How to Use Time Study RN to Improve the Staffing Model/Plan

The starting point in the performance improvement process within CIT is the “Time Study RN Unit Assessment”. The Unit Assessment includes 4 tools/indicators that are used to inform teams on the efficacy of the staffing model. These indicators when combined, provide a comprehensive evaluation of the staffing model and provide critical feedback to planners who are tasked with providing adequate levels of care that meet specific outcomes. One interesting observation is that I have never seen a staffing model request denied when the TSRN Unit Assessment indicators call for it, even when overall FTE’s increase.

Four indicators used to inform teams on the efficacy of the staffing model:

Nurse Utilization Targets

Nurse Utilization is a core metric that is critical in any staffing model assessment. Paired with the utilization targets developed from heuristics in the Time Study RN National Benchmarking Database and guidelines in the ANCC Safe Staffing legislation, these targets are used to determine whether over/under utilization is occurring. Over/Under utilization is a result of a misalignment in the execution of the staffing plan with the real time demands of caregiving and it can indicate inadequacies in staffing model planning and execution. Time Study RN compares actual nurse utilization with the safe staffing targets to determine if over/under-utilization is occurring so that corrections to the staffing model can be indicated.

Time Spent Working Below Licensure – Perceived

Nurses believe that they spend time working below licensure: Time Study RN measures the percent of work performed by RN’s that can be done by other lower skilled resources. The determination is made by the RN doing the work and it is used to determine whether caregivers believe they are working below their licensure, which is a common complaint among nurses. Based on data from the National Benchmarking database, the average percent of time RN’s spend doing work that could be done by other lower skilled resources is around 12%; therefore, when this measure is higher than 12% a staffing model assessment is indicated.

Time Spent Working Below Licensure – Actual

Nurses actually spend time working below licensure: The LEAN Dashboard report measures the actual time spent in specific activities that could be done by lower skilled resources. When these activities such as ADL’s are higher than average, then it is a primary signal that a staffing model assessment is indicated.

Work Priority

Is RN work content aligned with caregiving priorities? At the heart of every staffing plan are assumptions about how planners think nurses should spend their time. While many staffing committees rely almost exclusively on estimates of nursing hours per patient day to determine staffing levels; within those estimates are assumptions about caregiving best practices and nurse work content. It is critical that nursing planners validate that the staffing plans are delivering the care intended, based on best practice. The level 2 and level 3 pie charts in Time Study RN provide planners with the tools to confirm that the staffing plan is producing the desired nurse work content that supports best practice. When gaps are identified by level 2 and level 3 pie charts, a staffing model assessment is indicated.

Any one of these indicators can trigger a staffing model assessment by itself, but when multiple indicators are observed the staffing model assessment should be a high priority.

These 4 tools give nursing organizations a “fool proof” methodology to produce continuously improving staffing models and staffing plans that outperform current staff planning methods. The method is also aligned with the guidelines of the ANCC Safe Staffing legislation by providing a feedback loop to the staff planning committee so they can make better decisions as staffing demands change with changing patient mix, volume, and caregiving best practices.

Safe Staffing Summary

The new safe staffing targets provide the Staffing Committee at each hospital with new insight on determining and monitoring the staffing plan for each nursing unit and comparing “Patient Hours per Nurse Day”, “Nurse Utilization”, and “Value-Added Care” with the 600 other hospital unit datasets in the Time Study RN National Benchmarking Database.

Safe Staffing Trigger Tool


Improving the Staffing Model