Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Staffing Is More Than a Number

Using Workflow to Determine an Appropriate Nurse Staffing Ratio in a Tertiary Care Neurocritical Care Unit

Hill, Michelle; DeWitt, Jessica

Journal of Neuroscience Nursing: October 2018 - Volume 50 - Issue 5 - p 268–272
doi: 10.1097/JNN.0000000000000387
Clinical Nursing Focus

ABSTRACT Objective: To enhance nursing staff retention and ensure a consistently high standard of care, a study was conducted to determine an appropriate nurse staffing model for a neurocritical care unit. In addition to being critically ill, these patients often require extensive diagnostic testing to determine treatment. Nurses traveling with patients leave higher nurse-patient ratios remaining on the unit. Methods: Prospective observation was used to assess relationships between neurologic assessment, documentation, and the amount of time spent traveling with patients. Patient acuity and nursing experience were also measured. Results: Over the 30-day study period, more than 226 hours were spent traveling, equivalent to approximately 38% of a single nurse’s shift. There was no correlation between the experience of nurses and the time necessary to perform a neurologic assessment. When controlling for acuity, a relationship was found between nursing experience and the time needed to chart an assessment. Conclusions: Significant time was spent every day off the floor, in addition to the documentation and performance of frequent assessments. These results advocate for a staffing position without a dedicated patient assignment but to assist with traveling and high-acuity patients so that safe and attentive care can be consistently given.

Questions or comments about this article may be directed to Michelle Hill, MS RN AGCNS-BC CNRN CCRN SCRN, at She is Stroke Program Coordinator, Riverside Methodist Hospital, Columbus, OH.

Jessica DeWitt, BSN RN, is Neuroscience Outcomes Manager, Riverside Methodist Hospital, Columbus, OH.

The authors declare no conflicts of interests.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2018 American Association of Neuroscience Nurses