Factors to Consider in Decisions 皇冠6686官网 Staffing in Rehabilitation Nursing Settings

基本原理

Staffing decisions involve a process of determining patient care needs and providing the staff skill mix that offers an effective number of nursing hours per patient day to deliver care. Rehabilitation nursing settings differ in patient population, 可用职员的数目, 的人才, 员工的经验和技能, 行政和预算问题, 录取标准, 水平的护理, 和工作负载. Variables to be considered when planning and assigning staff include:

  • 病人视敏度
  • Availability of specialized rehabilitation nursing professionals
  • 支持系统的可达性
  • Availability of substitute/float staff that are appropriately oriented and cross-trained
  • 招生
  • 排放
  • 转移
  • 病人的诊断
  • 患者文化多样性
  • 员工文化多样性
  • 可用的技术
  • Availability of resources for evidence based practice
  • Architecture and geography of the environment

Review and accrediting agencies generally expect staffing to be within an assessed level which is based on patients’ diagnoses and patient census. Rehabilitation nurse managers must be creative in meeting the needs of the nursing service areas by scheduling the available staff so that the days of the week and shifts correspond to the needs of the organization and the patient (e.g. bathing, managing bowel programs, and providing patient education activities). Maximum flexibility is desirable in terms of assignment of specialized rehabilitation nursing professionals to meet patient care needs effectively and in a fiscally sound manner.

Value-based care has added new challenges. 的 四倍的目标(这样 & Sinsky, 2014) requires staffing levels so that nurses feel successful in meeting patient care needs. This requires strategic planning with the patient, resources and the care giver in mind.

Research demonstrates that good outcomes result from the quality of staff more than quantity (Buhlmun, 2016). Rehabilitation must use big data that includes Functional Independence Measures that are rehab specific, quality measures such as those collected by the National Database of Nursing Quality Indicators (NDNQI®) tool and 病人满意度 data gleaned from resources such as Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) and Press Ganey scores. Other tools such as 的 Logical Observation Identifiers Names and Codes (LOINC) developed from the normalizing of data including the Nursing Management Minimum Data Set (NMMDS) is a profession-specific data set adjusted for care setting and can be utilized by rehabilitation organization and organizations providing rehabilitation services to determine how staffing influences both patient experience and outcomes. Most rehabilitation programs already collect the data elements used in the NMMDS.

建议

Since there is not a standard system for determining nurse staffing ratios specific to rehabilitation nursing based on available research, 康复护理管理者应:

  1. Use data to develop an organization-specific, outcomes-driven staffing model based on its nursing value that balances workload, 结果和员工满意度.
  2. Support nursing in its ongoing quality improvement endeavors that support staffing as it relates to positive patient outcomes, 功能改进, 病人满意度, 护士满意度, and prevention of patient readmissions.
  3. Provide for opportunities to develop staff talent, pay for advanced degrees and establish a clinical ladder that recognizes nurses who prepare to meet the ongoing challenges in caring for patients across the continuum.
  4. Provide input into the selection of a written nurse staffing plan and validation of its applicability to their individual setting.

参考文献

美国护士协会. (2012). 护士人员配备原则 (第二版.). 银泉,医学博士:作者.

皇冠6686官网. (2003). Role Description: Rehabilitation nurse manager. (手册). 从检索 www.write.nkussh.com.

便雅悯J. M., & 华纳,B. H. (1996). Principles of leadership and management for rehabilitation nurses. 在年代. P. Hoeman (Ed.), Rehabilitation nursing: Process and application (第二版., pp. 70–86). St. 路易:处于.

这样,T. & Sinsky C. (2014). From triple to quadruple aim: Care of the patient requires care of the provider. 家庭医学年鉴, 12(6), 573–576.

Buhlman N. (2016). Nurse staffing and patient-experience outcomes: A close connection, combining NDNQI® and patient experience data yields insight into how key variables relate. 今天美国护士, 11(1), 49–52.      

Commission on Accreditation of Rehabilitation Facilities. (2008). 标准手册和 interpretive guidelines for medical rehabilitation. 图森:CARF.

纳尔逊,., Powell-Cope, G.帕拉西奥斯P.路德,年代.L.、黑色、T.希尔曼T.,等. (2007). Nurse staffing and patient outcomes in inpatient rehabilitation settings. 康复护理,32(5), 179–202.

Pruinelli L.加西亚,.,德莱尼,C.,鬼马小精灵B., & Westra B. (2016). Nursing management minimum data set: Cost-effective tool to demonstrate the value of nurse staffing in the big data science era. 护理经济,美元 34(2), 66–89.

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