Collected Input: Administrative Practices (Staffing/Service Volume & Staffing Mix)
Original information from MDH worksheet is in orange highlight, italicized serif font. When original information is used or modified in input
materials, the original information is italicized.
Staffing volume relative to service volume including quantity of nursing attention
Variable and Data Element
Description
Nursing hours per patient day
OR
Nurse to patient ratio
OR
Nurse staff full-time equivalent
employment (FTEE)
Key Assumptions
•
•
•
•
•
•
•
•
[Nursing hours per patient day
OR Nurse to patient ratio
OR Nurse staff full-time equivalent
employment (FTEE)]
[Nursing hours per patient day
OR Nurse to patient ratio
OR Nurse staff full-time equivalent
employment (FTEE)]
Includes registered nurse (RN), licensed vocational/practical nurse
(LVN/LPN), unlicensed assistive personnel (UAP), and contract nurses.
Only includes inpatient “productive hours” and excludes non-patient care
hours for documentation, supervision, care coordination and other noninpatient care as well as time off for illness, vacation or continuing
education.
Nurse to patient ratio is expressed as:
𝑁𝑢𝑟𝑠𝑒𝑠
𝑃𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑁𝑢𝑟𝑠𝑖𝑛𝑔 𝐻𝑜𝑢𝑟𝑠
=
𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠
Measurement and Data
Source
Hospital staffing reports
from payroll or
management system.
𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐷𝑎𝑦𝑠 𝑋 24
Full-time nursing staff is assumed to have “productive hours” of 85 percent
of a potential of 52 weeks per year at 40 hours per week, resulting in 1,768
potential hours per year: FTEE = Total nursing hours/1,768
Data is provided at the inpatient care unit level and provided in both
medical/surgical and intensive care categories.
A patient day is 24 hours.
Is adjusted for patient turnover.
Is adjusted for patient acuity
Includes registered nurse (RN), licensed vocational/practical nurse
(LVN/LPN), unlicensed assistive personnel (UAP), and contract nurses.
The MHA website will be
an unadjusted source of
this information for all
inpatient units in all
Minnesota hospitals
Variable and Data Element
Description
“careful matching of nurse staffing on
a shift-by-shift basis with the actual
patients cared for during that shift.”
(Shekelle, p. 407 referencing
Needleman)
Key Assumptions
•
•
•
Includes registered nurse (RN), licensed vocational/practical nurse
(LVN/LPN), unlicensed assistive personnel (UAP), and contract
(definition?) nurses, calculated separately.
Only includes inpatient “productive hours” and excludes non-patient
care hours for documentation, supervision (what is the definition of
supervision?), care coordination and other non-inpatient care as well
as time off for illness, vacation or continuing education.
Nurse to patient ratio is expressed as:
𝑁𝑢𝑟𝑠𝑒𝑠
𝑃𝑎𝑡𝑖𝑒𝑛𝑡𝑠
=
𝑃𝑟𝑜𝑑𝑢𝑐𝑡𝑖𝑣𝑒 𝑁𝑢𝑟𝑠𝑖𝑛𝑔 𝐻𝑜𝑢𝑟𝑠
𝑃𝑎𝑡𝑖𝑒𝑛𝑡 𝐷𝑎𝑦𝑠 𝑋 24
Full-time nursing staff (definition?) is assumed to have “productive
hours” of 85 percent of a potential of 52 weeks per year at 40 hours
per week, resulting in 1,768 potential hours per year: FTEE = Total
nursing hours/1,768 (is “productive hours” synonymous with direct
patient care?)
• Data is provided at the inpatient care unit level and provided in both
medical/surgical and intensive care categories.
• A patient day is 24 hours.
• Is adjusted for patient turnover.
Is adjusted for patient acuity.(these items are accounted for later in
“patient care” section
•
Measurements of Inputs:
• Staffing HPPD
• Resource Availability Inventory
24 hours is helpful, [but] data at the 8
hour shift level might be more
informative as it reflects changes in
number of staff as well as changes in
mix that may occur at different times
of the day
Measurement and Data
Source
Hospital staffing reports
from payroll or
management system.
Electronic medical record.
Variable and Data Element
Description
Key Assumptions
If the unit of analysis is the hospital, then we should measure at least an
average activity adjusted N-P ratio or activity adjusted productive nursing
hours per patient day. I would advocate for looking at N-P ratios,
The average N-P ratio can be close to the target N-P ratio in a unit, but
the variability can be significant. For a unit level analysis, I would
recommend that there be a metric that captures not just the average
activity adjusted N-P ratio, but also the variability.
Measurement and Data
Source
I don't know if this is a
reasonable request from
hospitals in terms of how
hard it would be for them
to create the data to
produce it.
