Factors Associated With the Implementation of a Nurse Staffing Directive

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Abstract

BACKGROUND

In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing.

OBJECTIVE

We aimed to describe experiences and factors related to SM implementation.

METHODS

We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified.

RESULTS

Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers.

DISCUSSION

Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.

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