A staffing template based on daily patient volume and hours of operation with defined nurse roles and responsibilities ensures efficient nursing practice, reduces costs, and maintains quality patient care across a health care system, according to a poster presented at the 2016 ASCO Quality Care Symposium.1
Because nursing roles and responsibilities and appropriate staffing levels were not established for the ambulatory oncology infusion suites across a health care system, whether nurses were working to their highest skill level or performing appropriate activities could not be determined. Furthermore, treatment across the system varied despite similar patient populations at the different sites, introducing unnecessary costs to the system as a whole.
This project sought to establish a defined role for the infusion nurse, a target nurse-to-patient ratio, and create efficiencies within the clinical setting.
To do this, daily patient volume and hours of operation were compiled for the outpatient sites across the health care system, and 3 methodologies—an acuity-based ratio tool, an hours per unit (HPU) method using billed charges for technical procedures, and a simple 1:6 nurse-to-patient ratio based on patient volume—were used to determine nurse-to-patient ratio. The 3 methodologies produced similar results.
The project team chose a target nurse-to-patient ratio of 1:6 as the model, and created a staff template for each site. In addition, the team observed workflows to determine potential staffing adjustments.
The pilot site was initially staffed with 14 full-time nurses. However, the project team found nurses performed many nonclinical, nonnursing duties.
Through process improvement, clear role delineation was created that maximized the efficiency of the nursing team; the site currently operates with 5 full-time nurses. The adjustments maximize the efficiency of the nursing team and reduce costs without any decline or compromise in quality of patient safety.
The team was able to duplicate the staffing template and its effects at the other infusion sites, thereby achieving a staffing level that matches patient care needs across the health system.
1. Rodgers GT. Development of an infusion nurse staffing model for outpatient chemotherapy centers. J Clin Oncol. 2016;34(suppl7S):Abstract 103.