Collaborating on Staffing Guidelines

In a recent article published in AACN Advanced Critical Care, the collaborative efforts of L.A. County Department of Health Services (DHS) hospitals were highlighted as they worked together to develop unit-specific guidelines for staffing critically ill patients. The hospitals involved in this initiative, including Harbor UCLA, Los Angeles General Medical Center, Olive View Medical Center, and Rancho Los Amigos Medical Center, recognized the need for standardized staffing ratios when patients require 1:1 nursing care.

The project originated at Harbor-UCLA Medical Center, a Level 1 trauma center with five critical care units that cater to extremely ill patients needing high levels of care. These patients often experience rapidly changing acuity levels, making it necessary to adjust nurse-to-patient ratios accordingly.

The article “Leadership and Staff Working Collaboratively to Develop Appropriate Staffing Guidelines” underscores the vital role of the collaborative process between frontline nurses, hospital leaders, and various healthcare professionals. This process is integral to establishing a clear policy for staffing critical care units, making each participant a valued contributor to the healthcare system.

While the standard staffing ratio across the DHS hospitals is one nurse to two patients, the guidelines address situations where patients require 1:1 care for an extended period. By providing objective criteria for determining when 1:1 care is necessary, the guidelines aim to prevent nurses from being assigned to care for two critically ill patients simultaneously. This ensures quality care and boosts staff morale and satisfaction by promoting equitable assignments.

The policy outlines specific scenarios that warrant 1:1 nurse-to-patient staffing, such as patients undergoing CRRT, postoperative open heart surgery, ECMO, proning, and critical burns. It also empowers charge nurses, trusting them to initiate 1:1 care when needed, even if the acuity scheduling system does not automatically trigger it. This responsibility enhances their sense of trust and promotes a culture of accountability.

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Nancy Blake, PhD, RN, CCRN, NEA-BC, FACHE, FAONL, FAAN, Chief Nursing Officer at Los Angeles General Medical Center, emphasized the initiative’s positive impact on staff well-being and retention. By involving frontline staff in the decision-making process regarding appropriate staffing, the project aims to reduce burnout and enhance morale among nurses.

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Renee Hewitt

Editor & Content Strategist at Springer Publishing

Renee is the editor and content strategist for Daily Nurse. When enjoying life unplugged from the digital world, you'll find Renee on a trail taking wildlife photos or birdwatching.