AACN Publishes Standards for Appropriate Staffing in Adult Critical Care

The American Association of Critical-Care Nurses (AACN) has published “AACN Standards for Appropriate Staffing in Adult Critical Care,” the specialty’s first, action-oriented staffing standards.

Appropriate staffing has long been one of the “AACN Standards for Establishing and Sustaining Healthy Work Environments” (HWE standards), first published in 2005. It has also been one of the most complex areas to address.

On every national survey conducted by AACN to measure the health of clinical work environments between 2005 and 2019, nurses consistently gave lower ratings for survey items related to the appropriate staffing standard than for items related to the other HWE standards. In the most recent national survey, conducted in 2021, the item labeled “ensuring an effective match between patient needs and nurse competencies” received the lowest mean rating of any element on any of these surveys conducted to date.

Besides the HWE standards, the new staffing-specific standards build on AACN’s other influential resources related to nurse staffing, including AACN Synergy Model for Patient Care and its 2018 “Guiding Principles for Appropriate Staffing.”

The standards also respond to recent recommendations from the Partners for Nurse Staffing Think Tank and the Nurse Staffing Task Force, both co-convened by AACN. Both groups called for specialty nursing organizations to define staffing standards for the patient populations they serve.

Developed by a work group with representatives from a variety of nursing roles, “AACN Standards for Appropriate Staffing in Adult Critical Care” outlines seven standards to incorporate appropriate staffing into everyday operations and patient care. Each standard includes actions for organizational leaders, clinical leaders and direct care nurses, as well as suggested exemplars, tools and resources.

“The link between healthy work environments and patient safety, nurse retention and recruitment, and an organization’s bottom line is irrefutable,” said Vicki Good, AACN chief clinical officer and co-editor of the staffing standards document. “These standards, coupled with a deep commitment to collaboration and change, provide an opportunity for evidence-based transformation that can profoundly improve the U.S. healthcare system’s ability to meet patients’ needs.”

The seven standards are as follows:

• Direct care nurses participate in all aspects of staffing: planning, implementation and evaluation.
• Hospital patient care areas establish, evaluate and refine unit-specific staffing guidelines based upon their impact on patient and nurse outcomes.
• For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient’s needs and align nurse competency with patient characteristics.
• Clinical leaders such as charge nurses, educators and nurse managers are not included in patient assignments, except in rare crisis situations.
• Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.
• Organizational staffing plans are designed to prioritize the health of the work environment and thus drive nurse retention and optimal patient outcomes.
• Organizational staffing plans anticipate that critically ill or injured patients generally require a ratio of one nurse to two patients.

The document also includes a section with answers to common questions that arose during development of the standards, a glossary and references.

“AACN Standards for Appropriate Staffing in Adult Critical Care” can be downloaded at no charge on the AACN website after signing in. A print version of the 42-page document can be purchased for $10 for AACN members and $25 for nonmembers from AACN’s online store.

The document joins other AACN publications developed to describe the level of practice or performance expected by the nursing profession in order to provide excellent and compassionate care. In addition to the HWE standards and staffing standards, AACN has published guidelines specific to clinical nurse specialists, acute care nurse practitioners, tele-critical care nurses, and progressive care and critical care nurses.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme