To make informed decisions about staffing on specific nursing units, it is critical to explore all the factors associated with staffing levels. Nurses or managers wishing to revise staffing patterns within their hospital should consider multiple factors to determine how best to optimize resources. Often, the first response to perceptions of unmanageable workload is to increase the number of people on each shift. However, increasing staff might not always be the best solution; inefficient processes should also be explored when making decisions about staffing numbers.

The Rapid Modeling Corporation (2006) performed an extensive observational study in which it literally tracked the physical movements and associated tasks of a nurse in 40 hospitals across the United States. They found that nurses spend a significant amount of the shift on nonvalue-adding or wasteful work. Non-value-added activities are those that do not benefit the patient in any way and can be eliminated from patient care without any impact on patient outcomes. These activities might include searching for equipment or people, waiting on delays in other departments, or waiting for phone calls. Upenieks et al. (2007) duplicated this work and found that up to 20% of nursing work can be considered wasteful. By changing the physical layouts of nursing units and putting processes into place that efficiently provide necessary supplies, this percentage can be significantly decreased, leaving time for essential nursing work (Hendrich & Lee, 2003).

When exploring staffing on an individual unit, begin by assessing the present state of nurse staffing on that unit. What are the budgeted hours of care for the unit? If the organization is using productivity benchmarks, what are the unit targets, in both overall productivity and labor? Explore how the unit was designed to be staffed every shift. Is there a budgetary difference between day staffing and night staffing? Evaluate the unit’s staffing over the past three months, using a shift-by-shift basis. How many times has the unit had less than the budgeted number of staff, and why?