The American Association of Critical-Care Nurses (AACN) has published AACN Standards for Appropriate Staffing in Adult Critical Care, the specialty’s first action-oriented staffing standards.
Appropriate staffing has long been one of the “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards), first published in 2005. It has also been one of the most complex areas to address.
On every national survey conducted by AACN to measure the health of clinical work environments between 2005 and 2019, nurses consistently gave lower ratings for survey items related to the appropriate staffing standard than those associated with the other HWE standards. In the most recent national survey conducted in 2021, the item labeled “ensuring an effective match between patient needs and nurse competencies” received the lowest mean rating of any element on any of these surveys.
Besides the HWE standards, the new staffing-specific standards build on AACN’s other influential resources related to nurse staffing, including the AACN Synergy Model for Patient Care and its 2018 “Guiding Principles for Appropriate Staffing.”
The standards also respond to recent recommendations from the Partners for Nurse Staffing Think Tank and the Nurse Staffing Task Force, both co-convened by AACN. Both groups called for specialty nursing organizations to define staffing standards for the patient populations they serve.
Developed by a work group with representatives from various nursing roles, “AACN Standards for Appropriate Staffing in Adult Critical Care” outlines seven standards to incorporate appropriate staffing into everyday operations and patient care. Each standard includes actions for organizational leaders, clinical leaders, and direct care nurses, as well as suggested exemplars, tools, and resources.
The link between healthy work environments and patient safety, nurse retention and recruitment, and an organization’s bottom line is irrefutable,” says Vicki Good, AACN chief clinical officer and co-editor of the staffing standards document. “These standards, coupled with a deep commitment to collaboration and change, provide an opportunity for evidence-based transformation that can profoundly improve the U.S. healthcare system’s ability to meet patients’ needs.”
The seven standards are as follows:
- Direct care nurses participate in all aspects of staffing: planning, implementation, and evaluation.
- Hospital patient care areas establish, evaluate, and refine unit-specific staffing guidelines based on their impact on patient and nurse outcomes.
- For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient’s needs and align nurse competency with patient characteristics.
- Clinical leaders such as charge nurses, educators, and nurse managers are not included in patient assignments, except in rare crisis situations.
- Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.
- Organizational staffing plans are designed to prioritize the health of the work environment, driving nurse retention and optimal patient outcomes.
- Organizational staffing plans anticipate that critically ill or injured patients generally require a ratio of one nurse to two patients.
The document also includes a section with answers to common questions that arose during the development of the standards, a glossary, and references.
