York Hospital Improves Patient Safety and Nurse Staffing

When staff surveys and feedback revealed a concern among nurses about patient assignments and the provision of safe patient care, the TCAB team at York Hospital set out to determine the number of patients one nurse can care for. This is a difficult task, as individual patients have varying care requirements. With staff input, the team developed and tested a patient acuity tool designed to predict how much nursing time each patient requires and based staffing assignments on the estimates. The tool incorporates specific care tasks, such as feeding patients, as well as factors affecting medical stability, such as abnormal labs. During every shift, a patient’s acuity is assessed on a 1-5 scale, with 1 being the lowest acuity (e.g., waiting for discharge) and 5 being the highest acuity, with more complex patients needing the most nursing time. Additional nurses may be needed on the floor when there are many patients with high acuity, and fewer nurses when the acuity is low. The tool meets American Nurses Association guidelines and incorporates unit specific characteristics, evidence-based best practices, and overall hemodynamic stability guidelines. York nurses now know where the sickest patients are-where the most help is needed . As a result of the acuity tool, nurses feel empowered and engaged, and that work is being performed in safer and more equitable ways. Recent team vitality surveys show that more than 94 percent of the nurses feel they can speak up when they have a safety concern, feel free to discuss challenging issues, and feel that their ideas count.