Schwalenstocker, E., Bisarya, H., Lau, S. & Adebimpe, O. (2007). Nursing-sensitive indicators for children's hospital care quality: Indicators are essential, but further testing is needed for use in comparing hospital performance. A white paper prepared by the Pediatric Data Quality Systems (Pedi-QS) Collaborative. September 2007. Retrieved on line February 8, 2011. http://www.childrenshospitals.net/AM/Template.cfm?Section=Site_Map3&Template=/CM/ContentDisplay.cfm&ContentID=29730.
Problem Statement
Rationale and Supporting Information
American Organization of Nurse Executives. (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 2011. http://www.aone.org/aone/advocacy/ps_ratios.html.
American Organization of Nurse Executives. (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 2011. http://www.aone.org/aone/advocacy/ps_ratios.html.
American Nurses Association. (2010). Safe staffing saves lives. Federal legislation: Registered nurse safe staffing act. Retrieved on-line February 13, 2011. http://www.safestaffingsaveslives.org/whatisANAdoing/federallegislation.aspx?css=print
- ■There are unique challenges with caring for children. These challenges include the following:
- ○Infants and young children are dependent upon adult caregivers and require closer supervision.
- ○Many children have not yet acquired the communication skills to warn clinicians about a potential mistake or verbalize possible adverse effects about their care.
- ○Medication administration is much more complex since weight based dosing is required for most medications (Kaushal et al., 2001).
- ○
- ■The acuity and intensity of nursing resources required to care for children have been growing steadily (Monsen and Finley, 2007,National Association of Children's Hospitals and Institutions, 2003).
National Association of Children's Hospitals and Related Institutions. (2003). Clinical practices service program: Benchmark data. Available from www.childrenshospitals.net/nachri.
- ■Of the 14.1 million children in the United States living in poverty, 1 in 10 lack health care coverage (Children's Defense Fund., 2010). Childhood poverty contributes to deficits in primary and preventative health care and results in increased health care issues and higher acuity for these children (
Children's Defense Fund. (2010). The state of America's children 2010. Retrieved on line February 13, 2011. http://www.childrensdefense.org/child-research-data-publications/data/state-of-americas-children-2010-report.html.
Children's Defense Fund, 2002). - ■Pediatric nurses practice in many settings including hospitals, schools, homes, clinics, long term care facilities, and public health centers. The multitude of settings and the wide range of resources available in each setting greatly affect the type and number of nursing staff required to care for any given patient population. The level of experience of nursing staff, unit layout, and level of ancillary support must be considered when establishing the staffing needs and assignment plan for any given unit (Nurses Association, 2007,
American Nurses Association. (2007). Acute care staffing. Nursing's legislative and regulatory initiatives for the 110th Congress: Appropriate staffing. Retrieved on-line: February 13, 2011. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/legis/AcuteCare.aspx.
Institute of Medicine, 2010).
Society of Pediatric Nurses Position/Recommendations
- 1.Staffing is a complex issue composed of multiple variables (American Organization of Nurse Executives, 2003). No single published ratio for nursing staffing is automatically applicable in all settings where children receive care. Published recommendations for staffing ratios must be carefully evaluated for the particular pediatric setting since these ratios may inadvertently minimize the complexity and multitude of issues that must be considered in the care of pediatric patients and their families.
American Organization of Nurse Executives. (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 2011. http://www.aone.org/aone/advocacy/ps_ratios.html.
- 2.The professional registered nurse must be considered an essential member of the team providing care for children and their families; staffing plans must reflect this vital role (Nurses Credentialing Center, 2003).
- 3.Health care institutions should develop valid and reliable staffing plans (Nurses Association, 2010) and patient assignments should promote developmentally appropriate, high quality care for children and families. Nursing leadership, registered nurses and other designated nursing staff should be involved in the development of staffing plans and proper preparation of staff for the patient populations cared for within the facility (
American Nurses Association. (2010). Safe staffing saves lives. Federal legislation: Registered nurse safe staffing act. Retrieved on-line February 13, 2011. http://www.safestaffingsaveslives.org/whatisANAdoing/federallegislation.aspx?css=print
Joint Commission, 2010).Joint Commission. (2010). Joint commission accreditation resources: Accreditation manager plus. Retrieved on-line: February 21, 2011. http://qvcsql01/JCRAMP/Frame.aspx.
