Staffing ratio trends a survey of perioperative nurse managers

AORN Journal,  May, 2005  by Cynthia Saver

• E-mail
• Print
• Link

Perioperative nurses across the United States are leading the way in seeking workable solutions to staffing challenges. One strategy for ensuring appropriate OR staffing and quality patient care is to create staffing ratios that specify the number of health care personnel needed to provide direct care for each patient. To determine these ratios, it is important to establish the desired skill mix of personnel by analyzing data from a large number of practice settings.

The AORN Management Issues Task Force was charged with conducting a survey to assess current staffing ratios in ORs across the United States. Results from this survey indicate that a 67% to 33% ratio (ie, two RNs for one surgical technologist [ST]) is the recommended staffing ratio for patients undergoing a surgical or invasive procedure. This skill mix ensures perioperative nurses can carry out their core activities, including assessment, diagnosis, outcome identification, planning, implementation, and evaluation.

RESPONDENT PROFILE

In September 2004, an invitation to participate in the survey was distributed to 5,167 members of AORN who had managerial titles. A total of 1,075 surveys were completed, for a response rate of 20.8%. Respondents, who mirrored the distribution of nurses in the United States and AORN, took an average of five minutes to complete the survey.

Most respondents chose "manager" (ie, 39.63%) or "director" (ie, 39.54%) as the title that best described their position (Figure 1). A low number selected "administrator" (ie, 4.54%) or "educator/ staff development" (ie, 2.22%). Respondents who chose "other" as a response frequently reported management-related titles (eg, supervisor) or a coordinator title (eg, surgical coordinator).

[FIGURE 1 OMITTED]

Consistent with national trends, the top practice area for respondents was hospital (ie, 75.63%), followed by free-standing ambulatory surgical center (ie, 19.61%), and hospital-based ambulatory surgical center (ie, 4.76%). Most respondents (ie, 62.99%) were managers in nonteaching facilities.

The facilities where respondents practiced represented a cross-section of the United States. Most respondents have 19 or fewer ORs in their facilities, although some reported having 50 or more (Figure 2). Most facilities perform between 1,000 to 14,999 procedures annually, but procedure rates in responding facilities range from fewer than 1,000 to more than 50,000 (Figure 3).

[FIGURES 2-3 OMITTED]

Most respondents (ie, 15.78%) chose "none" for the number of beds, indicating that they practice in an ambulatory care setting. The top three groupings were 200 to 299 beds (ie, 15.21%), 300 to 399 beds (ie, 11.88%), and 100 to 149 beds (ie, 10.65%).

STAFFING RATIOS

Staffing ratios were examined from the perspectives of practice area, number of ORs, number of procedures, and whether the facility is a teaching or nonteaching facility. Two ratios were reported for each area:

* RN:ST and

* RN + ST:ancillary personnel.

Ancillary personnel were defined as aides, orderlies, and other unlicensed personnel. All ratio numbers were rounded for ease of use.

PRACTICE AREA. The RN:ST ratio in all three practice areas (eg, hospitals, hospital ambulatory centers, free-standing ambulatory centers) was 2:1. When RNs were combined with STs and compared to ancillary personnel, the ratio was 5:1 in hospitals and hospital-based ambulatory surgical centers and 6:1 in free-standing centers (Table 1).

NUMBER OF ORs. For each grouping of the number of ORs, the RN:ST ratio was 2:1. The ratio for RN + ST:ancillary personnel was 5:1 for all perioperative services, except for those with 40 to 49 ORs, which reported a 6:1 ratio. The low number of respondents who practice in settings with 30 or more ORs, however, may have affected the reported ratios.

NUMBER OF PROCEDURES. An RN:ST ratio of 2:1 was consistently reported in facilities where up to 34,999 procedures are performed per year. A ratio of 3:1 was reported in facilities that perform 35,000 to 39,999 procedures per year and drops to 1:1 for facilities that perform 40,000 to 49,999 procedures per year. When reported procedures rose above 50,000, the ratio increased to 2:1 (Table 2).

The ratio of RN + ST:ancillary personnel was relatively consistent at 5:1 with the exception of a 4:1 ratio for facilities that perform fewer than 1,000 procedures or between 30,000 and 34,999 procedures per year. Respondents in facilities that perform more than 50,000 procedures per year reported a ratio of 3:1. As with the number of ORs, a lower number of responses from respondents in facilities performing 30,000 or more procedures per year may have affected the reported ratios in those categories.

TEACHING OR NONTEACHING FACILITY. The teaching affiliation of an organization had no effect on staffing ratios. These staffing ratios were 2:1 for RN:ST and 5:1 for RN + ST:ancillary personnel.

One limitation of the ratio analysis is that respondents were not asked if all of the RNs reported in the skill mix were engaged in direct patient care. The AORN Management Issues Task Force conducted a follow-up survey that requested information about both direct and indirect caregivers. The reported ratios of direct caregivers were similar to those found in the first survey, although the low number of respondents in the second survey requires that caution is used in interpreting the results. Additional support for respondents basing their original numbers on direct caregivers can be found in that ratios typically are discussed within that context.