“The goal of staffing each oncology inpatient unit is to ensure patient safety in healthcare delivery,” Adjetey-Appiah explained. “Nurses are scheduled in sufficient numbers to provide quality and safe care. The staffing mix is a determinant of the safety of the work environment and the safety of patient care. Nurse recruitment and retention efforts are critical to retaining expert staff.”
According to Adjetey-Appiah, the American Nurses Association’s principles for nurse staffing suggest that the following factors be identified:
- Volume of patients
- Intensity level of the care needed by patients
- Characteristics of the work environment, including architecture and available technology
- Experience and expertise of the nursing staff
The support of a multidisciplinary staff is important, she added, as is a facility’s involvement, or lack thereof, in research at the basic-science or clinical level.
Because patient needs are ever-changing, Adjetey-Appiah said, patient classification and acuity systems that are used to track and predict nurse staffing needs can be helpful, and easily understood by nurses when taught appropriately.
“To determine how many patients one nurse can care for is a difficult question to answer due to the variety of settings in oncology inpatient units. Any nurse will tell you it all comes down to the individual patient and how much care he or she needs,” Adjetey-Appiah commented.
Two hundred people responded to the ONS survey (Table). Responses give a bird’s-eye view of staffing situations in various inpatient units; however, about two-thirds of respondents did not answer several questions.
Based on the survey results and on staffing principles, some examples of staffing guidelines are as follows, with the same number of registered nurses (RNs) needed for either a day or a night shift:
- For 1-8 patients, 2 RNs
- For 9-12 patients, 3 RNs
- For 13-16 patients, 4 RNs
- For 17 to 20 patients, 5 RNs
- For 21 to 24 patients, 6 RNs
- For 25 to 28 patients, 7 RNs
- For 29 to 32 patients, 8 RNs
- For 33 to 36 patients, 9 RNs
“The survey confirms why ONS opted not to have set guidelines on staffing,” Adjetey-Appiah said. “The diversity and variety of inpatient units are too complex to set one standard. However, the survey revealed a need to use exemplars as guidelines when staffing oncology units. Examples collected from different institutions will be posted on the ONS website.”