Patient Safety Tip of the Week Archive

What’s New in the Patient Safety World

June 2024

AACN Standards for Critical Care Staffing

AACN (American Association of Critical-Care Nurses) has recently published “Standards for Appropriate Staffing in Adult Critical Care” (AACN 2024). The document includes 7 standards that deal with multiple aspects of nursing staffing issues in critical care. Each of the seven staffing standards includes actions, exemplars, tools and resources to implement, evaluate and improve nurse staffing practices.

Here are the new standards:

1. Direct care nurses participate in all aspects of staffing, including planning, implementation, and evaluation.

2. Hospital patient care areas establish, evaluate, and refine unit-specific staffing guidelines based upon their impact on patient and nurse outcomes.

3. For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient's needs and align nurse competency with patient characteristics.

4. Clinical leaders such as charge nurses, educators, and nurse managers are not included in patient assignments, except in rare crisis situations.

5. Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.

6. Organizational staffing plans are designed to prioritize the health of the work environment and thus drive nurse retention and optimal patient outcomes.

7. Organizational staffing plans anticipate that critically ill or injured patients generally require a ratio of 1 nurse to 2 patients.

We are especially happy to see Standard 3. Many of our columns on nursing staffing and nursing workload have stressed the importance of matching staffing to actual patient needs rather than simply using simple patient:nurse ratios. Those ratios do not take into account actual nurse workload nor do they take into account the fatigue factor that may accompany long work shifts or forced overtime. A mandated patient:nurse ratio may be too high if the intensity of patient care needed is excessive or the nurses are too fatigued to deliver all necessary care.

Some of our other columns on nursing workload and missed nursing care/care left undone:

November 26, 2013 “Missed Care: New Opportunities?”

May 9, 2017 “Missed Nursing Care and Mortality Risk”

March 6, 2018 “Nurse Workload and Mortality”

May 29, 2018 “More on Nursing Workload and Patient Safety”

October 2018 “Nurse Staffing Legislative Efforts”

February 2019 “Nurse Staffing, Workload, Missed Care, Mortality”

July 2019 “HAI’s and Nurse Staffing”

September 1, 2020 “NY State and Nurse Staffing Issues”

February 9, 2021 “Nursing Burnout”

August 2021 “The New NY State Law on Nursing Staffing”

January 2022 “Another Striking Nurse Staffing Study”