Variability of staffing and staff mix across acute care units in Alberta, Canada

Abstract

BackgroundThe health workforce has a crucial position in healthcare, and effective distribution of the workforce is one of the critical areas for healthcare improvement. This requires a proper understanding of the allocation of healthcare providers including staffing levels and staffing variability within a healthcare system. High variability may imply significant differences in outcomes and greater opportunity to better distribute staffing and improve patient outcomes. The objective of this study was to examine staffing variation across acute care units in a large and integrated healthcare system.MethodsWe used survey and administrative data on full time equivalencies of Registered Nurses, Licensed Practical Nurses, Health Care Aides, and allied health staff for 287 acute care units to examine staffing levels across multiple unit types. We used a subsample of 157 units in a more detailed analysis of staffing levels and staff distribution.ResultsResults from the full sample indicate that staffing levels, particularly for Registered Nurses, vary substantially across unit types. Subsample analyses showed that the highest variation in staffing levels occurred in rural units, which also had higher average staffing for licensed practical nurses and allied health staff. Rural units had fewer Health Care Aides than did other units. The majority of units were staffed with a combination of all three nursing providers, but the most common arrangement in rural units was staffing of Registered Nurses and Licensed Practical Nurses only. We also found that units with the highest number Registered Nurses also tended to have higher numbers of other staff, particularly allied health providers.ConclusionsWe observed significant variation in staffing levels and mix in acute care units. Some of the differences might be attributable to differences in patient needs and unit types. However, we also observed high variability in units with similar services and patient populations. As other research has shown that staffing is linked to differences in patient outcomes, there is an important opportunity to improve staffing for greater efficiency and higher quality care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12960-016-0172-1) contains supplementary material, which is available to authorized users.

Workplace Violence among British Columbia Nurses Across Different Roles and Contexts

“…In acute care and long-term care sectors, patients and their families/visitors typically have length of stays long enough to recognize changes in quality of care imposed by work environment conditions such as staffing shortages, heavy workloads and long wait times [5,17,21]. Despite, differences in the conditions of nurses' works environments across geographical areas [18][19][20], we did not find statistically significant differences in the prevalence of most types of workplace violence across geographical areas. That said, the raw prevalence for most types of workplace violence was slightly higher in rural areas.…”

“…A recent study, for example, found associations between nurses' heavy workloads, patient/family complaints and violence escalation [5]. Other research has established differences in adequacy of nurse staffing and workload management between healthcare sectors (e.g., acute care, long-term care) [17] and geographical regions (e.g., urban, rural) [18][19][20]. Violence research with nurses, therefore, needs to consider the variety of contexts that may influence acts of violence against them.…”

A quantitative systematic review of the association between nurse skill mix and nursing‐sensitive patient outcomes in the acute care setting

“…Despite these efforts, clear evidence-based guidelines on staffing levels are lacking, particularly in regard to skill mix (Brennan, Daly, & Jones, 2013;Sharma, Hastings, Suter, & Bloom, 2016). A recent systematic review (Myers, Pugh, & Twigg, 2018) that examined the importance of nurse skill mix on patient outcomes focussed specifically on stand-alone high acuity areas, meaning that findings from this review may not be easily transferrable to other care settings.…”

“…A systematic review and meta-analysis published in 2007 for example (Kane, Shamliyan, Mueller, Duval, & Wilt, 2007), which analysed nurse staffing levels, focussed on the ratio of Registered Nurses (RNs) to patients and patient outcomes, but not on nurse skill mix. Despite these efforts, clear evidence-based guidelines on staffing levels are lacking, particularly in regard to skill mix (Brennan, Daly, & Jones, 2013;Sharma, Hastings, Suter, & Bloom, 2016). A recent systematic review (Myers, Pugh, & Twigg, 2018) that examined the importance of nurse skill mix on patient outcomes focussed specifically on stand-alone high acuity areas, meaning that findings from this review may not be easily transferrable to other care settings.…”

Nursing care providers’ perceptions on their role contributions in patient care: An integrative review

“…Nursing care is increasingly provided by a nursing team with providers who have varying levels of education and roles (Aiken et al, 2017;Sharma, Hastings, Suter, & Bloom, 2016). Within the nursing team, in addition to RNs, LPNs and HCAs have been increasingly employed in homecare, community care and long-term facilities (Arain, Deutschlander, Rostami, & Suter, 2016;Hewko et al, 2015;Huynh, Alderson, Nadon, & Kershaw-Rousseau, 2011).…”