Running head: RELATIONSHIP-BASED CARE PROJECT

Relationship-Based Care Project

Kaytlyn Stephens
Dixie State University

RELATIONSHIP-BASED CARE PROJECT

Relationship-based Care Project

Staffing ratios for nurses has been debated over for years now. How many patients should
a nurse take? How many patients can a nurse safely handle? How many patients can a nurse take
to cut down on costs? There are two different viewpoints, the nurses and the people in
administration. The nurse standpoint is based on patient care and safety, that also be the
standpoint for people in administration, but at the end of the day, there job is about managing the
money and staying on budget. When nurses have a high patient ratio, patient outcomes and
patient safety are at risk. In a study based in California, research showed that each additional
patient per nurse was associated with a 7% increase in the likelihood of dying within 30 days of
admission and a 7% increase in the odds of failure-to-rescue (Aiken, Clarke, Sloane, Sochalski,
& Silber, 2002, p. 16). Nurse-patient rations have a huge effect on patient outcomes. I
developed an acuity rating system to help with staffing issues and to improve the outcome of our
patients.
Project
My relationship-based care project was to develop an acuity rating system to help nurses
with their work load and fix staffing issues. I started my project off by looking up what an acuity
rating was, and how one was put together. I got some very important information that helped me
from my director of nursing (DON), who I completed this project for. He was able to tell me
some of the acuity rating systems that he had worked with and gave me information to use to
make my own. I have been working at this same rehabilitation facility for 14 months. I know in
this particular setting what tasks take up most of my time related to patient care. As I researched
online and got some ideas, I came up with my own acuity rating tool based on patients at my
place of work. The acuity rating went from one to four, with four being the highest. There are

RELATIONSHIP-BASED CARE PROJECT

two categories: medications, treatments and other. Other is for things that might not happen
every day like admissions, discharges and doctors appointments. I wanted to keep it simple so it
is easy and fast to do. My acuity rating system:
Acuity Category 1
2
Medications
o 1 Scheduled Time o 2-3 Scheduled
o 1 PRN request per

Time
o 2 PRN request

3
o4 Scheduled

4
o 5+ Scheduled

Time
Time
o3-4 PRN request o 5+ PRN request

shift
per Shift

Treatments
Others

o 0 Treatments

o 1-3 Treatments
Doctor

per Shift

o 4-6
Treatments
Discharge

per shift

o 7+ Treatments
Admits

Appointments
The average acuity number the DON and I decided on was 35. This is to be done once to
twice a week, and then depending on how the patients change. Every Sunday at the end of the
shifts, the nurses for those patients will fill this out and turn them into the DON; from there the
DON will make the patient staffing assignments for the week. I taught all the nurses how to use
this system and explained why I believed this would help with staffing issues and patient ratios.
We have been staffed by acuity for a month now and it has helped not overload the nurses. As I
worked on this acuity rating system, I realized that we did not have enough nurses currently to
staff all the patients. This tool helps more than just nurse-patient ratio, it also can help you look
at how many staff members you need versus how many staff members you have on hand.
Relationship-Based Care

RELATIONSHIP-BASED CARE PROJECT

As I read the Relationship-Based Care: A Model for Transforming Practice this semester
my project was in the back of my mind. Almost all the chapters are linked to my semester project
in a way. There were a few chapters that stood out to me; chapter five which was Patient Care
Delivery was one of them. Patient care delivery is an infrastructure for organizing and providing
care to patients and families (Person, 2004. p. 159) Patient care is the structure that supports the
role in nursing (Person, 2004 p. 159). What really stood out to me were the four elements of care
delivery system, there are four elements that define a care delivery system, and those elements
include: nurse/patient relationship and decision making, working allocation and/or patient
assignments, communication between members of the health care team and management of the
unit or environment of care (Person, 2004 pp161-162). My project on developing a patient
acuity system is a type of patient care delivery system, as I was developing my project I looked
that these four elements. All four elements must be in sync for patient outcomes to be positive.
Each of the elements is different from each other, but when they are all put together they work in
harmony. When nurses have manageable nurse-patient ratios it enhances a caring and healing
environment similar to what is discussed in chapter one of the Relationship-Based Care: A Model
for Transforming Practice. The environment in which you provide for your patients is essential
for the healing process. As we continue to use the acuity rating system at my place of work we
will start gathering data and developing outcome measurements. It is important to research and
find out how this system is working, if it is not, it is essential to change it to better fit the needs
of the nurses and the patients.

Literature Review

RELATIONSHIP-BASED CARE PROJECT

As I did some research on acuity staffing and systems, I found a few articles related to
patient acuity. In the first article I found entitled Nine Principles for Improved Nurse Staffing, the
author came up with nine principles on how to improve staffing levels. Number seven of the nine
was assignments are acuity based (Dent, 2015 pp41-44). Each patient was assigned an acuity
number, and then each nurse would be scheduled on the unit based on that days acuity rating
(Dent, 2015 pp.41-44). The conclusion of this article was that using these nine principles, the
researchers were able to improve staffing and staff for effectiveness (Dent, 2015 pp.41-44). The
second article I found was about how to determine staffing needs. The authors developed a
workload intensity measurement system (WIMS), or in other words a patient acuity rating
system (Hois, Ismail, Ong, & Kang, 2010 pp.44-53). The authors surveyed nineteen different
units for one week and evaluated them. As WIMS was introduced, staffing started to be arranged
by acuity. In conclusion, in this setting WIMS worked, but the only problem with it was its need
to be updated often, if it was reviewed and updated often, it was a great way to measure staffing
needs. (Hois, Ismail, Ong, & Kang, 2010 pp.44-53). These three research articles showed how
important acuity staffing is and its importance to patient care. Through my project I was able to
produce an acuity rating system to help improve staffing and patient ratios in my workplace just
like acuity based staffing worked in these articles.
Conclusion
When nurses have too many patients to take care of, this becomes a major stressor and
the nurses are not able to perform duties to their fullest extent. In turn, this decreases patient
outcomes and hurts patient safety. By developing an acuity rating system for my place of
employment I was able to analyze staffing needs. The literature shows that acuity improves
staffing and also reduces the nurse-patient ratio. As Stonehenge of Ogden continues to use this

RELATIONSHIP-BASED CARE PROJECT

system, nurses are better staffed and we are better able to predict patient outcomes. Patient care
delivery is an important part in nursing. Having a good patient care delivery system and a caring
and healing environment will ensure your patients are getting the care they need. Staffing by
acuity and having manageable nurse-patient ratios will improve patient outcomes and ensure our
patients safety.

RELATIONSHIP-BASED CARE PROJECT

References
Aiken L.H., Clarke S.P., Sloane D.M., Sochalski J., Silber J.H. (2002). Hospital Nurse Staffing
and Patient Mortality, Nurse Burnout, and Job Dissatisfaction. JAMA. ;288(16):19871993. doi:10.1001/jama.288.16.1987.
Dent, B. (2015). Nine principles for improved nurse staffing. Nursing Economics,33(1), 4144,66. Retrieved from http://search.proquest.com/docview/1655479984?
accountid=27045
Hois.Y., IsmailL, N., Ong, L.I., & Kang, J.(2010). Determining nurses staffing needs: the
workload intensity measurement system. Journal of Nursing Management. Vol 18(1) pp.
44-53. DOI: 10.1111/j.1365-2834.2009.01045.x
Person, C. (2004). Patient Care Delivery. In Koloroutis, K, Relationship-Based Care: A Model
for Transforming Practice (pp.159-182). Minneapolis, MN: Creative Health Care
Management Inc.