Process Measurements
• Filled/Unfilled shifts
on final schedule
• Planned HPPD
• Actual HPPD
Staffing mix
Variable and Data Element
Description
Key Assumptions
Measurement and Data
Source
Type of nursing staff (share of
RN,LVN/LPN,UAP)
Experience levels of staff
Concentration of nurse(s) to patient
(single nurse attention or many)
[Type of nursing staff (share of
RN,LVN/LPN,UAP)]
The MHA website will be
an unadjusted source of
this information for all
inpatient units in all
Minnesota hospitals
This does not currently
exist to our knowledge
[Experience levels of staff]
Type of nursing staff (share of
RN,LVN/LPN,UAP)
Categories of providers [not Staffing
Mix]
Skill Mix - Experience, education
levels of staff (Benner’s model of
novice to expert)
Non-nursing staff available to support
the work of the nurses. If you have a
full, competent complement of
pharmacists, respiratory techs, lab,
housekeeping, etc., the impact on the
nursing job could be significant
Charge nurses eval staffing mix for pt assignments is experience level. NO
charge nurse states that I have all these LPN and UAP so I do not need
RNs to perform care.
Variable and Data Element
Description
The use of specialty teams or nursing
assignments might need to be
captured … these nurses are often not
assigned to patients and therefore
may not be included in the
calculations. Here I am thinking of
teams such as transport teams, rapid
response teams, admitting nurses,
float or support nurses (sometimes
called the flying squad or other unique
names).
Key Assumptions
We need more discussion regarding whether all nursing types would be
included as one group (RN, LPN, etc) versus splitting them out. Activity
plus LOS adjustment would get at the notion of 'patient turnover'.
It will be helpful to gather this in a manner similar to the staffing volume
as the mix is not uniform and does change by shift and day. By
incorporating the mix with the volume the same data source might be
able to be used.
Measurement and Data
Source
Collected Input: Patient Care (Patient Medical Needs, Patient Demographics)
Original information from MDH worksheet is in orange highlight, italicized serif font. When original information is used or modified in input
materials, the original information is italicized.
Patient Medical Needs
Variable and Data Element
Description
Key Assumptions
Measurement and Data
Source
Reason for admission, clinical service
type, patient acuity, discharge status,
disposition of patient
[Reason for admission, clinical service
type, patient acuity, discharge status,
disposition of patient]
Available through claims
data at hospital-level, not
unit level
Ideally, the staffing metric should also adjust for acuity workload, but I
think an acuity standardized metric across hospitals would be difficult
since the acuity software is usually a 'black box' in terms of how it is
calculated.
Measurements of Inputs:
• Patient Days
• LOS
• Acuity Score
• Admissions/discharges
[Reason for admission, clinical service
type, patient acuity, discharge status,
disposition of patient,] case mix
Patients’ hospital course as compared
to the staffing. I would staff a patient
who is day 1 post-spine surgery
differently than day 3 for example
Patient Demographics
Variable and Data Element
Description
Key Assumptions
Measurement and Data
Source
Age, gender, payment source
Alone or visited
Patient education on reason for
admittance (printed or
communicated)
Cooperative or resistant patient
[Age, gender, payment source]
Age, gender, payment source
Available through claims
data at hospital-level, not
unit level
Collected input: Patient Outcomes (Nurse Sensitive Indicators)
Original information from MDH worksheet is in orange highlight, italicized serif font. When original information is used or modified in input
materials, the original information is italicized.
Nurse-sensitive indicators
Variable and Data Element
Description
Key Assumptions
Measurement and Data
Source
Death among surgical inpatients with
treatable serious complications (failure
to rescue)
Pressure ulcer prevalence
Patient falls
Restraint prevalence
Medication administration accuracy
Catheter associated blood stream
infections
[Death among surgical inpatients with
treatable serious complications (failure
to rescue)]
[Pressure ulcer prevalence]
[Patient falls]
[Medication administration accuracy]
[Restraint prevalence]
[Catheter associated blood stream
infections]
Currently reported
through SQRMS at
hospital-level
Variations of this may be
collected at hospital level;
not publicly reported
Not collected to our
knowledge
Publicly reported to CDC
for ICUs – PPS hospitals
only
Variable and Data Element
Description
Key Assumptions
Considers nurse driven catheter removal protocol
HCAHPS evaluates satisfaction with pain management
• Catheter Associated UTI
• Pain Management
[Death among surgical inpatients with
treatable serious complications (failure
to rescue)]
• Mortality
• Pneumonia
• length of stay/readmission
• restraint
• pulmonary compromise
• deep vein thrombosis
• GI bleed
• Shock arrest
• Nosocomial infections
• UTIs
• Skin breakdown
Outcome Measures:
• LOS/Readmission rates
• Mortality Rates
• Reportable Events
• Patient Experience Scores
• Accreditation status
Ventilator assisted blood stream
infections among ICU patients
Patient Experience
There is evidence to show that this outcome is related to nursing care
Should include both positive and negative outcomes
Measurement and Data
Source
MDH, Hospital Compare
Many (all?) hospitals are
measuring this