Developing a staffing matrix using CMI as acuity indicator

Adequate staffing levels on an acute rehabilitation unit may not be maintained because staffing needs fluctuate according to the needs of patient groupings. Acuity regulations from some state agencies and the Joint Commission on Accreditation of Healthcare Organizations require that staffing address patient acuity needs. Proposed ratio laws either require concrete patient-to-nurse ratios or neglect to consider acute rehabilitation. Neither have practical working tools to support their proposals. The questions of what to measure and how to translate this into effective nursing staffing remain unanswered. At the same time, nursing dissatisfaction grows with increased workloads, overtime, and perceptions of ineffectiveness. This article describes one effort to define and use a working tool for staffing acute rehabilitation units. The study used case mix index as an indicator of nursing time, integrated into a shift staffing matrix. Early results have shown it to be effective, quick, flexible, and efficient. Using this tool, quality patient outcomes within national length of stay benchmarks were maintained and staff satisfaction on this unit improved.