Nadolski Charles, Britt Pheraby, Ramos Leah C
Pheraby Britt, ADN RN SCRN, is Clinical Nurse, NSICU, Medical University of South Carolina, Charleston, SC. Leah C. Ramos, MSN RN CCRN-K NE-BC, is Nursing Director, Medical University of South Carolina, Charleston, SC.
J Neurosci Nurs. 2017 Jun;49(3):169-173. doi: 10.1097/JNN.0000000000000278.
The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit's capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics.
This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units.
The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels.
The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.
神经科学中级护理单元是一个拥有23张床位的单元，最初配备的护士与患者比例为1:4至1:5。随着时间的推移，该单元照顾日益增多的急症患者的能力未能达到员工期望目标，影响了护士满意度。临床护士希望降低护患比。本项目的目的是通过投资回报率和提高质量指标来证明增加人员配备的合理性。
该倡议采用混合方法来确定神经科学中级护理单元的理想人员配备。定量部分侧重于对患者病情严重程度的审查。定性部分基于对来自类似单元的大学医疗联盟护士经理的描述性访谈。
该研究审查了9832个患者日的病情严重程度，以确定神经科学中级护理单元患者的准确病情严重程度。联系了12家大学医疗联盟医院的护士经理以及南卡罗来纳医科大学的8个单元，以比较人员配备水平。
护士人员配备的增加促成了许多质量指标的提高。降低护患比后，可控的护士流失率下降了80%，受伤跌倒率下降了75%。这两个指标为增加人员配备带来了投资回报率。此外，由于床边护士的倡导，Press Ganey员工敬业度调查中的人员配备满意度问题从2013年的2.44提高到了2015年的3.72。
