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An Objective Method to Determine Nurse Staffing for an Acute Care for Elders (ACE) Hospital Unit: Discrete Event
Sandra F Simmons1,2,3, Emily K Hollingsworth1,2, Jason M Slagle4
1Vanderbilt University Medical Center, Center for Quality Aging, Nashville, Tennessee, USA.
Journal of the American Geriatrics Society
|May 9, 2025
Summary
Discrete event simulation (DES) can objectively evaluate nurse staffing for acute care for elders (ACE) units. Optimal staffing reduces workload and care omissions, improving elder inpatient care.
Area of Science:
- Geriatric Medicine
- Healthcare Management
- Nursing Science
Background:
- Acute Care for Elders (ACE) units are common, but objective nurse staffing models are under-evaluated.
- Older inpatients often have complex needs, including mobility and cognitive assistance.
Purpose of the Study:
- To objectively evaluate registered nurse (RN) and nursing assistant (NA) staffing allocations in an ACE unit using discrete event simulation (DES).
- To assess the impact of different staffing models on nursing workload, care quality, and efficiency.
Main Methods:
- Discrete event simulation (DES) was applied to model an ACE unit's clinical care environment.
- Standardized data on nursing tasks and time requirements were collected to simulate varying RN and NA staffing levels.
Main Results:
- The most common staffing model (4 RNs, 1 NA) led to high workload (89% RNs, 88% NAs) and predicted care omissions (6.2%).
- RNs frequently assisted with NA tasks (83% for toileting/mobility).
- Alternative staffing (4 RNs/3 NAs or 5 RNs/2 NAs) showed lower workload, fewer omissions, and reduced RN reliance on NA tasks.
Conclusions:
- DES offers an objective method for determining nurse staffing needs in ACE units.
- This simulation approach can safely evaluate the impact of nurse staffing variations.
- The DES model is adaptable for other hospital units caring for older patients.
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