Safe Staffing For Pediatric Patients
Increasing attention is being focused on the impact of adequate nurse staffing on patient-outcomes and the multiple factors that can affect safe staffing. At the same time that mounting research is supporting the vital role that nurses play in patient outcomes, the national nursing shortage is negatively affecting the number of nurses available (American Nurses Association, 2000; Buerhaus, Staiger, & Auerbach, 2000).
The Institute of Medicine’s report of September 1999 first called the public’s attention to the problem of increased patient morbidity and mortality related to errors occurring within healthcare delivery systems (Institute of Medicine, 1999). Since this time there has been a growing emphasis on patient safety, process improvement, and the potential effects of adequate staffing. In 2002, the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) supported this patient safety initiative by introducing a standard requiring hospitals to measure performance indicators of staffing effectiveness linked to patient outcomes (JCAHO, 2002).
Studies by Aiken and colleagues demonstrated an increase of 30% in mortality risk for patients being cared for by nurses with average workloads of eight or more patients compared with those patients being cared for by nurses with a workload of four or fewer patients (2002, 2003). While these studies focused on adult patients, the same concerns exist regarding the relationships between adequate staffing and outcomes in pediatrie patients.
The Society of Pediatric Nurses (SPN) believes the following additional factors are of critical importance regarding safe staffing for pediatric patients:
* The acuity and intensity of nursing resources required to care for children have been growing steadily over the last decade (National Association of Children’s Hospitals and Related Institutions [NACHRI], 2003).
* The number of children living below the poverty level is higher now than 25-30 years ago and contributes to deficits in primary and preventive health care and results in increased healthcare issues and higher acuity for these children (Children’s Defense Fund, 2002).
* The multitude of settings providing pediatric care and the wide range of resources available in each setting greatly affect the type and number of nursing staff required to care for any given patient population.
SPN believes that all children and their families should receive high quality family-centered care. As an advocate for patients, families, and the pediatric nursing profession, SPN endorses the following recommendations:
1. No single published ratio for nurse staffing is automatically applicable in all settings where children receive care. Published recommendations for staffing ratios must be carefully evaluated for the particular pediatrie setting since these ratios may inadvertently minimize the complexity and multitude of issues that must be considered in the care of pediatric patients and their families.
2. The professional registered nurse must be considered an essential member of the team providing care for children and their families; staffing plans must reflect this vital role (American Nurses Credentialing Center, 2003).
3. Staffing plans and assignments should be developed which promote developmentally appropriate, high quality care for children and families.
4. While the specific details of these staffing plans will vary with individual patient needs and facility resources, SPN believes the following factors should be considered in all staffing situations:
a. Number and acuity of patient population.
b. Assessment of patient needs including special developmental, physiological, psychosocial, and learning needs of children and their families,
c. Availability of specialized pediatric equipment and supplies to provide the necessary care and the availability of other support services to assist in the delivery of care (e.g., child life, social services, chaplain services).
d. Staff competency, specifically the extent of experience and specialized pediatric training of available staff.
e. Family involvement and/or the family’s special needs related to. meeting the healthcare needs of the child (Lewandowski & Tesler, 2003).
f. Comparable pediatric staffing benchmark data and/ or staffing guidelines from other pediatric focused professional organizations should be used if at all possible (NACHRI, 2003; National Association-of Neonatal Nurses [NANN], 1999); the American Academy of Pediatrics [AAP] (2003, 2002, 1999, 1993).
5. Nurses caring for pediatric patients must have appropriate education and experience to demonstrate competency in the care of this highly-specialized patient population. The core concepts as cited in the following sources should be included in education and training:
* Scope and Standards of Pediatrie Nursing Practice (American Nurses Publishing, 2003)
* Core Curriculum for the Nursing Care of Children and Their Families (Broome & Rollins, 1999)
* Standards and Guidelines for Pre-Licensure and Early Professional Education for the Nursing Care of Children and Their Families (Woodring, 1998).
6. Organizations and nursing staff providing care for pediatric patients should commit to ongoing maintenance of nursing staff’s clinical competency through continuing education that ensures a current knowledge base of issues and trends in pediatrie care delivery.
7. Organizations should work to establish practice environments characterized by open communication, teamwork, and effective collaborative problem solving to address nurse staffing issues and ensure safe, effective care for children and families.
8. Nurses are encouraged to assume professional accountability for their own practice. Nurses have the accountability for the following:
* Being an advocate for the role of the registered professional nurse
* Being knowledgeable of state practice acts
* Being knowledgeable of the mechanisms available to address potential staffing issues
Aiken, L.H., Clark, S.P., Sloane, D.M., Sochalski, J., & Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288, 1987-1993.
Aiken, L.H., Clarke, S.P., Cheung, R.B., Sloane, D.M., & Silber, J.H. (2003). Education levels of hospital nurses and patient mortality. Journal of the American Medical Association, 290, 1-8.
American Academy of Pediatrics. (2003). Clinical report: Facilities and equipment for the care of patients in a community hospital. Pediatrics, 111(5), 1120-1122.
American Academy of Pediatrics. (2002). Policy statement: Guidelines for pediatric cardiovascular centers. Pediatrics, 109(3), 544-549.
American Academy of Pediatrics. (1999). Policy statement: Guidelines for pediatric perioperative anesthesia environment. Pediatrics, 103(2), 512-515.
American Academy of Pediatrics. (1993). Policy statement: Guidelines and levels of care for pediatric intensive care units. Pediatrics, 92(1), 166-175.
American Nurses Association. (2003). Scope and standards of pediatric nursing practice. Washington, DC: American Nurses Publishing.
American Nurses Association. (2000). Nursing staffing and patient outcomes: In the inpatient setting. Washington, DC: Author.
American Nurses Credentialing Center (ANCC). (2003). The Magnet Recognition Program For Excellence in Nursing Service Health Care Organization, Instructions and Application Process. Pub# MAGMAN03. Washington, DC: Author.
Broome, M., & Rollins, J. (Eds.). (1999). Core curriculum for the nursing care of children and their families. Pitman, NJ: Jannetti Publications.
Buerhaus, P.I., Staiger, D.O., & Auerbach, D.I. (2000). Implications of an aging registered nurse workforce. Journal of the American Medical Association, 283, 2948- 2954.
Children’s Defense Fund. (December 2002). Basic facts on poverty. Child Poverty FAQs. Washington, DC: Author. Institute of Medicine. (1999). To err is human: Building a safer health care system. Washington, DC: Author.
Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). (2002). Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: Author.
Lewandwoski, L. A., & Tesler, M. D. (Eds.). (2003). Family-centered care: Putting it into action: The SPN/ANA guide to family-centered care. Washington, DC: American Nurses Publishing.
National Association of Neonatal Nurses. (1999). Minimum staffing in NICUs. Glenview, IL: Author.
National Association of Children’s Hospitals and Related Institutions (NACHRI). (2003). Clinical Practices Service Program: Benchmark data. Available from www.childrenshospitals.net/nachri.
Woodring, B. (Ed.). (1998). Standards and guidelines for pre-licensure and early professional education for nursing care of children and their families. DDHS, Bureau of MCH, Document, #H112R77. Washington, DC: U.S. Government Printing Office.
Printed with permission from Patricia M. Adkison
Copyright Alabama State Nurses’ Association Mar-May 2004
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