Vanguard MacNeal Hospital Staffing Plan
Current evidence clearly points to appropriate staffing levels as a key factor leading to improved patient outcomes. The American Nurses Association's Principles of Nurse Staffing give guidance as to how to effectively plan and allocate staffing resources to ensure optimal patient care outcomes. This staffing plan describes our:
- Vanguard MacNeal Care Delivery Team
- Staffing Guidelines
- Staffing Assignments
- Resources for Additional Staffing
- Acuity Model
- Staffing Council
- Budgeting for Staffing
- Staffing Grids by Specialty
The Vanguard MacNeal Care Delivery Team
An interdisciplinary team participates in the provision of patient care. At Vanguard MacNeal Hospital, patients are admitted into different units based on their diagnosis and the clinical competencies of the staff caring for them. Member of the team are included based on the physical, psychosocial and spiritual needs of the patient and family. Members of the team are as follows:
Registered Nurse (RN)—Professional nurses who hold a license and are required to graduate from an accredited nursing program. MacNeal Hospital employs RNs with a variety of education backgrounds such as Associate, Diploma, Bachelors and Masters Degree. By hospital policy, certification in Basic Life Support is required of all nurses. In addition to this general requirement, each unit has determined additional education and or specialty training staff are required to obtain to work in that department or nursing unit. MacNeal Hospital encourages and supports professional nurses in obtaining specialty certifications in their specific practice area. Nurses are responsible for initiating and coordinating the care prescribed for the patient by the physician.
Patient Care Tech (PCT)—As unlicensed caregivers, PCTs assist the nurse in providing care to the patient. PCTs are certified nursing assistants who are competent to monitor vital signs (blood pressure, temperature, and pulse), draw blood and meet the activities of daily living needs of patients. They function under the guidance and direct supervision of a registered nurse.
Unit Secretary (US)—Unit secretaries coordinate unit communications between visitors, families and the interdisciplinary team. They also facilitate care via order processing and by ensuring an orderly work environment for all.
Nursing Management—The Chief Nursing Officer sits at the highest level of administration and is also a member of the Board of Trustees. At Vanguard MacNeal Hospital, registered nurse have 24/7 support from nursing management. Nursing supervisors are available for support during evenings and weekend and nurse managers and directors are on-call.
Other care providers include—Chaplains, physicians, residents, nurse educators, wound care nurses, pain management consultants, respiratory/physical/occupational/speech therapists, case management staff, social workers, dieticians and pharmacists.
Staffing needs are determined by several factors that include but are not limited to: Age of the patient, the complexity of patient care and the frequency of assessments and interventions, tests required, education needs of the patient and their family, the special cultural needs of the patient and family/significant other, the need for specialized equipment and technology, the need for infection protection protocols, psychosocial needs, and patient progress toward recovery.
Staffing assignments consider the following variables in selecting the group of patients a nurse will manage for her/his shift.
- Acuity Model Score—An acuity model is an assessment tool that assesses complexity of patient care needs requiring professional nursing care and skills and aligns patient care needs and nursing skills consistent with professional nursing standards.
- Continuity of Care—Whenever possible, patients are assigned to the same nurse. This helps facilitate care as the nurse is familiar with the patient's needs.
- Competency and Experience of the Staff—All nurses are trained and competent in the care of their patient population.
- Unit Geography—Rooms close to an assigned nurse may be preferred in assignment making.
Resources for Additional Staffing
Additional resources are utilized when necessary to meet the needs of our patients. Should the unit require additional help, the following options are available:
- Internal registry nurses are available for increased census, vacation and illness coverage.
- Add float pool and regular staff working above their time commitment (voluntary only).
- Occasionally, agency staff members from local staffing agencies are selected based on specific criteria.
Vanguard MacNeal Hospital's Acuity Model
Vanguard MacNeal Hospital's staffing guidelines for nursing care are based on the principles of a 1, 2 and, 3 acuity model. As stated above, there are many factors taken into consideration when planning for staffing. Patients requiring a low level of care are given a score of 1, patients requiring a medium level of care are scored a 2, and patients requiring a high level of care are scored a 3. Scoring is done in collaboration with the nurse manager, charge nurses on every shift, and direct care nursing staff. Acuity assessments are done every shift and whenever necessary so adjustments can be made in order to align the needs of the patients with the necessary skill mix of the nursing staff and the other considerations.
As a part of Vanguard MacNeal Hospital's extensive nursing self-governance model a nursing staffing committee was formed. It is composed of more that 50% direct care nurses and is facilitated by the Chief Nursing Officer with a direct care nurse Chair and Chair-Elect. The objectives of the nurse staffing council are to provide input and feedback based on selection, implementation, and evaluation of minimum staffing levels for inpatient units and to review the nurse-to-patient staffing guidelines and current acuity tools and measures in use. MacNeal Hospital leadership gives significant regard and weight to the recommendations of the nurse staffing committee and is actively involved in providing support to the process.
Budgeting for Staffing
At Vanguard MacNeal Hospital, Nursing Hours per Patient Day (HPPD) is used. The HPPD levels are one variable used to plan the annual budget and build variable staffing grids. However, in determining shift to shift patient care assignments, and validate staffing budgets, multiple factors are considered in addition to HPPD such as:
- Patient's Acuity
- Environment of care
- Skill mix of the staff
- Quality and Safety considerations
- Guidelines from Specialty Nursing Organizations
- External benchmarking such as:
- Nursing Database for Nursing Quality Indicators (NDNQI) indicators:
- Total nursing hours per patient day
- RN hours per patient day
- LPN/LVN hours per patient day,
- Unlicensed assistive personnel hours per patient day,
- Percent of total nursing hours supplied by RN's,
- Percent of total nursing hours supplied by LPN,
- Percent of total nursing hours supplied by unlicensed assistive personnel
- Percent of total nursing hours supplied by agency staff of all licensure categories,
- Percent of RN hours supplied by agency staff, RN education,
- Percent of RN education with BSN,
- Percent of RN with National Certification
After the annual budget is completed and approved, unit level variable staffing grids are created to serve as a guide in resource allocation and staffing decisions each shift, every day. Staffing grids for each patient care unit are located on this nursing website, at each unit and in the nursing staffing office.
Intensive Care Staffing
Medical & Surgical Staffing
Behavior Health Staffing
Labor and Delivery Staffing
Mother & Baby Staffing
Transitional Care Staffing