Implementing an Alternative Patient Care Technician Staffing Model on a Medical Unit: A Cross-Sectional Study

Many patient care tasks can be safely performed by nonlicensed personnel, allowing licensed nursing staff to focus on care that requires specific clinical expertise. A shortage of nurses and patient care technicians (PCTs) often leads to missed essential nursing care, reduced job satisfaction, poorer outcomes, and increased costs.

The purpose of this study was to evaluate whether a newly established staffing model, which paired one nurse and one PCT for every five patients, markedly increasing the number of PCTs, could enhance patient and staff outcomes while also lowering costs.

A project proposal was developed and approved by leadership that included estimates of cost savings after the changes in staffing ratios. The study period was from July 1, 2024, to December 31, 2024. Data analysis took place from January 1, 2025, to February 28, 2025. After discussions with leadership, the acute care medical unit transitioned from a 1:4 RN-to-patient ratio and a 1:10 to 1:12 PCT-to-patient ratio to a 1:5 RN-to-patient ratio and 1:5 PCT-to-patient ratio. A MISSCARE Survey, which evaluates perceptions of and reasons for missed nursing care, as well as perceptions of a unit's working environment (teamwork), was distributed to all unit staff members before implementation of the staffing change and again six months after implementation. Quantitative data included MISSCARE Survey responses, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) nursing communication scores, and bathing compliance, as well as the financial calculations (contingency labor hours and unit overtime and vacancy rates). Data were analyzed using descriptive statistics and Mann-Whitney tests.

Of 51 eligible staff members, 26 completed the baseline survey and 32 completed the postimplementation survey. Of the 24 missed care items in the survey, statistically significant improvements were seen in six: complete documentation, meal setup, toileting, bathing and skin care, feeding patients, and patient teaching and education. Additionally, statistically significant improvements were observed in HCAHPS nursing communication scores and unit bathing compliance. All cost-related outcomes also improved significantly, including reduced contingency labor hours, decreased RN/PCT vacancy rate, and decreased overtime, resulting in a total of $453,228 in annual departmental savings.

Meaningful improvements in care delivery, patient outcomes, staff experience, and unit costs were observed on this acute care medical unit after the creation of a more balanced staffing model through adjustments in the RN and PCT staffing ratios. These findings support expansion and scaling of the new model to gather longitudinal data on its potential impact.