Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Levels of Decision-Making Related to Promoting Effective Staffing and Workload Practices
  • Nursing staff must not work beyond capacity (i.e. understaffing) and must work to full scopes of practice to enable healthy work environments. All adjustments starting with the demand for care must be based on these premises.
  • Within the staffing process, decisions are made by all nursing staff on an ongoing basis and include nurse staffing decision-making and patient/client flow decision-making.
  • Three levels of decision-making are characterized as:
    1. Nursing management strategic decision-making:
      • Strategic nursing staffing decision-making (guidelines on nurse utilization rates, staff mix and staffing levels).
      • Strategic patient/client-flow decision-making (policies on nursing regarding the number and types of patients/clients admitted).
    2. Nursing management logistical decision-making:
      • Logistical nursing staffing decision-making (nursing staff scheduling for a fixed period).
      • Logistical patient/client-flow decision-making (patient/client admission scheduling, etc.).
    3. Nursing management tactical decision-making:
      • Tactical nursing staffing decision-making (last minute adjustments).
      • Tactical patient/client-flow decision-making (transfer of patient/client from one unit or another, cancellation of scheduled admissions).