Appropriate nurse staffing levels contribute to the delivery of safe quality care and optimal patient outcomes. However, developing nurse staffing models, particularly in the ambulatory setting, is an ongoing challenge. Within this position statement, the term ambulatory setting includes infusion centers that provide treatment to patients with cancer, including non-chemotherapy treatment centers (e.g., blood products) and radiation therapy treatment centers. These settings share commonalities, including rapid turnover of patients and the administration of some type of treatment or intervention. Nurse staffing refers to the clinical nurses in the setting and does not include advanced practice nurses or nurses in other roles.
Oncology treatments continue to transition to the ambulatory setting, and the care needed for patients is multifaceted. Many inpatient staffing models exist, with federal and state regulations often driving the requirements for nurse staffing levels. No standard staffing model or nurse-to-patient ratio currently exists for ambulatory infusion/chemotherapy treatment centers or radiation therapy treatment centers.
In previous surveys of Oncology Nursing Society (ONS) members, staffing is frequently cited as a top concern. Determining appropriate staffing can be complex, with several variables affecting decisions, including patient-, personnel-, and institution-based. Some centers have developed home-grown tools or implemented a commercial product to address scheduling and staffing. Many of these tools are based on the acuity rating of the patient and may incorporate other factors, such as a nurse’s skill set and experience. However, acuity is not just measured by time spent in the infusion center. The care needs of the patient and his or her support system are complex and can fluctuate throughout the care spectrum.
In addition to surveys of membership, ONS has engaged with members on the topic of ambulatory staffing via the online ONS Communities, focus groups, and email inquiries sent to ONS. Based on member feedback, survey data, and a review of the existing literature, ONS has developed this position statement to provide recommendations and guidance for ambulatory centers as they develop their specific staffing plan. Definitions of terminology are provided (American Nurses Association, 2017, 2019):
It is the position of ONS that
Approved by the ONS Board of Directors, October 2019.
American Nurses Association. (2017). Defining staffing: Workforce management, patient classification and acuity systems, the request for proposal process. Retrieved from http://bit.ly/33CPGDz
American Nurses Association. (2019). ANA’s principles for nurse staffing (3rd ed.). Silver Spring, MD: Author.
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