1. Improving Safety & Quality in Staffing & Communication
Kelli Benson, BSN, RN, RNC-MNN
Nursing sensitive indicators
Nursing care hours per patient day
Voluntary turnover
Hospital National Patient Safety Goals
Improve staff communication

2. Nursing Care Hours Per Patient Day (NHPPD)
RN care hours
Nursing staff hours
Productive hours/ inpatient days
Number of nursing hours available per admitted patient
National Quality Forum (NQF),2004

3. NHPPD Increased NHPPD Get involved S 864 HR 1602
Improved patient quality & outcomes
Nurse satisfaction
Cost effective
Get involved
S 864
National Nursing Shortage Reform
and Patient Advocacy Act
HR 1602
Nurse Staffing Standards for
Patient Safety and Quality Care Act
Mensik, 2014
National Nurses United, 2015
Twigg, Duffield, Bremmer, Rapley, & Finn, 2011
Twigg , Geelhoed, Bremmer, & Duffield, 2013

4. Voluntary Turnover Uncontrolled separations Exclusions
Number of voluntary separations /Number of employees on last day of month
Exclusions
Death, illness, pregnancy, relocation, retirement, performance or discipline, cutbacks, layoffs, per diem, consultants, temporary, agency, non-salaried, students
NQF,2004

5. Voluntary Turnover Overworked (inadequate staffing & resources)
Reasons for turnover
Impact of turnover
Overworked (inadequate staffing & resources)
No opportunities
No recognition
Lack of role clarity
Lack of collaboration/team support
Poor communication with management
Decreased patient care quality
Decreased patient satisfaction
Increased staff cost
Increased additional turnover of medical/nursing staff
Increased accidents
Increased absenteeism
Bae, Kelly, Brewer, & Spencer,2014
Hayes, et al., 2012;Hunt, 2009

6. Voluntary Turnover Cost of turnover Rate of turnover Retention
$10,000-$88,000 (to replace one RN)
Rate of turnover
50% for RNs
27% for new grads
51.5% for CNAs
Retention
American Health Care Association, 2012
Hayes et al., 2012
Kovner, Brewer, Fatehi, & Jun,2014
Krsek, 2011

7. Improve Staff Communication
Improve effectiveness of communication
Report critical results
Within established time frame
To the responsible licensed caregiver
Eliminate treatment delays
Elements of performance
Develop written procedures
Implement procedures
Evaluate timeliness of reporting
TJC, 2015

8. Improve Staff Communication
20-62% of inpatient tests with no follow-up
Critical lab values related to adverse effects
Bleeding, prolonged hospital stay, cerebrovascular accident, cardiac injury, death
Role of nursing
Help develop new policies
Educate
Research
Braun, 2012
Goldstein, Prosser, & Travis, 2013
University of North Carolina, 2013

9. References
American Health Care Association. (2012). American health care association 2012 staffing report. Retrieved from
Bae, S., Kelly, M., Brewer, C., & Spencer, A. (2014). Analysis of nurse staffing and patient outcomes using comprehensive nurse staffing characteristics in acute care nursing units. Journal of Nursing Care Quality, 29(4), doi: /NCQ
Braun, B. (2012). Evaluating and improving the handoff process. Journal of Emergency Nursing, 38(2), doi: /j.jen
Goldstein, R., Prosser, D., & Travis, L. (2013). Analysis of critical laboratory value nurse-to-physician follow-up calls at a community hospital. Journal of Nursing Care Quality, 28(4), doi: /NCQ.0b013e ff
Hayes, L., O’Brien-Pallas, L, Duffield, C., Shamian, J., Buchan, J., Hughes, F.,... & North, N. (2012). Nurse turnover: A literature review-an update. International Journal of Nursing Studies, 49(7), doi: /j.ijnurstu
Hunt, S. (2009). Nursing turnover: Costs, causes, & solutions. Retrieved from
Kovner, C., Brewer, C., Fatehi, F., & Jun, J. (2014). What does nurse turnover rate mean and what is the rate? Policy, Politics, & Nursing Practice, 15(3-4), doi: /
Krsek, C. (2011). Investing in nursing retention is a smart move in today’s economy. American Nurse Today, 6(4), online. Retrieved from

10. References
Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today, 9(2), online. Retrieved from National Nurses United. (2015). National campaign for safe RN-to-patient staffing ratios. Retrieved from National Quality Forum [NQF]. (2004). National voluntary consensus standards for nursing-sensitive care: An initial performance measure set. Retrieved from The Joint Commission [TJC]. (2015). National patient safety goals effective January 1, Retrieved from Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. (2011). The impact of the nursing hours per patient day (NHPPD) staffing method on patient outcomes: A retrospective analysis of patient and staffing data. International Journal of Nursing Studies, 48(5), doi: /j.ijnurstu Twigg, D., Geelhoed, E., Bremner, A., & Duffield, C. (2013). The economic benefits of increased levels of nursing care in the hospital setting. Journal of Advanced Nursing, 69(10), doi: /jan University of North Carolina. (2013). Policy on: Communications: Critical imaging findings. Retrieved from