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ANA Resource Helps Make the Case for Nurse Staffing

To achieve quality care, better patient outcomes and financial stability, optimal nurse staffing should be viewed by health care employers as a necessity rather than an option—particularly as health care reforms and new regulations take hold.

That is a key message reflected in a new white paper commissioned by the American Nurses Association (ANA) and developed by Avalere Health, LLC in collaboration with nurses and policy experts.

Nurses at all levels and in all settings can use the white paper, “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes,” as a resource to advocate for and implement sound, evidence-based staffing plans.

“Nurses on the front lines are in the best position to determine the staffing needed for safe and equitable, quality care, but they consistently tell us they must fight for optimal nurse staffing. This white paper is our way of providing evidence to support the need for changes in nurse staffing across all health care settings,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of the American Nurses Association.

The white paper highlights studies that demonstrate how appropriate nurse staffing helps to achieve both clinical and economic improvements, from reducing medication and other errors to shortening patients’ hospital length of stay.

“The evidence from hundreds of studies—and the white paper—make it clear that there is a relationship between staffing and patient outcomes,” said Matthew McHugh, PhD, JD, MPH, RN, FAAN, an associate professor at the University of Pennsylvania School of Nursing who helped develop the paper. “If there are not enough nurses at the bedside, bad things are likely to happen.”

The white paper also examines the various forces that have impacted discussions about nurse staffing and health care, from Affordable Care Act provisions and Institute of Medicine reports to changing patient demographics.

This paper specifically notes that existing staffing systems are often antiquated and lack flexibility to adjust to factors such as patient complexity, a rise in admissions, discharges and transfers, and the physical layout of the unit. It further addresses efforts by ANA and other organizations to advocate for federal regulation and legislation promoting flexible staffing plans, and highlights ANA activities to support transparency and public reporting of staffing data.

For example, the Registered Nurse Safe Staffing Act (H.R. 2083/ S.1132), endorsed by ANA, would require Medicare-participating hospitals to establish registered nurse (RN) staffing plans using a committee, comprised of a majority of direct-care nurses, to ensure patient safety, reduce readmissions and improve nurse retention.

“We in nurse leadership have to be able to defend our budgets [for optimal staffing],” said Bob Dent, DNP, MBA, RN, NEA-BC, CENP, FACHE, senior vice president and chief operating officer at Midland Memorial Hospital in Texas. “We need to be able to tell our boards of trustees and other administrators: “If we want to be able to deliver quality care to our community, then here is the staffing we need and here is the evidence [that supports that decision].”

The paper is the first in a series aimed at addressing the value of nursing care and services.

Individuals can learn more and access the white paper executive summary here. Members of the media can obtain the full white paper by sending a request to Ms. Jemarion Jones at [email protected].


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The American Nurses Association (ANA) is the premier organization representing the interests of the nation’s 3.4 million registered nurses. ANA advances the nursing profession by fostering high standards of nursing practice, promoting a safe and ethical work environment, bolstering the health and wellness of nurses, and advocating on health care issues that affect nurses and the public. ANA is at the forefront of improving the quality of health care for all.

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