In 2023, 94% of healthcare facilities reported a shortage of nurses.1 These shortages can compromise patient care quality, hinder operational efficiency, and put a greater burden on the remaining staff members who must compensate for poor staffing levels.2 Meanwhile, higher staffing levels often result in fewer hospital-related mortality and adverse events. With 94% of nurses already reporting burnout symptoms, it’s imperative to manage healthcare staffing shortages effectively.3
Understanding Healthcare Staffing Ratios
Healthcare staffing ratios directly affect patient outcomes. One study indicated that patient mortality increased 7% for every additional patient in a nurse’s workload beyond a baseline ratio of 1:4.4 Another study showed the odds of in-hospital mortality were 12% higher with each extra patient.5 When nurses received an additional three patients in a 24-hour period, diagnostic evaluation in trauma emergency departments doubled from 30 minutes to one hour.5
California is currently the only state in the United States to mandate nurse-to-patient ratios:6
- General medical-surgical wards require a 1:5 ratio.
- Emergency wards require a 1:4 ratio.
- Critical care units require a 1:2 ratio.
Higher physician levels also lead to lower hospital mortality rates. According to one study, the risk of mortality doubled when a physician had more than 14 patients compared to having less than eight.7
Factors Affecting Ideal Staffing Levels
Finances typically drive staffing levels on the part of the hospital. This could lead to healthcare staffing shortages if facilities haven’t set the appropriate benchmarks for their staffing requirements and are instead aiming short of the optimal mark. The ideal healthcare staffing level for a hospital varies, depending on factors such as:
- Total number of patients: Assessing the average patient flow through the facility informs the number of required healthcare professionals.
- Patient acuity distribution: Average acuity distribution places the majority of patients in the intensification or intermediate category (26.7% and 42%, respectively), while 16% are acute, 14.4% are preintensive, and less than 1% are intensive or superintensive.8 Facilities with higher-than-average acuity require more staffing.
- Patient needs: Facilities should evaluate their patients’ demographics and most common needs. For example, one hospital reported that they serve many elderly people with low education levels who require additional time from nurses.
Methods for Calculating Staffing Needs
Calculating staffing needs is far from straightforward. To that end, organizations have developed and implemented several different methodologies to assess their staffing needs.
Patient Classification Systems
Patient classification/acuity systems (PACS) inform electronic staffing solutions by evaluating patient care needs and determining how these needs translate to appropriate staffing levels. PCASs evaluate patient needs based on several factors, including:
- Healthcare history
- Symptom burden
- Functional ability
- Social and career supports
- Personal resources
- Communication
- Care environment
The system will then apply a measure to this information. The most common tools are:
- Prototype tools: Patients receive a care level, such as minimum, moderate, or maximum.
- Summative task tools: Patient care is expressed in terms of concrete tasks and activities that receive an increment of time. This time converts to staff hours.
- Care interaction tools: This tool professionally evaluates care requirements, considering factors such as the type, frequency, duration, and complexity of care tasks.
Workload Management Systems
Workload management systems evaluate staffing levels, patient acuity, unit priorities, and nursing tasks to help facilities maintain proper staffing and efficient workflow. The World Health Organization developed the Workload Indicators of Staffing Need tool to help evaluate these factors and enable the efficient analysis of nurse workloads, facility staffing needs, and staffing imbalances.
Benchmarking
Healthcare benchmarking is the process of comparing one hospital, department, or other healthcare dimension against another to determine the best practices. This method requires active, voluntary collaboration among entities to drive quality improvement. Common key performance indicators for benchmarking include staff-to-patient ratios as well as:
- Patient follow-up rates
- Emergency room wait times
- Childhood immunizations
- Childhood obesity
- Media mentions
- Partnerships with advocacy groups
When organizations participate in benchmarking, it’s important to consider factors such as geographic region, regulatory climate, organization type, and demographic conditions, adjusting appropriately for these key differentiators. For example, geographic region and patient demographics play a major role in how many patients have insurance. In turn, coverage may determine whether patients complete the recommended follow-up visits.
