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Improving Staffing and Nurse Engagement in a Neuroscience Intermediate Unit

Nadolski, Charles; Britt, Pheraby; Ramos, Leah C.

Journal of Neuroscience Nursing: June 2017 - Volume 49 - Issue 3 - p 169–173
doi: 10.1097/JNN.0000000000000278
Clinical Nursing Focus
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ABSTRACT The neuroscience intermediate unit is a 23-bed unit that was initially staffed with a nurse-to-patient ratio of 1:4 to 1:5. In time, the unit’s capacity to care for the exceeding number of progressively acute patients fell short of the desired goals in the staff affecting the nurse satisfaction. The clinical nurses desired a lower nurse-patient ratio. The purpose of this project was to justify a staffing increase through a return on investment and increased quality metrics. Methods: This initiative used mixed methodology to determine the ideal staffing for a neuroscience intermediate unit. The quantitative section focused on a review of the acuity of the patients. The qualitative section was based on descriptive interviews with University Healthcare Consortium nurse managers from similar units. Design: The study reviewed the acuity of 9,832 patient days to determine the accurate acuity of neuroscience intermediate unit patients. Nurse managers at 12 University Healthcare Consortium hospitals and 8 units at the Medical University of South Carolina were contacted to compare staffing levels. Discussion: The increase in nurse staffing contributed to an increase in many quality metrics. There were an 80% decrease in controllable nurse turnover and a 75% reduction in falls with injury after the lowered nurse-patient ratio. These 2 metrics established a return on investment for the staffing increase. In addition, the staffing satisfaction question on the Press Ganey employee engagement survey increased from 2.44 in 2013 to 3.72 in 2015 in response to the advocacy of the bedside nurses.

Pheraby Britt, ADN RN SCRN, is Clinical Nurse, NSICU, Medical University of South Carolina, Charleston, SC.

Leah C. Ramos, MSN RN CCRN-K NE-BC, is Nursing Director, Medical University of South Carolina, Charleston, SC.

Questions or comments about this article may be directed to Charles Nadolski, BSN RN SCRN CNRN CSRN, at nadolski@musc.edu. Medical University of South Carolina, Charleston, SC.

The authors declare no conflicts of interest.

© 2017 American Association of Neuroscience Nurses