- 4.While the specific details of these staffing plans will vary with individual patient needs and facility resources, SPN believes the following factors should be considered in all staffing situations:
- a.Number and acuity of the patient population.
- b.Assessment of patient needs including special developmental, physiological, psychosocial, and learning needs of children and their families.
- c.Availability of specialized pediatric equipment and supplies to provide the necessary care and the availability of other support services such as respiratory care, child life, social services, and spiritual care (American Academy of Pediatrics, 1998,American Academy of Pediatrics, 2004a,American Academy of Pediatrics, 2004b,American Academy of Pediatrics, 2006).
- d.Level of education, competency, and the extent of experience and specialized pediatric training of available staff.
- e.Family involvement and/or the family's special needs related to meeting the health care needs of the child (American Academy of Pediatrics, 2006,Lewandowski and Tessler, 2003).
- f.Comparable pediatric staffing benchmark data and/or staffing guidelines from other pediatric focused professional organizations should be integrated into developing staffing plans if at all possible (American Academy of Pediatrics, 1998,American Academy of Pediatrics, 2004a,American Academy of Pediatrics, 2004b,American Academy of Pediatrics, 2006,American Nurses Association, 2008,National Association of Children's Hospitals and Institutions, 2003,
National Association of Children's Hospitals and Related Institutions. (2003). Clinical practices service program: Benchmark data. Available from www.childrenshospitals.net/nachri.
National Association of Neonatal Nurses, 2008).National Association of Neonatal Nurses. (2008). Minimum RN staffing in NICU's. Retrieved online February 11, 2011. http://www.nann.org/pdf/08_3009_rev.pdf.
- a.
- 5.Nurses caring for pediatric patients must have appropriate education and experience to demonstrate competency in the care of this highly specialized patient population. The core concepts as cited in the following sources should be included in education and training:
- ■Pediatric Nursing: Scope and Standards of Pediatric Nursing Practice (American Nurses Association, 2008)
- ■Position Statement on Family Centered Care Content in the Nursing Education Curriculum (Society of Pediatric Nurses, 2008)
Society of Pediatric Nurses. (2008). Position statement on family centered care content in the nursing education curriculum. Retrieved on-line: February 21, 2011. https://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,doc_view/gid,193/.
- ■Position Statement on Child Health Content in the Undergraduate Curriculum (Society of Pediatric Nurses, 2007)
Society of Pediatric Nurses. (2007). Position statement on child health content in the undergraduate curriculum. Retrieved on-line: February 21, 2011. https://www.pedsnurses.org/component/option, com_docman/Itemid,222/task, doc_view/gid,102/.
- ■Core Curriculum for the Nursing Care of Children and Their Families (Broome and Rollins, 1999)
- ■Standards and Guidelines for Pre-Licensure and Early Professional Education for the Nursing Care of Children and Their Families (Woodring, 1998).
- ■
- 6.Organizations and nursing staff providing care for pediatric patients should commit to ongoing maintenance of nursing staff's clinical competency through continuing education that ensures a current knowledge base of issues and trends in pediatric care delivery.
- 7.Organizations should work to establish practice environments characterized by open communication, teamwork, and effective collaborative problem solving to address nurse staffing issues and ensure safe, effective care for children and families.
- 8.Nurses are encouraged to assume professional accountability for their own practice. Nurses have accountability for the following:
- ■Being an advocate for the role of the registered professional nurse
- ■Being knowledgeable of state practice acts
- ■Being knowledgeable of the mechanisms available to address potential staffing issues.
- ■
References
- Implications of the California nurse staffing mandate for other states.Health Services Research. 2010; 45: 904-921
- Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction.Journal of the American Medical Association. 2002; 288: 1987-1993
- Child life services.Pediatrics. 2006; 118: 1757-1763
- Levels of neonatal care.Pediatrics. 2004; 114: 1342-1347
- Guidelines and levels of care for pediatric intensive care units.Pediatrics. 2004; 114: 1114-1125
- Facilities and equipment for the care of pediatric patients in a community hospital.Pediatrics. 1998; 101: 1089-1090
American Nurses Association. (2010). Safe staffing saves lives. Federal legislation: Registered nurse safe staffing act. Retrieved on-line February 13, 2011. http://www.safestaffingsaveslives.org/whatisANAdoing/federallegislation.aspx?css=print
- Pediatric nursing: Scope and standards of practice.Author, Washington DC2008
American Nurses Association. (2007). Acute care staffing. Nursing's legislative and regulatory initiatives for the 110th Congress: Appropriate staffing. Retrieved on-line: February 13, 2011. http://www.nursingworld.org/MainMenuCategories/ANAPoliticalPower/Federal/legis/AcuteCare.aspx.
