Frequently Asked Questions:
Below are some questions and answers to help explain staffing plans and reports and interpret their information.
If you can't get an answer to your question here, please feel free to email us.
What types of hospitals are there?
There are four major categories of hospitals at which you may receive care.
Acute care community hospitals provide medical and nursing care for medical and surgical conditions.
Tertiary hospitals provide medical and nursing care for medical and surgical conditions and also provide specialized consultative care by specialists, usually on referral from a medical provider, such as your primary care doctor.
Teaching hospitals provide training for interns and residents who are studying to advance their skills as doctors. In general, all tertiary hospitals are teaching hospitals. Some acute care community hospitals may also have training programs for interns and residents.
Specialty hospitals include long-term acute care hospitals, and rehabilitation or behavioral health hospitals that provide diagnostic and treatment services to patients with specified medical conditions or, in the case of behavioral health hospitals, diagnostic and treatment services for patients who have mental health-related illnesses.
The staffing plans and reports you will see are divided into three groups: Acute Community Hospitals (58), Tertiary (10) and Specialty (13).
What types of hospital "units" are there?
Hospitals have different types of units that are usually categorized based on the care that a patient will need. For example, a medical surgical unit may have a mix of patients with different kinds of problems, such as respiratory, cardiac, or cancer problems. Patients needing more specialized intensive care may spend part of their hospital stay in an intensive care unit, such as a cardiac care unit (CCU) or surgical intensive care unit (SICU). Some hospitals also have “step-down” units or telemetry units, for those patients who require more monitoring but do not need to be in an ICU.
 What is a staffing plan?
Every hospital develops a staffing plan to make sure that patients in their hospital receive appropriate care. Many different factors go into development of a staffing plan. Some of these include the experience and education of the registered nurse, the availability of other caregivers, the needs of the patients on the unit, and the severity of the patients’ illnesses.
Have hospitals always compiled staffing plans and reports?
Yes, hospitals have always compiled staffing plans and reports. Under Patients First these plans and reports are being developed in a uniform way so the public can see the different factors that go into the development of a plan.
How are staffing plans and reports determined?
Staffing plans and reports are determined based on patients needs. The Nurse Manager together with other staff develop the plan based on the anticipated needs of the patients who will be assigned to the unit. The plans and reports need to be flexible to account for changes that occur. Patients’ needs change over the course of a day and staffing is adjusted to account for those changes. Every patient needs the right care, not the same care.
Are staffing plans and reports only for nurses?
Staffing plans and reports involve the team of professionals who may be involved in the care of a particular patient and are based on the patient’s individual clinical needs. Nursing plays an important role in the care of every patient but nurses are just one part of a larger team of caregivers who work together to make sure that patients receive the highest quality of care.
Why do some hospital staffing plans and reports list licensed practical nurses (LPNs) separately and others group them with registered nurses (RNs)?
In those hospitals with only a few LPNs on staff, it is difficult to predict when they will be working. These hospitals have included the LPN numbers into the overall licensed staff numbers, which include both RNs and LPNs.
Can any conclusion be drawn if the staffing on one unit is higher or lower than another?
Direct comparisons like that can not be made between or across units. Staffing is based on the needs of a particular patient unit and can differ from unit to unit within the same hospital. For example, staffing in an intensive care unit is higher than staffing in a general medical surgical unit because of the critical needs of patients that are in intensive care units. They require more hours of nursing care and close monitoring for changes in condition. Staffing across similar units can also vary based on the experience and education of the registered nurses and the availability of other clinical caregivers, such as therapists. When looking at a staffing plan, it is important to look at the indirect resources who also provide care, and to look at other attributes of the unit, such as technicians or specialists who may provide care and services.
Why do staffing numbers differ from hospital to hospital and unit to unit?
Staffing numbers vary because patient care needs differ and can change minute to minute, hour to hour. Staffing has to be closely watched and adjusted from time to time based on the changes in the needs of the patients.
The plan is based on averages. There are times when more staff will be needed and times less staff will be needed.
Activity on a patient care unit changes constantly and, therefore, patient needs change constantly. For example, admissions, transfers and discharges occur on a regular basis, changing the make-up of a unit, and patients may become sicker during a day and need more than expected nursing care.
Nurse staffing is frequently evaluated and readjusted to make sure patients are properly cared for. The staffing plans and reports, therefore, are not meant to compare one hospital to another or one unit to another, but are a planned baseline from which patient care needs are adjusted.
Why is a particular inpatient medical and/or surgical unit in a hospital missing?
Some units may not be posted on the website. For example, units that have opened since the posting of the plans and reports are not included.
Why are some units missing, such as obstetrical, emergency departments, and post anesthesia care?
We began with inpatient medical, surgical, intensive care, rehabilitation, behavioral health and skilled nursing care units first. We are exploring the feasibility of adding other units in the future.
What are Worked Hours Per Patient Day (WHPPD)?
Worked hours per patient day are the number of hours of direct care a patient can expect to receive from an RN, along with LPNs and nursing assistants, in a 24-hour period. The actual number of direct care (worked) hours per patient day for RNs only – and for RNs, LPNs, and nursing assistants combined – are nationally recognized measures endorsed by the National Quality Forum and are included among a larger set of nursing-sensitive care measures. The NQF assembled experts in the fields of nursing and quality measurement to develop this set of measures.
What do these numbers mean for patients?
This number will tell patients how many hours of nursing care they are receiving. It is not meant to be compared across units or across hospitals. It is one more piece of information for consumers to have in understanding how care is provided to them when they are in the hospital.
Why does it seem there are fewer staff on the evening and night shifts?
On some units, there are fewer admissions, transfers and discharges on the later shifts. Also, during the evening and night, patients may receive fewer treatments, testing and transporting, and may have fewer needs for assistance with daily activities, such as bathing or eating. Some units have the same number of RN staff on all shifts, however, such as Intensive Care Units (ICUs) where the care needs vary less.
Where should I be able to find the staffing plans and reports for hospitals?
Staffing plans and reports for hospitals are now available on the Patients First website at www.patientsfirstma.org or by asking individual hospitals for a copy.
How frequently will the staffing plans and reports be updated?
At the hospital level, these plans are constantly changing depending upon the needs of the patients on a particular unit. On an annual basis, this site will be updated to include the next year's Staff Plans and the prior year's Staff Reports. The Staff Reports will also include information about why the staffing delivered may be different from the Plan.
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