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EXECUTIVE SUMMARY
ANA's Principles for Nurse Staffing, Second Edition, does not offer the sole methodology to planning and allocating nurse staffing, but does explain the myriad of factors that must be taken into account in order to achieve a successful plan.
It is a compass for navigating those "natural forces" that can foil even the best staffing plans.
As delivery systems evolve towards better care, so too must the attitudes towards nurse staffing.
ANA's Principles provide policy direction that all nurses, managers, policymakers, and consumers can use to address nurse staffing.
Appropriate nurse staffing must be the purview of all who have a stake in patient safety, quality care, and better health for the nation.
REGISTERED NURSE STAFFING is a complex issue that requires nimble, flexible solutions. Yet, it is a de-cades-old conquest. Thirty years ago, a U.S. Department of Health and Human Services (DHHS) report, Factors Affecting Nurse Staffing in Acute Care Hospitals: A Review and Critique of the Literature, introduced the topic in this way:
Nurse staffing problems are perennial and universal. The history of nursing can be said to be, in large part, a history of attempts to respond to patient care needs with an appropriate organization and allocation of nurse staffing resources. The choice, however, of optimal strategies for the provision of patient care is complicated by underlying natural forces that give rise to an erratic flow of patients through hospital facilities and by concomitant uncertainty as to expected demands (DHHS, 1981, p. 1).
Even then, it was evident the complex, ever-changing dynamics of health care, and in particular hospital care, made nurse staffing difficult. The best staffing plans were subject to failure in light of unexpected occurrences, such as rapid changes in the census and unforeseen rises in patient acuity levels. Unfortunately, those realities are much the same in today's care environment, if not more complicated. And, as in 1981, an absolute solution to all staffing issues in all facilities is elusive.
But the intent of the DHHS report was not to lay out the problems without offering a road to a solution. One of the recommendations states, "Finally there is an urgent need for greater discussion, communication, and evaluation of the interaction of the many factors affecting the...