Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Recommendations

For detailed discussion of evidence and framework, please consult the full guideline, available for download at www.rnao.org/bestpractices.

Organizational Recommendations (Consult the full guideline for detailed organizational recommendations, pg. 39 – 51)

  1. Organizations plan, implement, and evaluate staffing and workload practices at the three levels of decision-making – strategic, logistical, and tactical – that result in staffing that facilitates the delivery of safe, competent, culturally sensitive and ethical care.

    Decisions about staffing to facilitate safe and quality care incorporate the following principles:

    1.1 Strategic nursing staffing processes support the delivery of safe, competent, culturally sensitive and ethical care by:

    • Ensuring that the budget is aligned with the required staffing levels to meet patient/client needs and accommodate replacement, orientation and professional development.
    • Maximizing continuity of care and continuity of care givers.
    • Responding to staff work life considerations and work preferences.
    • Being fair and equitable.
    • Ensuring a full-time/part-time ratio of 70% / 30% to enable continuity of care and to ensure patient/client safety, a quality work environment and stability in the workplace.
    • Ensuring that the category of nurse used reflects the best evidence available, recognizing the strong association between category of nurse and health outcomes for patients/clients.
    • Ensuring that nursing utilization rates are kept at a level necessary to achieve a balance between patient/client needs, the nursing effort, the experience, educational preparation and scope of practice of nursing staff, and the organizational demands.

    1.2 Logistical nursing staffing processes are conducted by unit/operational nurse
    leader(s) who have the requisite knowledge, professional judgment, skills and authority, in collaboration with nursing staff, at the point of care by ensuring that:

    • Nurse leaders can make decisions about the impact of changes to the patient/client care delivery systems on nursing staffing and workload.
    • A process is in place that results in a schedule that reflects an optimal trade-off between nurses’ preferences and the required coverage to meet patient/client care needs, while recognizing contractual obligations and human resources policies

    1.3 Tactical nursing staffing processes result in balancing the required and actual nursing staff on each nursing unit or team at each shift or time-frame of care and are carried out by nurses at point of care who have the requisite knowledge and skills.

    Tactical staffing decision-making includes:

    • adjusting staff supply (using contingency staff);
    • adjusting staff required (transferring patient/client or cancelling scheduled admissions, scheduled programs or nurse visits); or
    • adjusting both staff supply and staffing required.

    Tactical staff decision-making is facilitated by:

    • mechanisms in place to adjust to changes in patient/client acuity and staff replacement needs such as an internal resource team and pre-scheduling of replacement staff; and
    • nurses in all roles empowered to make appropriate staffing decisions that result in safe, competent, ethical care.
  2. The board, administrative leadership and human resources planning department work collaboratively to ensure that processes, infrastructure and staff are in place to provide adequate nurse staffing to meet patients’/clients’ needs.

    2.1 Nursing fiscal planning provides for effective base staffing, and replacement of staff, and has the flexibility to accommodate changes in patient/client acuity affecting nursing intensity.

    2.2 Nursing budgets include financial resources for professional development, education, orientation, mentoring and other support systems needed to augment the skills and competencies in the face of changing technologies and influx of new staff.

  3. Organizations engage nurses in all roles, in all phases of the strategic planning process, including development, implementation and evaluation.
  4. Strategic planning and policy making that affects nursing workload and nurse staffing strategies are informed by measures that capture the impact of inputs, throughputs and outputs, as reflected in the Patient Care Delivery Systems Model (view guideline pg.14).
  5. Financial and human resources are dedicated to support an infrastructure of integrated electronic systems to effectively design, manage and evaluate the scheduling, staffing, workload measurement and patient/client flow processes to meet the needs of patients/clients, nurses, other providers and the health care system.

Health System Level Recommendations (Consult the full guideline for all the Health System Recommendations, pg. 52-56)

  • Recommendations for Accreditation Bodies (pg. 52)
  • Recommendations for Government (pg. 53-54)
  • Recommendations for Research ( pg. 55-56)