Albeit controversial, mandating nurse staffing ratios is one way of approaching staffing in patient care areas. The American Nurses Association (ANA) has been outspoken on this issue, calling for legislation mandating staffing plans and ratios. A recent ANA survey of nearly 220,000 RNs reported that 54% of nurses do not have sufficient time with patients, 43% have been working extra hours because of short staffing, and 20% found that inadequate staffing affected admissions, transfers, and discharges.
If you are seeking resources related to determining nurse staffing in radiation oncology, the following organizations can help guide you. As part of its mission, the American College of Radiation Oncology (ACRO) has developed a Practice Accreditation Program, consisting of standards for radiation oncology. According to the Manual for ACRO Accreditation, general staffing recommendations call for 1 nurse per 200–300 new patients per year.
More work has been done looking at staffing in ambulatory care settings. This work has focused on nursing workload models and adequate staffing based upon these measures. In 2005, Gaits identified four categories of questions that can be used to guide staff allocation decisions. The questions focus on
To date, most of the data related to staffing in the inpatient setting have been general, with few addressing oncology unit needs. Nursing Management: Principles and Practice (Gullatte, 2011) includes two chapters that may be helpful when looking at inpatient nurse staffing.
The American Nurses Association’s (ANA’s) Principles for Nurse Staffing is designed to address safe and sufficient nurse staffing across diverse healthcare settings and specialty areas, establishing criteria for evaluating the comprehensiveness of healthcare systems. The ANA development panel recognized that patient care needs are so complex and variable that relying on minimum staffing standards often does not reflect the reality of safe patient care.
There are currently no published standards for nurse-patient ratios in oncology settings. In fact, ONS has decided not to recommend staffing standards because of significant variations among institutions, patient populations, care settings, and individual patient needs.
Research has demonstrated a correlation between nurse staffing ratios and patient outcomes. In her integrated analysis, Curtin (2003) wrote:
With healthcare reform legislation and a diverse set of challenges presenting themselves each day, nursing management has never been more complicated. Nursing leaders need resources and tools to support the constantly shifting demands in healthcare management and, ultimately, patient care.