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Factors Associated With the Implementation of a Nurse Staffing Directive
Ann M Annis1, Claire H Robinson, Nicholas Yankey
1Author Affiliations: Postdoctoral Fellow (Dr Annis), Research Health Science Specialist (Ms Robinson and Mr Yankey), Research Career Scientist (Dr Krein), and Research Scientist (Dr Duffy and Dr Sales), Center for Clinical Management Research, VA Ann Arbor Healthcare System, Michigan; Research Professor (Dr Krein), School of Nursing and Department of Internal Medicine, and Professor (Dr Sales), Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor; Professor (Dr Duffy), College of Nursing, Ohio State University, Columbus; and Associate Director for Patient Care Services (Dr Taylor), VA Southern Arizona Health Care System, Tucson.
Background:
In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing.
Objective:
We aimed to describe experiences and factors related to SM implementation.
Methods:
We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified.
Results:
Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers.
Discussion:
Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.
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