Inpatient Nursing- Medical/Surgical

RRM Category: INPATIENT CARE

Overview

Inpatient Nursing Service provides a variety of types of nursing care; usually organized by nursing unit around a central control station. The RRM Inpatient Nursing - staffing module estimates the requirements for nursing staff to provide all inpatient nursing services. Inpatient Nursing Service contains distinct and separate services, organized by unit with separate nursing stations by specialty, i.e., General Medicine, Surgical, Obstetrics, Operating/Recovery Room, and ICU/CCU. Most units have their own nurse manager. The workload parameters that are the key variables in the staffing estimation are the Average Daily Patient Load (ADPL) and the number of surgical or OB/GYN cases, plus deliveries.

Types of care may be organized by specialty i.e. medicine (MED), surgical (Surg), obstetrics and gynecology (OB/GYN), Labor and Delivery (LDR), operating/recovery room (OR), and intensive care unit (ICU). Nursing units may be a combination of service types such as a medical/surgical unit. Staffing is based on the driver of the service, i.e. Average Daily Patient Load (ADPL) for medical, surgical, and the LDR units while surgical cases are used for OR. The driver workload is determined by the Health Systems Planning (HSP) workload projection methodology. The number of beds on a unit is determined by the workload and a projection formula which rounds up to the next even number of required beds. Remoteness of a location will be an additional factor in determining the number of beds.

Nursing services will not be generated until the driver threshold is met. Generally there will be a fixed minimum staff based on the presence of the nursing unit which will be augmented through use of the variable staffing formulae. Variable staff is determined based on workload for a specific user population beyond the workload driver threshold required for the service. Workload projections are based on sex and age groupings use ratios of the user population.

Nurses provide acute care services 24 hours per day, 365 days per year to patients with a high intensity of illness. These patients may be no longer dependent, but may still require complex technologies Most units have their own Supervisory Clinical Nurses (SCN).

There are two basic types of hospitals in the Indian Health Service, the Alternative Rural Hospital (ARH) and the Full Service Hospital (FSH).

• The ARH ranges in size from 4 to 16 beds with ADPL of 2 to12 and requires a minimum user population of 6,000. The ARH offers emergency room services and low acuity inpatient care. The ARH may also include low risk birthing services, but must provide a minimum of 125 deliveries. This facility does not provide inpatient surgery, C-sections or ICU services.
• The FSH, as a minimum, shall have 5,500 inpatient days or an ADPL of 15 and a minimum user population of 16,000. The FSH shall perform a minimum of 300 deliveries per year to qualify for OB/GYN and 200 surgery cases for surgery services.

Services Description:

The Medical Surgical Inpatient Nursing RRM module estimates the number and type of nursing staff and describes the scope of services for the Medical/Surgical service. The Average Daily Patient Load (ADPL) is the driver of staffing for Med/Surg and the type of facility planned. This module estimates the need for Nurse Managers, Registered Nurses, LPN/Technicians, and Clerical Support by type of nursing unit for the two types of hospitals, alternative rural or full service. The ADPL is computed as patient days divided by 365; however, this quotient is increased by 25% to account for staffing requirements to meet peak workload periods.

Gen Medicine/Surgery: Nurses provide general medical and post surgical nursing care. These services include all duties pertaining to inpatient nursing care. Rapid changes in the patient’s condition may occur and nursing assessments and management of multiple problems is essential. The patients may have multi-system problems, are at risk for complications, and are relatively unstable. For example: There are different classification levels of patients. There also include patients awaiting transfer to a higher level of care.

Pediatrics on the Medical/Surgical unit: Nursing services may be provided in a Med/Surg unit at some FSH and at ARH for pediatric patients Special requirements for security and safety will be addressed in the physical design of a unit.

Detox Service/Mental Health: Detoxification services may occur on the Med/Surg unit in the absence of an ICU. If detox services are included in a service plan special planning must occur in the planning stages and special consideration to provide appropriate care and patient management as well as staff adjustments.

Palliative Care: Includes terminal care and end of life nursing services which are not currently included in the HSP but may be included in future service planning.

Staffing Criteria

Alternative Rural Hospital

Fixed Supervisory Registered Nurse - Staff of 0.5 for facilities with 4-6 ADPL , 1.0 FTE for facilities with 7-12 ADPL.

Register Nurse - Fixed Staff of 5.0 FTE/facility plus variable FTE of 0.3 times ADPL.

Licensed Practical Nurse/LPN - Fixed staff of 1 FTE plus variable FTE of 0.16 times ADPL

Health Tech - Variable FTE of .16 times ADPL. Clerical Support staff - Fixed Staff of 0.5 FTE for facilities with 4-6 ADPL and 1.0 FTE for facilities with 7-12 ADPL.

Nurse Educator – 1.0 FTE

The Alternative Rural Healthcare Facility with a Birthing Unit will receive the following Birthing Unit Staff:

Registered Nurse - 5 FTE per Unit

Midwife – 2.0 FTE per Unit

Staffing Formulae

Driving Variables:

ADPL
Birthing Unit

Personnel Categories:

Supervisor Registeres Nurse
Registered Nurse
Nurse Educator
LPN/LVN
Clerical Support
Midwife
Health Tech
Nurse Specialist (Multiple Function)

MINIMUM STAFFING LEVELS:

VARIABLE STAFFING LEVELS:

Staffing Criteria

Full Service Hospital

Supervisory Clinical Nurse Unit Manager – Staff of 1.0 FTE per Gen Med/Surg nursing unit.

Registered Nurse - Staff of 14.65 FTE per Med/Surg nursing unit, plus 0.30 RN FTE for every additional 1 ADPL above 10 ADPL.

Licensed Practical Nurse/LVN – Staff of 4.65 FTE per Med/Surg nursing unit, plus 0.16 FTE for each additional 1 ADPL above 10 ADPL.

Nurse Educator – 2.0 FTE for each facility.

Transport/Lift – Staff of 0.50 FTE per Med/Surg nursing unit, plus 0.25 FTE for every 10 ADPL above 10 ADPL.

MSA/Certified Nurse Assistant – Staff of 4.0 FTE per Med/Surg nursing unit, plus 0.4 FTE for every 1ADPL above 10 ADPL.

Multiple Function RN – Staff of 0.25 FTE per Med/Surg nursing unit, plus 0.25 for every 10 ADPL above 10 ADPL (may be combined with other nursing units).

Staffing Formulae

Driving Variables:

Nursing Stations
ADPL
Unit

Personnel Categories:

Supervisory Clinical Nurse
LPN/LVN
Transport/Lift Tech
Nursing Assistant
Nurse Educator
Nurse Specialist (Multiple Function)

MINIMUM STAFFING LEVELS:

VARIABLE STAFFING LEVELS: