Using Medication Pass Analysis to Examine Longitudinal Changes in VA Inpatient Nurse Staffing and Workload Before and...

The COVID-19 pandemic resulted in extended disruption to the health care system. National-level data-driven comparisons of inpatient nurse staffing and workload before and during the pandemic have been limited.

Assess the extent to which registered nurse (RN) staffing and workload changed from prepandemic levels in a national integrated health care system.

Longitudinal descriptive analysis. Medication pass analysis using bar code medication administration data for the peak-time medication pass (PTM) assessing year-over-year changes from 2019 to 2022. To assess significance of year-over-year changes in means we used the Welch 2-sample t test.

Staff (N=42,999) administering PTM medications on Veterans Health Administration acute-care inpatient units (643 units; 127 facilities) from January 1, 2019, to December 31, 2022 (3,681,802 staff days).

Staffing: unique staff, staff days, staff per day, patients per staff (PPS); workload: patient days, medications, medications per patient, medications per RN, PTM duration.

RNs administered 93.6% of peak-time medications. Fewer non-RNs administered medications after the onset of the pandemic. The average number of patients per RN (PPS) in 2022 was 3.3 on medical, 3.2 on mixed medical-surgical, 3.3 on surgical, 2.5 on step down, and 1.5 on critical care units. The greatest increase in PPS from 2019 to 2022 occurred on surgical units (+0.20, P<0.0001). Across nearly all unit types and levels of PPS, medications per RN were greater and duration was longer in 2022 than in 2019.

RN staffing and workload fluctuated widely at the onset of the pandemic. In 2022, new patterns began to emerge, showing a higher RN workload than before the pandemic.