivers.
- Because Massachusetts hospitals believe the public has a right to know who is caring for
them when they are hospitalized, a key component of Patients First is the public posting
of nurse staffing plans.
- Massachusetts hospitals are the first in the nation to voluntarily post such plans both in
hospitals as well as on the website www.patientsfirstma.org.
- While the staffing plans are compiled in the same format, each hospital and each unit
within a hospital is different. In addition, each patient has individual needs and hospitals
continually customize the care they provide to support each patient’s needs. Therefore,
staffing plans will look different from hospital to hospital and unit to unit.
- The care an individual receives in a hospital is provided by a team of people – and
comprised of more than nurses alone.
- Massachusetts hospitals will continue their commitment to public accountability and
next year make public “nursing sensitive-care measures.”
Here are some questions and answers to help explain
staffing plans and interpret their information.
What types of hospitals are there?
There are four major categories of hospitals at
which you may receive care.
- Acute care community hospitals provide
medical and nursing care for medical and
surgical conditions.
- Tertiary hospitals provide medical and
nursing care for medical and surgical conditions
and also provide specialized consultative
care by specialists, usually on referral
from a medical provider, such as your
primary care doctor.
- Teaching hospitals provide training for
interns and residents who are studying to
advance their skills as doctors. In general,
all tertiary hospitals are teaching hospitals.
Some acute care community hospitals may
also have training programs for interns and
residents.
- Specialty hospitals include long-term
acute hospitals, rehabilitation or behavioral
health hospitals that provide diagnostic
and treatment services to patients with
specified medical conditions or, in the case
of behavioral health hospitals, diagnostic
and treatment services for patients who
have mental health-related illnesses.
The staffing plans you will see are divided into
three groups: Acute Community Hospitals
(58), Tertiary (10) and Specialty (13).
What types of hospital “units” are there?
Hospitals have different types of units that are
usually categorized based on the care that a
patient will need. For example, a medical surgical
unit may have a mix of patients with different
kinds of problems, such as respiratory,
cardiac, or cancer problems. Patients needing
more specialized intensive care may spend part
of their hospital stay in an intensive care unit,
such as a cardiac care unit (CCU) or surgical
intensive care unit (SICU). Some hospitals also
have “step-down” units or telemetry units, for
those patients who require more monitoring
but do not need to be in an ICU.
What is a staffing plan?
Every hospital develops a staffing plan to make
sure that patients in their hospital receive
appropriate care. Many different factors go
into development of a staffing plan. Some of
these include the experience and education of
the registered nurse, the availability of other
caregivers, the needs of the patients on the
unit, and the severity of the patients’ illnesses.
Have hospitals always compiled staffing
plans?
Yes, hospitals have always compiled staffing
plans. Under Patients First these plans are
being developed in a uniform way so the
public can see the different factors that go
into the development of a plan.
How are staffing plans determined?
Staffing plans are determined based on
patients’ needs. The Nurse Manager together
with other staff develop the plan based on the
anticipated needs of the patients who will be
assigned to the unit. The plans need to be
flexible to account for changes that occur.
Patients’ needs change over the course of a
day and staffing is adjusted to account for
those changes. Every patient needs the right
care, not the same care.
Are staffing plans only for nurses?
Staffing plans involve the team of professionals
who may be involved in the care of a particular
patient and are based on the patient’s individual
clinical needs. Nursing plays an important role
in the care of every patient but nurses are just
one part of a larger team of caregivers who
work together to make sure that patients
receive the highest quality of care.
Can any conclusion be drawn if the staffing
on one unit is higher or lower than another?
Direct comparisons like that can not be made
between or across units. Staffing is based on
the needs of a particular patient unit and can
differ from unit to unit within the same hospital.
For example, staffing in an intensive care
unit is higher than staffing in a general medical
surgical unit because of the critical needs of
patients that are in intensive care units. They
require more hours of nursing care and close
monitoring for changes in condition. Staffing
across similar units can also vary based on the
experience and education of the registered
nurses and the availability of other clinical caregivers,
such as therapists. When looking at a
staffing plan, it is important to look at the
indirect resources who also provide care, and
to look at other attributes of the unit, such as
technicians or specialists who may provide care
and services.
Why do staffing numbers differ from hospital
to hospital and unit to unit?
Staffing numbers vary because patient care
needs differ and can change minute to minute,
hour to hour. Staffing has to be closely
watched and adjusted from time to time based
on the changes in the needs of the patients.
The plan is based on averages. There are times
when more staff will be needed and times less
staff will be needed.
Activity on a patient care unit changes constantly
and, therefore, patient needs change
constantly. For example, admissions, transfers
and discharges occur on a regular basis, changing
the make-up of a unit, and patients may
become sicker during a day and need more
than expected nursing care.
Nurse staffing is frequently evaluated and readjusted
to make sure patients are properly cared
for. The staffing plans, therefore, are not meant
to compare one hospital to another or one unit
to another, but are a planned baseline from
which patient care needs are adjusted.
What are Worked Hours Per Patient Day
(WHPPD)?
Worked hours per patient day are the
number of hours of direct care a patient can
expect to receive from an RN, along with LPNs
and nursing assistants in a twenty-four hour
period. Worked hours per patient day is a
measure that is nationally recognized and part
of the National Quality Forum’s Nurse Sensitive
Measure Set. This measure set was established
by experts in the field of Quality Measurement
and Nursing Care.
What do these numbers mean for patients?
This number will tell patients how many hours
of nursing care they are receiving. It is not
meant to be compared across units or across
hospitals. It is one more piece of information
for consumers to have in understanding how
care is provided to them when they are in the
hospital.
Why does it seem there are fewer staff on
the evening and night shifts?
On some units, there are fewer admissions,
transfers and discharges on the later shifts.
Also, during the evening and night, patients
may receive fewer treatments, testing and
transporting, and may have fewer needs for
assistance with daily activities, such as bathing
or eating. Some units have the same number
of RN staff on all shifts, however, such as
Intensive Care Units (ICUs) where the care
needs vary less.
Where should I be able to find the staffing
plans for hospitals?
Staffing plans for hospitals are now available
on the Patients First website at www.patientsfirstma.org or by asking individual hospitals
for a copy.
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