Health Care Executive Develops Evidence-Based Staffing Tool To Enhance Current Nurse Staffing System

- American Sentinel's DNP Executive Leadership Provided Tools Needed to Tackle a Complex Problem and Design an Evidence-Based Solution -

Nurses represent the largest proportion of direct health care providers and an under- or over-staffed unit could have major implications for quality of patient care, costs, patient satisfaction and nurse job retention - that is, until one health care executive identified a solution for a gap she detected in the IT industry's collective offering of nursing scheduling solutions.

Ellen Harper, DNP, MBA, RN, vice president, chief nursing officer-premier west of Cerner Corporation and recent graduate of American Sentinel University's Doctor of Nursing Practice (DNP) Executive Leadership program felt that nursing was missing a world-class acuity tool to help with staffing that can determine how many patients one nurse can care for based on each patient's daily needs, which can change over the course of a patient's hospitalization.

As an executive for one of the world's largest providers of health care information technologies and as chief nursing officer, she works with clients to help them with their vision for data-driven process improvement initiatives.

Harper was among the first DNP Executive Leadership cohort to graduate from American Sentinel University and used her Capstone project to embark on research needed to develop just such an evidence-based staffing tool - something the nursing industry sorely lacked.

"Because American Sentinel's program is designed to address the complexities of modern-day health care, I found it easy to apply this newfound knowledge to the high-tech field of informatics," says Harper.

She points out that there's a huge body of evidence pointing out the relationship between staffing levels and outcomes, both clinical and financial, yet there is currently no consensus on the best way to determine nurse-to-patient ratios.

"I've always thought that nurses weren't given the credibility they deserved and that staffing levels were always being questioned. So I thought if only we could find an objective tool that takes the emotions out of that," says Harper. "It's been both a personal and professional goal to find the sweet spot between staffing and outcomes - both clinical and financial."

Harper obtained administrative approval to perform an on-site study at a carefully selected hospital, and this research formed the basis of her Capstone project.

The goal was to create a new model for predicting nurse intensity, which can be defined as the total time and staffing mix of nursing resources used by an individual patient across an episode of care.

Harper found that American Sentinel's DNP program provided her all the tools she needed to tackle a complex problem and devise an evidence-based solution.

She notes that one course that was particularly useful to her covered the contemporary use of health care information technology (HIT). It was this course that set the theoretical framework. Harper performed her research from a comparative effectiveness approach, which was stressed in her DNP course work.

Harper found that the problem with existing staffing systems is that they are not real-time or designed to consider variables such as the patient's medical diagnosis, age morbidities, family demands, best practices research and the skill set and experience of the individual nurses on staff.

Harper's mixed-methods study used observation and data mining techniques to determine which care activities have the greatest impact on the amount of direct care needed for each patient.

She notes that identifying these activities is not possible for a human:
hunches are usually wrong and often reflect bias. "That's what computers are good at," she says.

Another strength of Harper's study was that it involved using multiple sources and techniques for the data gathering process, including the admission, discharge and transfer data collected from the electronic medical records (EMRs) of the patients on the nursing unit.

Harper is now working along with her employer to further refine the Clinical Demand Index (CDI), an algorithm that calculates the amount of staff needed to care for an individual patient.

The CDI model can create a profile of nurse intensity and the data can be used to predict the amount of patient care needed in real time. This is turn will more precisely determine the workload for nursing care hours so neither quality of care nor cost considerations are compromised.

"It's very exciting to think that this pilot study is the foundation to build an objective way of calculating nurse intensity," says Harper. 

Harper's Capstone mentor, Betty Nelson, Ph.D., MSN, RN, associate dean, graduate nursing studies at American Sentinel University, praises Harper's Capstone project and pilot study initiative.

"Ellen possesses an incredible ability to be flexible with her thinking when new information presented itself or when advisors had suggestions for expanding during the course of the study," says Dr. Nelson. "She clearly focused on work being correct and no ego or pride deterred her from what she originally thought to be true, yet she was open to the possibility that there was more to know. This is scholarly thinking at its best and a great reason why she was invited to present this tool at an international HIT meeting."

Harper presented at the 11th International Congress on Nursing Informatics (June 23-27, 2012), in Montreal, Canada.

Learn more about American Sentinel University's online Doctor of Nursing Practice Executive Leadership program at http://www.americansentinel.edu/DNP.

The 42-credit program is open to nursing executives who have at least three years of senior executive experience and a Master's degree. No GRE or other placement testing is required. The next cohort group begins on October 1, 2012 and registration is due in early September.

About American Sentinel University
American Sentinel University delivers the competitive advantages of accredited online degree programs in nursing, informatics, MBA Health Care, DNP Executive Leadership and DNP Educational Leadership. Its affordable, flexible bachelor's and master's nursing degree programs are accredited by the Commission for the Collegiate Nursing Education (CCNE). The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.