Nurse-StaffingDear Apheresis Nurses,

One of the main tasks of wheres the gold free pokies is developing guidelines that support quick hit slots online, effective and ethical nursing care in apheresis settings. Adequate staffing is one of the important aspects. There is a general consent that nurse staffing is a key factor for optimal functioning of a health care unit. Based on this understanding a CAAN focus group drafted a set of recommendations intended to facilitate safe nurse staffing in apheresis settings. These recommendations were discussed during this year CAG/CAAN meeting. As a next step, we would like to initiate a larger discussion in our professional group and invite you to review the draft of the CAAN Recommendations for Nurse Staffing in Apheresis Practice Settings. Below you can leave your comments or answer to your colleagues comments. Your thoughts and insights on this important topic are very important to ensure these recommendations will be a helpful for various apheresis settings.

Looking forward for your feedback,

Thank you,

CAAN team. 


 

CAAN Recommendations for

Nurse Staffing in Apheresis Practice Settings

Introduction

Research evidence shows that nurse staffing may significantly impact patient safety quality and the outcome of patient care as well as nurse satisfaction (Aiken, 2002). Yet, in a contemporary, dynamic health care environment determining appropriate nursing staff management often remains challenging task.

The delivery of nursing care in the apheresis practice setting is additionally multifaceted because of the various apheresis procedures and apheresis equipment used. Nurse staffing in apheresis may often vary from one center to another. However, there is growing consensus that there is a need to develop a consistent and standardized approach for nurse staffing for apheresis practice settings. The CAAN Recommendations for Nurse Staffing in Apheresis Practice Settings are intended to outline the core principles of the appropriate nurse staffing process for apheresis practice settings.

Apheresis Nurse Staffing Goal

 The goal of appropriate apheresis nurse staffing is:

  • To ensure safe, quality and cost-effective outcomes of apheresis nursing care
  • To match apheresis nurse competence and skill sets with apheresis patient needs, acuity, complexity and the type of apheresis procedure.

Recommendations Related to Organizations and Practice Aspects

The organizations should promote appropriate nurse staffing conditions that at minimum include the following:

  1. Apheresis nurses should be able to practice to the full extent of their education, documented competencies and scope of practice
  2. Qualifications and credentials required for apheresis nurses should be clearly specified in order to ensure an appropriate, universal competency level and minimize professional variability.
  3. Shift length, breaks and overtime are appropriately regulated to ensure healthy staffing conditions
  4. Efficient support services (e.g. clerical, information technology, supply, transportation, housekeeping)
  5. Effective inter-professional support networks (e.g. medical coverage, blood bank, laboratory, cell processing, interventional radiology)
  6. Sufficient time for interdisciplinary communication
  7. Sufficient time for nursing documentation
  8. Timely and consistent access to resources and relevant clinical information.
  9. A developed staffing guideline that:
    • is specific for the organization’s health care setting and the apheresis patient/donor’s population
    • Meets relevant legislation, standards and guidelines of provincial and territorial nursing regulatory bodies, the organization’s policies and SOP’s
    • Promotes a safe work environment
    • Promotes participatory decision-making
    • Provides a standardized tool for apheresis patient complexity evaluation (e.g. patient acuity, complex care needs, procedure specifics)
    • Establishes a safe nurse-to-patient ratio

Recommendations Related to Apheresis Nurses

  1. Apheresis nurse competences should be determined on an individual basis and reviewed at predetermined intervals as part of an ongoing professional development process.
  2. Apheresis nurses should be knowledgeable about the organization’s staffing guideline,
  3. Nurses involved in the staffing process should be provided appropriate training, resources and information.
  4. Direct-care apheresis nurses should play an active role in the apheresis unit staffing processes as they are well positioned to note staffing issues.
  5. The workload level should not impact the nurse’s ability to meet professional standards and scope of practice
  6. It should be mandatory that RNs report inappropriate nurse staffing issues that create unsafe conditions for patient care.

Recommendations Related to an Apheresis Procedure and Patients/Donors

 Individual assessment of the complexity of the apheresis patient/donor care needs and apheresis procedure parameters is an important part of an adequate nurse staffing process and should include the following criteria:

  1. Donors/patient:
    • Diagnosis
    • Acuity and stability
    • Complexity and intensity of care needs
    • Vascular access type and difficulty
    • Medications
    • Required lab tests
    • History of adverse events
  1. Apheresis procedure
    • Procedure type
    • Apheresis equipment
    • Replacement fluid (when applicable)
    • Exchange volume (when applicable)
    • Estimated length of procedure
    • Procedure location

For practical reasons the organizations can standardize apheresis patient complexity assessment process (e.g. assigning complexity scores according organizational guideline).

Recommendations Related to Workload/Assignment

 Typically, staffing is done on a shift-to-shift bases and doesn’t extend further than 24 hours in advance of the shift, or 48 hours for a weekend or holiday. Staffing decision making should be based on the following considerations:

  1. The number and type of apheresis procedures scheduled
  2. The number of apheresis nurses available and their individual level of competence, skill set and experience
  3. The established nurses rotation practice
  4. Efficient use of apheresis nurses resources and apheresis equipment
  5. Use of a collaborative approach to involve direct-care nurses in the staffing process
  6. The process of appropriate nursing staff  should not be influenced by reimbursement considerations.
  7. Avoid using overtime or supplemental staffing as a routine way to achieve appropriate nurse staffing.
  8. The number of apheresis procedures/nurse/shift will be estimated based on:
    1. Length of shifts and break time
    2. Estimated patient/donor’s/procedure complexity (e.g. assigned scores according to established guidelines)
    3. Anticipated length of indirect care (e.g. interdisciplinary communication, documentation)
    4. Environmental considerations (e.g. procedure location)
    5. Previous staffing approaches that have being shown to be efficient
    6. Nurse-to-patient/donor ratio in apheresis practice setting is generally 1:1
      • For photopheresis and autologous stem cell collection procedures the nurse-to-patient/donor ratio can be increased to 1:2 if the complexity assessment and organizational guidelines allow doing so.
      • The nurse staffing might be adjusted during the shift as this is dynamic decision making process that should respond to the changing acuity and complexity of patients/donors.

DISCLAMER

These recommendations can serve as a guide to determine staffing solutions that are adaptable to a particular apheresis practice setting and can ensure delivery of safe and quality care. The CAAN recommendations are not binding for nurses and organizations and their use should be flexible to accommodate client/family wishes and local circumstances. They neither constitute a liability nor discharge from liability.

 

References:

Aiken L H, Clarke S P, Sloane D M, Sochalski J, Silber J H. Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA. 2002 Oct 23-30;288(16):1987-93.

 

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