Ten client hospitals were concerned that they were paying highly skilled RN’s to perform work that could be done by less skilled and less expensive staff.
The ten hospitals had recently implemented a comprehensive patient classification and nurse staffing system. The purpose of the system was to measure the intensity of patient needs for nursing support and then to adjust the nurse staffing levels appropriately.
The hospitals wished to jointly collect specific nurse activity data to document actual functions performed by all levels of staff and reallocate functions to most appropriate staff levels.
Ten hospitals wanted to compare:
The ten hospitals showed substantial differences in nursing hours per patient day, requirements of patients and patient mix, and activities performed by different levels of nursing staff. Some of the differences resulted from staff experience, unit layouts, amount of support staff, and organizational philosophy. Others resulted from a lack of consistent management policies and a lack of clear understanding of nursing activities.
An “Implementation Team” consisting of representatives from each hospital and consultants was formed. The consulting group developed a data collection strategy supported by their hospital leaderships.
The consultants facilitated the agreement across the ten hospitals on 37 specific work items and definitions. Nurse observers collected work-sampling data across all shifts in each hospital.
The Implementation Team met together to identify the tasks that should be a lower priority for RN’s and moved to less expensive workers.
The consultants trained and managed the data collectors and provided analyses for each hospital. The reports compared the hospitals on many indicators including staff hours per patient, acuity of patients by unit and shift, activities and activity frequency observation of 30 activities by six levels of nursing staff by unit and shift reports.
The ten hospitals reduced nursing costs by 3% to 8%. The project returned more than three times the cost of the study in the first year.
The project found low priority activities consumed an average of 18% of RN time with a variation of 12% to 32% among hospitals.
The range of RN time in “Direct Care” varied from 35% to 49% among hospitals.