The document discusses issues with inadequate nursing staffing on an orthopedic unit, which can negatively impact patient safety, quality of care, and financial costs. Understaffing can lead to complications, never events, increased overtime and agency nurse costs, and poor patient outcomes. Implementing strategies like overlapping shifts during peak times, utilizing float nurses, scheduling software, and federal programs could help ensure adequate staffing to improve patient care and reduce costs.

1. By Azin Bagheritar,
Adriel Cansino,
Cost Savings: Gurpreet Kaur,
Meagan Fitzsimmons
Staffing
Improvement
on the
Orthopedic
Unit

2. Background and Highlights of the Issue
 Issues:
Inadequate RN staffing for responsibilities that cannot be delegated
Inefficient use of UAP (Unlicensed Assistive Personnel)
Inadequate staffing during times when patient needs are at peak
Need for more RNs during more complicated cases
 Nursing responsibilities in the delivery of care on the orthopedic unit:
Post-op admission assessment
Pain management
Patient needs
Discharge planning and teaching
Transfers
Monitoring patient equipment and therapies (Continuous Passive
Motion machine, traction devices)

3. How are Quality of Care and Safety
Outcomes Affected
 Major adverse events on orthopedic floor that can be reduced with
adequate staffing:
Late detection of urinary retention
Wound infection
Pneumonia/sepsis/clostridium
Adverse drug event
DVT/Pulmonary Embolism/Myocardial Infarction
Anesthesia related
Luxation of hip arthroplasty
Post-operative complications/dislocation
 Safety:
CAUTI (Catheter-Associated Urinary Tract Infections)
Pressure ulcers
Medication errors

4. Financial Implications
 Implications of the current process:
Use of agency nurses
Paying over-time
 Cost of complications related to error by overworked RN
 Occurrence of never-events related to staffing
 Over-staffing
 Estimated cost savings:
Assuming that a nurse is paid $32 hourly, over-time per nurse per hour is $16,
resulting in a $48 pay per over-time hour
Use of Agency Nurses– Costly because agencies charge their own fee to pay for
their own recruitment, advertisement, and job placement (about $10 her hour
extra paid to agency nurses)
Never-events not being reimbursed
 Falls
 CAUTI
 Pressure ulcers
 Medication errors
 Re-admission costs for poor patient outcomes
 Increased length of stay
Decreased staff turnover and hiring
Utilizing more UAP’s (Unlicensed Assistive Personnel) to do the tasks within their
scope of practice– Their average hourly pay is $12

5. Problem Solving Strategies
 Using technology to:
Track patient progress along length of stay (from pre-op assessment to
discharge)
Use EMR to predict when patient will arrive on unit
Utilize EMR when scheduling staffing (current process does not do this)
 Ensure adequate staffing during peak times:
Overlap 8 hour shift nurses with 12 hour shift nurses during peak times
 Example: Employ 12 hour shift nurses from 11P-11A. Overlap 8 hour
nurses to start at 7A-3P to ensure adequate staffing during peak times
Eliminate need for overtime and agency nurses to meet needs of peak
times
Promote resource utilization by reassigning float nurses when unit is under-
staffed
 Facility should maintain a readily available reserve of float nurses
Develop on-call schedule for unit staff
Implementation of Federal Nurse Reinvestment Act
Promote facility incentives for staff hiring

6. Summary of Lessons Learned
 Patients on an orthopedic unit often have complex conditions and
require skilled nursing care which is affected by staff shortages
 Unit under-staffing results in increased costs
 Agency hiring
 Staff turnover
 Patient never-events/ non-reimbursable conditions
 Over-time payments
 Poor patient outcomes/re-admissions
 Cost savings interventions
 Electronic staff scheduling software/template
 Overlap shifts during peak hours
 Float nurse utilization
 EMR technology to predict staffing needs
 Federal Nurse Reinvestment Act
 On-call nursing
 Facility incentives for hiring

7. References
Hassan, M., Tuckman, H., Patrick, R., Kountz, D., & Kohn, J. (2010). Cost of
hospital-acquired infection. Hospital Topics, 88(3), 82-89.
Stanton, M.W., Rutherford, M.K. (2004). Hospital nurse staffing and quality of
care. Rockville (MD): Agency for Healthcare Research and
Quality. Research in Action Issue 14. AHRQ Pub. No. 04-0029.
Unbeck, M., Dalen, N., Muren, O., Lillkrona, U., & Härenstam, K. P. (2010).
Healthcare processes must be improved to reduce the
occurrence of orthopaedic adverse events. Scandinavian
Journal of Caring Sciences, 24(4), 671-677. doi: 10.1111/j.
1471-6712.2009.00760.x