Effects of Staffing Matrix on Clinical outcomes

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					Effects of Staffing Matrix on
Clinical outcomes

         Karen Loden, MN, RN
   Dr. Linda Corson Jones Memorial Research Day
                   April 11, 2008
Learner Objective
   Discuss the relationship of the current
    staffing matrix to clinical patient
    outcomes
Staffing Matrix
   Definition: a mathematical model that
    shows the number of patients and
    required staff by skill level for a 24 hour
    period
Development
   Staffing matrix developed
       To achieve appropriate skill mix on in
        patient care units
       To achieve realistic and reliable staffing
        within budget parameters and professional
        standards
Staffing Matrix Sample
         Days          Evenings           Nights
Census    RN LPN     NA RN LPN         NA RN LPN         NA
  48     5.0   5.0   5.0   5.0   5.0   4.0   4.0   3.0   3.0
  47     5.0   5.0   5.0   5.0   5.0   4.0   4.0   3.0   3.0
  46     5.0   5.0   5.0   5.0   5.0   4.0   4.0   3.0   3.0
  45     5.0   5.0   5.0   5.0   5.0   4.0   4.0   3.0   3.0
  44     5.0   5.0   5.0   5.0   5.0   4.0   3.0   3.0   3.0
  43     5.0   5.0   5.0   5.0   4.0   4.0   3.0   3.0   3.0
  42     4.0   5.0   5.0   4.0   5.0   4.0   3.0   3.0   3.0
  41     4.0   5.0   5.0   4.0   4.0   4.0   3.0   3.0   3.0
  40     4.0   4.0   5.0   4.0   4.0   4.0   3.0   3.0   3.0
  39     4.0   4.0   4.0   4.0   4.0   4.0   3.0   2.0   3.0
  38     4.0   3.0   4.0   4.0   3.0   4.0   3.0   2.0   3.0
Application in clinical area
   Does not supersede professional
    judgment in staffing
   Matrix facilitates staffing decisions 3
    times daily based on available staff,
    patient acuity and activity and census.
Research Question asked

   Is there a relationship between the
    staffing matrix to patient outcomes of
       Length of stay
       Falls
       Medication Errors
       MET calls
       Code Blue
       Patient satisfaction (pain control, loyalty, personal
        needs, care and concern.
Data Collection sources
   Data was collected for a six month period (July 2007-
    December 2007) from the staffing software,
    Performance Improvement, Patient Satisfaction
    questionnaires and Financial services
   Used HPPD by skill level (hours worked not total
    hours) (hours per patient day = # hours worked by
    skill level/patient days or census for time period)
Relationship of clinical outcomes

   There was no relationship between the variables of
    LOS, MET calls, and Code Blue and the HPPD.
   There was not a statistical difference when
    comparing the matrix HPPD and the actual HPPD.
   There was an inverse relationship between RN HPPD
    and falls, and medication errors, but it was not
    statistically significant.
   There is a relationship between the RN, LPN and UAP
    HPPD to patient outcomes of pain control, loyalty,
    personal needs, care and concern.
    Correlation

Skill level         Pain control        Loyalty        Personal   Care and
HPPD                                                   needs      Concern
RH HPPD             .271*               .426**         .461**     .360**


LPN HPPD            -.228*              -.347**        -.369**    -.280**


UAP HPPD                                               .210***



*** r = 0.55, this was put into the regression model
** correlation is significant at the 0.01 level
* correlation is significant at the 0.05 level
       Regression: Pain Perception

  Skill level        Standardized
    HPPD              coefficients                 t                      Sig.
                         Beta
   RN HPPD                 .387                  1.449                .151


  LPN HPPD                 .127                   .475                .636




A great deal of effort has surrounded our communication related to pain
management which may be why there is not predictive relationship.
 Regression: Loyalty

Skill level   Standardized
  HPPD         coefficients     t     Sig.
                  Beta
RN HPPD           .675        2.706   .008


LPN HPPD          .272        1.089   .279
 Regression: Personal Needs

Skill level   Standardized
  HPPD         Coefficients     t     Sig.
                  Beta
RN HPPD           .697        2.884   .005



LPN HPPD          .256        1.057   .294



UAP HPPD          .196        2.022   .046
 Regression: Care and Concern

Skill level   Standardized
  HPPD         coefficients     t     Sig.
                  Beta
RN HPPD           .644        2.506   .014


LPN HPPD          .310        1.206   .231
Implications for Nursing Administration

   The matrix offers a guide to help consistency
    in number of hours provided by skill level.
   Review and adjust matrix at regular intervals
    during fiscal year
   Skill mix needs to be evaluated when staffing,
    to achieve positive patient outcomes.
   Value all skill levels in nursing to achieve
    positive patient outcomes.
Recommendations
   Identification of how to utilize the staff we have on
    duty to meet patient needs
   Ask the nursing staff what works, then act on it.
   Provide adequate support for RNs.
   Investigate the LPN role in patient care and patient
    satisfaction.
   Develop scripting using solution starters.
   Continue data collection for next 6 months
Questions
   kloden@ololrmc.com
   kloden@bellsouth.net

				
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