Tools and Technologies for Staffing Optimization
Understanding how many professionals you need is only half the battle with healthcare staffing. Many facilities struggle to maintain an adequate workforce. Healthcare workers face a unique set of challenges in their profession. Compared to other industries, more healthcare workers indicate that their mental, physical, and financial well-being has declined over the past year. According to a 2023 survey, half of nurses feel there’s a severe shortage in their field, and 80% of nurses expect the shortage to get worse over the next five years.1
Recruiting and hiring tools are essential for healthcare facilities to increase and maintain staffing.
Matching the right candidate to the right job can help decrease turnover and ensure optimal job satisfaction. Multifaceted software solutions can also help you track key metrics, such as cost-per-hire and time-to-fill, so you can optimize your recruiting strategies. The best products facilitate:
- Streamlined job postings
- Simplified resume tracking and screening
- Optimized communication
- Integration with recruitment tools, such as scheduling software
Best Practices for Implementing Staffing Changes
Increasing the size of your staff can help ease some of the burdens on your team, but you need to take an organized and intentional approach to staffing changes to yield the best results. Make sure to follow these best practices:
- Involve staff in decision-making. Employees are more supportive of changes they’re involved in via staff meetings or surveys.
- Evaluate and optimize team structure. Adjusting the structure of your staffing can increase availability where you need it most.
- Prepare employees ahead of major staffing changes. Let your healthcare workers know about pending changes before you implement them.
- Train leaders to properly develop and support their staff. Make sure your leaders maximize all available tools.
- Regularly review and emphasize best practices in the facility. Routines, such as attending huddles at the beginning of a shift, can get overlooked if they don’t get ample focus.
- Continuously evaluate staffing needs. Review key metrics and focus on optimizing patient outcomes and avoiding employee burnout.
- Find an effective staffing partner. Companies such as Medix can streamline the staffing process, freeing your employees to focus on onboarding, training, and optimization.
Measuring the Impact of Staffing Changes
Evaluating KPIs will help you optimize your approach to healthcare staffing so you can enjoy lasting results. As many as 57% of first-year nurses leave within two years, resulting in up to $7 million in turnover costs each year.9 Avoid these expenses by keeping a keen eye on:
- Employee Net Promoter Score: The likelihood your employees will recommend your hospital as a good place to work.
- Employee satisfaction index: A measurement of your workers’ attitudes toward their jobs.
- Employee turnover rate: A measurement of how quickly employees leave your organization.
- Absenteeism rate: The amount of time employees take off in a given period.
- Vacation time usage: How much of their allotted vacation time your employees use.
- Digital workplace adoption: The rate at which your employees adopt digital tools and systems.
Overcoming Common Staffing Challenges
Maintaining adequate staffing is a major challenge in the healthcare industry. Just 15% of nurses plan to continue working in their current location and position a year from now, and only 36% plan to stay in nursing at all.1 As more nurses leave the field, those remaining face the stress and strain of overtime. These extra hours lead to decreased mental and physical health among healthcare workers. To maintain the workforce you have and successfully attract new talent that will stay, implement some smart strategies for employee retention:
- Introduce acuity-based staffing models to determine how many nursing hours each situation requires.
- Utilize predictive analytics for staffing needs so past data informs future decisions.
- Offer flexible scheduling options to optimize work-life balance.
- Provide career advancement opportunities and continuing education programs.
- Create formal mentoring and residency programs.
- Address workplace safety concerns promptly.
- Offer competitive compensation packages.
Partner with a staffing agency to fill open positions so your HR staff can focus on the above enhancements. Medix can help you find the right people for your most essential positions.
Evaluating and maintaining ideal healthcare staffing levels is an ongoing process that requires thoughtful consideration, powerful tools, and a commitment to continuous improvement. The right partners can make a big difference in your outcome. Contact Medix for continuing support for all your staffing needs.
