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.

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. The recommended hours should be determined from census, admission, discharges, transfers, number of contacts a nurse has in a shift to meet the intensity of nursing care required by the patients who are served. This written system should consider the following critical factors: number of patients; levels of intensity of the patients for whom care is being provided; contextual issues including architecture and geography of the environment and available technology; and level of preparation and experience of those providing care. Rehabilitation nurse managers (who hold 24-hour accountability for the management of (a) rehabilitation unit(s) within a healthcare institution), should have input into the selection of the written system to validate its applicability to their individual settings, since there is not a standard system in use that is specific for rehabilitation based on available research. Additionally, rehabilitation nurse managers should participate in quality improvement endeavors that support staffing as it relates to Positive Patient Outcomes, functional improvement, patient satisfaction, and prevention of patient readmission.

Rehabilitation nursing settings differ by age and diagnoses and functional ability as to their patient populations, the number of staff available, administrative budgetary issues, admission criteria, and level of care and workload. Variables to be considered when planning and assigning staff are the acuity of the patients, as measured by the written system, the availability of specialized rehabilitation nursing professionals, the availability of substitute/float staff appropriately oriented and cross-trained, and the accessibility of support systems. The proportions of skill mix of licensed and unlicensed staff are also based on these variables and the chosen care delivery model. Review and accrediting agencies generally expect staffing to be within the assessed level, which is based on patients’ condition and 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 organization and patient’s needs, 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.

References

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. (1995). Standards Manual and Interpretive Guidelines for Medical Rehabilitation. Tucson: CARF.

ARN Rehabilitation Nurse Manager Role Description Brochure

Principles for Nurse Staffing (1999) American Nurses Association. Washington, D.C.

Approved August 1995
Revised July 1999
Reviewed June 2006

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