What are the ANA Safe Staffing Principles?
Given the strong evidence supporting positive links between safe staffing and quality patient care, the ANA published the Principles on Safe Staffing and the Utilization Guide to the Principles on Safe Staffing to guide the development of valid and reliable nurse staffing plans. This document recommends that nurse staffing plans be based on patient acuity, nursing expertise, skill mix, unit-level geography, and support services. The safe staffing principles are organized into three interrelated categories:
- Patient Care Unit Related: appropriate staffing levels for clinical units reflect individual and aggregate patient needs.
- Staff Related: patient needs should determine nurse competencies; RNs must have management support and be represented at both operational and executive levels.
- Institution Related: institutions should value nurses and seek their professional judgment on staffing needs, have documented competencies for all nursing staff, and recognize the various needs of both patients and nursing staff.
The importance of safe staffing principles is illustrated by some of the nurses who shared their stories on the ANA's Safe Staffing Website:
- One nurse who recently resigned from an Emergency Department (ED) staff position in a hospital where she had worked for 15 years, writes: "I loved the fast pace of the ED and making a difference with my patients, but when overflow stayed in the ED and I found myself with four beds of critical care patients, I had to say 'enough is enough;' my patients were not getting the care they deserved and my license was on the line…I'm now employed in a much safer ED and enjoy working again instead of being totally stressed out!”
- A nurse who works on a psychiatric unit, states: "…it is not uncommon for me to be responsible for 26 patients. Some of these patients may have medical problems, brittle diabetics included. Top this off with patients in psychosis and suicidal conditions; what you then have is a very unsafe/nerve-racking situation. Only a nurse could handle this, but he or she shouldn't have to…"
The ANA's safe staffing principles are designed to achieve safe, high quality patient care in clinical settings that value nursing competencies. ANA's principles call for registered nurses to drive the RN staffing levels through input of both nurses managers and direct care nurses, as it is the RNs who are critical to determining patient acuity and nursing care needs. Any staffing changes should be based on evaluation of unit-level nursing-sensitive indicators, such as those found in the ANA's National Database of Nursing Quality Indicators (NDNQI). The NDNQI staffing measures include nursing hours per patient day, staff mix, RN education and certification, RN job satisfaction, and nurse turnover. Data derived from such measures help to make the case that safe staffing improves outcomes for both patients and nurses. This collaborative approach to safe staffing can result in better outcomes for the nurse, the patient and the hospital.