Oncology Nurse Staffing Is Variable and Multifactorial

Nurse staffing varies from institution to institution, depending on many factors, both internal and external. To gain a better understanding of nurse staffing, ratios of nurses to patients, and productivity, a survey was sent to ONS members. At the ONS 37th Annual Congress, responses to the survey pertinent to inpatient oncology settings were presented and discussed by Angela Adjetey-Appiah, RN, patient care director, New York-Presbyterian Hospital/Columbia University Medical Center, New York City. Due to the survey’s findings, she said, the ONS plans to add a section with staffing exemplars to its website.

“The goal of staffing each oncology inpatient unit is to ensure patient safety in healthcare delivery,” Adjetey-Appiah explained. “Nurses are scheduled in sufficient numbers to provide quality and safe care. The staffing mix is a determinant of the safety of the work environment and the safety of patient care. Nurse recruitment and retention efforts are critical to retaining expert staff.”

According to Adjetey-Appiah, the American Nurses Association’s principles for nurse staffing suggest that the following factors be identified:

1. Volume of patients
2. Intensity level of the care needed by patients
3. Characteristics of the work environment, including architecture and available technology
4. Experience and expertise of the nursing staff

The support of a multidisciplinary staff is important, she added, as is a facility’s involvement, or lack thereof, in research at the basic-science or clinical level.

Because patient needs are ever-changing, Adjetey-Appiah said, patient classification and acuity systems that are used to track and predict nurse staffing needs can be helpful, and easily understood by nurses when taught appropriately.

Table. Nurse Staffing Survey Results

The total number of oncology beds in inpatient hospitals ranged from 30 to 217.

Overall, the average nurse-to-patient ratio was 1:5; with chemotherapy, the average ratio was 1:4 or 1:3.

Patient populations at respondents’ institutions were as follows: 32% included medical oncology; 12.5% had non-oncology medical; 15.5% had surgical oncology; and 8% had non-oncology surgical.

Twenty nine percent of respondents’ institutions utilized non-licensed staff; 6% did not; and 65% did not specify.

Productivity measures were used to determine staffing in 26.5% of respondents’ institutions and were not used in 5.5%; 68% of respondents did not answer this question.

Non-licensed personnel were included in the productivity measure, according to 24% of respondents, while 2.5 % of respondents said they were not included and 73.5% did not answer the question.

When asked which productivity measures were used to set staffing, 18.5% used hours per patient day; 1% used hours per adjusted patient day; 0.5% used budgeted hours; 0.5% used budgeted productive hours; 5% used nurse/patient ratio; 1% used “other”; and 73.5% did not answer the question.

“To determine how many patients one nurse can care for is a difficult question to answer due to the variety of settings in oncology inpatient units. Any nurse will tell you it all comes down to the individual patient and how much care he or she needs,” Adjetey-Appiah commented.

Two hundred people responded to the ONS survey (Table). Responses give a bird’s-eye view of staffing situations in various inpatient units; however, about two-thirds of respondents did not answer several questions.

Based on the survey results and on staffing principles, some examples of staffing guidelines are as follows, with the same number of registered nurses (RNs) needed for either a day or a night shift:

• For 1-8 patients, 2 RNs
• For 9-12 patients, 3 RNs
• For 13-16 patients, 4 RNs
• For 17 to 20 patients, 5 RNs
• For 21 to 24 patients, 6 RNs
• For 25 to 28 patients, 7 RNs
• For 29 to 32 patients, 8 RNs
• For 33 to 36 patients, 9 RNs

“The survey confirms why ONS opted not to have set guidelines on staffing,” Adjetey-Appiah said. “The diversity and variety of inpatient units are too complex to set one standard. However, the survey revealed a need to use exemplars as guidelines when staffing oncology units. Examples collected from different institutions will be posted on the ONS website.”