ENA's new guidelines for determining emergency department nurse staffing.

D uring the past decade, ENA has worked to address the need for defining what constitutes safe and effective ED nurse staffing. ED nurse managers, administrators, physicians, and, more recently, government officials have attempted to identify a method to determine the optimum number of nurses required to care for the patient population of individual emergency departments. Traditionally, staffing has been based on annual patient census alone. More recently, consideration has been given to patient acuity and/or nurse-to-patient ratios when determining ED nurse staffing. Based on a review of the literature, the most frequently mentioned system for determining nurse staffing in the emergency department was the calculation of hours per patient visit (HPPV). By using this method, the number of staff hours are calculated per year based on the actual paid hours and divided by the total number of ED visits to yield a number in hours per patient visit. However, the use of this type of system to determine staffing poses problems; it does not take into consideration critical factors such as patient acuity, length of stay (LOS), or nursing workload (interventions and activities). In this system an ED patient is counted as a single visit whether he or she has a sore throat or a myocardial infarction and remains in the emergency department 20 minutes or 20 hours. Benchmarking and comparing emergency departments is difficult in this system because of the variability in patient acuity and LOS, both of which have a dramatic impact on nursing resources. The Work Group considered it essential to focus on " safe and effective " staffing for emergency departments. To address the concept of safe and effective staffing, it is important to understand the difference between benchmark staffing data and best practice staffing data. Benchmarking has been used extensively in health care institutions to compare performance between facilities. Benchmarking is the continual and collaborative discipline of measuring and comparing the results of key work processes with those of the best performers in a group. 1 Being the best performer in a group does not necessarily indicate best practice; it simply compares a performance indicator between one institution and others. Best practice is defined as a service, function, or process that has been fine-tuned, improved, and implemented to produce optimal outcomes. 2 The Work Group has adapted that definition to define best practice staffing as that which provides timely and effective patient care while …