American Nurses Credentialing Center. (2003). The magnet recognition program for excellence in nursing service health care organization, instructions and application process. Pub# MAGMAN03. Washington, DC: Author.
American Organization of Nurse Executives. (2003). AONE policy statement on mandated staffing ratios. Retrieved on-line: January 21, 2011. http://www.aone.org/aone/advocacy/ps_ratios.html.
- Broome M. Rollins J. Core curriculum for the nursing care of children and their families. Jannetti Publications, Pittman, NJ1999
Children's Defense Fund. (2010). The state of America's children 2010. Retrieved on line February 13, 2011. http://www.childrensdefense.org/child-research-data-publications/data/state-of-americas-children-2010-report.html.
- Basic facts on poverty. Child Poverty FAQs. Author, Washington DC2002
- The future of nursing: Leading change, advancing health. Report brief: 2010. Author, Washington, DC2010
- To err is human: Building a safer health care system.Author, Washington, DC1999
Joint Commission. (2010). Joint commission accreditation resources: Accreditation manager plus. Retrieved on-line: February 21, 2011. http://qvcsql01/JCRAMP/Frame.aspx.
- The association of registered nurse staffing levels and patient outcomes. Systematic review and meta-analysis.Medical Care. 2007; 45: 1195-1204
- Medication errors and adverse drug events in pediatric inpatients.Journal of the American Medical Association. 2001; 285: 2114-2120
- Lewandowski L.A. Tessler M.D. Family-centered care: Putting it into action: The SPN/ANA guide to family-centered care. American Nurses Publishing, Washington, DC2003
- Nurse staffing and adverse events in hospitalized children.Policy, Politics & Nursing Practice. 2007; 8: 83-92
- Shortage of nurses and child health.Journal of Pediatric Nursing. 2007; 22: 231-232
National Association of Children's Hospitals and Related Institutions. (2003). Clinical practices service program: Benchmark data. Available from www.childrenshospitals.net/nachri.
National Association of Neonatal Nurses. (2008). Minimum RN staffing in NICU's. Retrieved online February 11, 2011. http://www.nann.org/pdf/08_3009_rev.pdf.
- Nurse staffing in hospitals: Is there a business case for quality?.Health Affairs. 2006; 25: 204-211
Schwalenstocker, E., Bisarya, H., Lau, S. & Adebimpe, O. (2007). Nursing-sensitive indicators for children's hospital care quality: Indicators are essential, but further testing is needed for use in comparing hospital performance. A white paper prepared by the Pediatric Data Quality Systems (Pedi-QS) Collaborative. September 2007. Retrieved on line February 8, 2011. http://www.childrenshospitals.net/AM/Template.cfm?Section=Site_Map3&Template=/CM/ContentDisplay.cfm&ContentID=29730.
Society of Pediatric Nurses. (2008). Position statement on family centered care content in the nursing education curriculum. Retrieved on-line: February 21, 2011. https://www.pedsnurses.org/component/option,com_docman/Itemid,222/task,doc_view/gid,193/.
Society of Pediatric Nurses. (2007). Position statement on child health content in the undergraduate curriculum. Retrieved on-line: February 21, 2011. https://www.pedsnurses.org/component/option, com_docman/Itemid,222/task, doc_view/gid,102/.
- Hospital nurse staffing and quality of care. Agency for Healthcare Research and Quality Research in Action Issue 14. AHRQ Pub. No. 04-0029, Rockville, MD2004
- Pediatric nurse staffing and quality of care in the hospital setting.Journal of Nursing Care Quality. 2008; 23: 105-114
- Woodring B. Standards and guidelines for pre-licensure and early professional education for nursing care of children and their families. DDHS, Bureau of MCH, Document #H112R77. US Government Printing Office, Washington, DC1998
Article info
Publication history
Footnotes
1Safe Staffing Position Statement initially developed: September 7, 2007, by the Public Policy Committee.
2Revised by Kathleen Van Allen, MSN, RN, CPN, February 2011, co-chair, Public Policy Committee.
3Revisions approved by the Public Policy Committee on April 1, 2011. Approved by the SPN Board of Directors on September 2011.
