The role of nurses in providing safe, quality care is globally understood by patients and caregivers alike. Despite this global understanding, the modern trend in healthcare administration is to squeeze as much cost as possible out of hospital operations, and the number one target is nurse staffing. Nursing associations have responded by proposing “The Registered Nurse Safe Staffing Act” to ensure that the decision-makers are providing and implementing adequate and safe nurse staffing plans. The TSRN time study tool supports the objectives of safe staffing for nurses and provides needed process analysis to decision-makers.

Nurse filling syringe
In 2008, one of our team members was admitted to a local hospital that was active in TCAB.  We decided to document the experience to inform our performance improvement practice for TCAB hospitals.  What we learned turned our entire philosophy upside down.

This hospital was a top performer in the percentage of time nurses spent in value added care and our expectations were high.  What we experienced as a patient in this environment of higher value added time was disappointing to say the least.  When we needed a nurse, we couldn’t find one, they were all with patients.  When the nurse did finally come it was always at the worst possible time.  This experience has shaped and informed our view on the definition of “value added care”. We realized that patients ARE willing to pay to have a nurse available when they need one.

Time Study RN:

Supporting the Objectives Of Safe Staffing

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Value Added Care

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Nurse Utilization

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Patient Hours per Nurse Day

As we learned more about ANA’s Registered Nurse Safe Staffing Act, it became evident that a new approach was needed in the performance improvement disciplines to support the objectives of safe staffing.  In an effort to align performance improvement activity with the principles of safe staffing we have introduced the safe staffing targets for Value Added Care, Nurse Utilization, and Patient Hours per Nurse Day in the Time Study RN National Benchmarking Database.  The safe staffing targets are calculated using algorithms from heuristics developed in the program and validated in a simulation model that associates staffing levels with safe care delivery.
Nurse Utilization Chart
The new safe staffing targets are calculated and unique for each unit and are included in the dashboard of the Time Study RN National Benchmarking Database.  The purpose of the new targets are to ensure that performance improvement groups using the LEAN model treat nurse availability as a value added activity in healthcare practice, which supports the Registered Nurse Safe Staffing Act objectives.

How Do Caregivers Spend Their Time?


Safe Staffing Trigger Tool


Improving the Staffing Model