Position Statement

Factors To Consider In Decisions About Staffing In Rehabilitation Nursing Settings

The following information was developed by a task force of the Association of Rehabilitation Nurses’ Administrative Management Special Interest Group (SIG). It suggests factors to consider to provide effective, cost-efficient quality care that is delivered by rehabilitation nursing staff who have specialized skills and knowledge.

Rationale

Staffing decisions involve a process of determining patient care needs and providing the staff skill mix that offers an effective number of nursing hours per patient day to deliver care. Rehabilitation nursing settings differ in patient population, the number of staff available, administrative/budgetary issues, admission criteria, levels of care, and workload. Variables to be considered when planning and assigning staff include:

• Patient Acuity
• Availability of specialized rehabilitation nursing professionals
• Availability of substitute/float staff that is appropriately oriented and cross-trained
• Accessibility of support systems
• Admissions
• Discharges
• Transfers
• Patients' diagnoses
• Available technology
• Architecture and geography of the environment

Review and accrediting agencies generally expect staffing to be within an assessed level which is based on patients' diagnoses and patient census. Rehabilitation nurse managers must be creative in meeting the needs of the nursing service areas by scheduling the available staff so that the days of the week and shifts correspond to the needs of the organization and the patient (e.g. bathing, managing bowel programs, and providing patient education activities). Maximum flexibility is desirable in terms of assignment of specialized rehabilitation nursing professionals to meet patient care needs effectively and in a fiscally sound manner.

Recommendations

Since there is not a standard system for determining nurse staffing ratios specific to rehabilitation nursing based on available research, rehabilitation nurse managers should:

1. Provide input into the selection of a written nurse staffing plan and validation of its applicability to their individual setting.
2. Participate in quality improvement endeavors that support staffing as it relates to positive patient outcomes, functional improvement, patient satisfaction, nurse satisfaction, and prevention of patient readmission.

References

American Nurses Association. (2012). Principles for nurse staffing (2nd ed.). Silver Spring, MD:
     Author.

Association of Rehabilitation Nurses. (2003). Role Description: Rehabilitation nurse manager
     [Brochure]. Retrieved from www.rehabnurse.org.

Benjamin, J.M., & Warner, B.H. (1996). Principles of leadership and management for
     rehabilitation nurses. In S.P. Hoeman(Ed.), Rehabilitation nursing: Process and application
     (2nd ed., pp. 70-86). St. Louis: Mosby.

Commission on Accreditation of Rehabilitation Facilities. (2008). Standards manual and
     interpretive guidelines for medical rehabilitation. Tucson: CARF.

Resources

Nelson, A. Powell-Cope, G., Palacios, P., Luther, S.L., Black, T., Hillman, T., Christiansen, B.,
     Nathenson, P., Coleman Gross, J. (October/November 2007). Nurse staffing and patient
     outcomes in inpatient rehabilitation settings. Rehabilitation Nursing, 32 (5), 179-202.

Approved August 1995
Revised July 1999
Reviewed June 2006
Revised October 2014

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