Contemporary staffing-mix changes: the impact on postoperative pain management

This retrospective, descriptive study of 2 surgical units in 2 hospitals examined correlations between staffing mix and pain management as a process indicator of quality after the implementation of a staffing model designed to increase unlicensed assistive personnel and decrease registered nurses and licensed vocational nurses in the skill mix. Statistically significant increases in numeric pain scores were found for patients (n = 203) in diagnosis-related group 209 who were dependent on nurse-administered analgesia (NAA) and for those patients given epidural or spinal analgesia. Pain scores for patients with patient-controlled analgesia tended to decrease, as did the scores of patients using a combination of patient-controlled analgesia and epidural/spinal anesthesia. A fair degree of relationship was found between increased registered-nurse staffing as a percentage of staffing mix and lower numeric pain scale scores for the NAA subgroup. Similarly, increased unlicensed assistive personnel staffing as a percentage of the staffing mix was found to be related to increased pain scale scores in the NAA subgroup.