Determining the required nurse staffing of an emergency department.

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D-G GpR#wM ST-G To analyze the number of nurses required for each shift, the nursing management of the Emergency Department of Kapiolani Medical Center for Women and Children, Honolulu, Hawaii, undertook a 6-month staffing study. The emergency department averages 16,381 visits per year (or 50 per 24-hour period), with an average of 9.8% patients admitted. Patient population included all types of pediatric emergencies and obstetric/gynegologic problems of women. Women with head and spinal cord injuries, and cardiac, respiratory, and orthopedic traumas are usually transported to other medical centers within a radius of three miles. At the time of the study, the following staffing pattern was in use: two RNs on Monday through Friday day shifts, three RNs on evenings, and three RNs on nights; for weekend staffing there were three RNs on the day shift, four RNs on evenings, and three RNs on nights. The unique environment of this hospital allows for ED coverage from both the pediatric intensive care unit (PICU) and the labor and delivery department (L&D) to cover short (1 to 2 hours) crisis periods. Clerical help was available on all shifts. Preliminary observation of the unit indicated that patient arrival patterns were not consistent with the scheduled work shifts of 7 to 3 o’clock, 3 to 11 o’clock, and 11 to 7 o’clock. Conceptually adjustments to staffing might result in a more efficient operation that matched scheduled work load with patient demands for service. In addition, it was not clear whether the unit had the optimum number of scheduled staff members for each shift per day.