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Nurse Staffing In Hospitals

Pocket reference guide available!

The Texas Hospital Safe Staffing Law - within the What Nurses Need to Know series - is TNA's latest resource for nurses who work in hospitals. It contains useful, straightforward information on how best to question a patient assignment and advocate for patient safety. It is FREE to TNA members and available to non-members for a mere $5.00 (price includes tax, shipping, and handling). Click here to order.

These requirements are stipulated in the Hospital Licensing Rules [Section 133.41(o)]. (Click here to see the actual rules and related annotations).

Staffing is a universal concern of nurses.  As a nurse, you are responsible for each patient you care for and as you know, inadequate staffing can lead to poor patient outcomes.  Decisions regarding nurse staffing are complex. Several methods have been employed to ensure adequate staffing. One method (implemented in California) has been to legislate specific nurse-to-patient ratios. Other methods, used in several states including Texas, have included patient-centered models that consider characteristics of the nurse, patient, and care environment. Texas currently has rules and regulations governing hospital nurse staffing and protections for nurses who advocate for safe staffing situations.  To gain a better understanding of how these affect your practice in Texas, take a look at TNA's online CNE on staffing (below). 

TNA has developed an educational program titled, Strategies for Self and Patient Advocacy, which provides practical information on Texas rules and regulations regarding staffing. Click here to check it out!

Did you know?

Texas hospitals are required to:

  • Have a written nurse staffing policy to ensure that an adequate number and skill mix of nurses is available to meet patient care needs;
  • Consider critical staffing factors in determining staffing levels; critical staffing factors include such things as patient characteristics (number of admissions/discharges/transfers), patient intensity and variability across the unit, scope of services provided, context of care (geography of unit, availability of technology), and nursing characteristics (staff consistency and tenure, perparation and experience, competencies, number of staff the nurse must collaborate with or supervise);
  • Utilize a Nurse Staffing Committee, made up of the chief nursing officer, a 60% representation of direct care nurses selected by their peers, and a representative from infection control, quality assurance or risk management; 
  • Consider nursing sensitive outcomes in evaluating the adequacy of staffing; e.g., patient outcomes, operational outcomes, and patient complaints related to staffing.
  • Facilitate timely and effective identification of concerns about the adequacy of staffing and provide feedback to on how nurses concerns are addressed.

Nurses who report concerns to the Nurse Staffing Committee are protected from retaliation.  

Nurses who feel their concerns have not been adequately addressed may file a complaint with the Texas Department of State Health Services by e-mail (click here) or by phoning 1-888-963-7111. 

The Joint Commission requires accredited institutions to have a mechanism for identifying current patient care needs for the effective and efficient deployment of nursing staff. Staffing concerns in Joint Commission-accredited facilities may be reported at 1-800-994-6610. 

Nurses who report to outside agencies in "good faith" are protected from retaliation.

TNA has also created a Questionable Staffing document. This document was developed by TNA to assist RNs in communicating their concerns when they question an assignment, including requests for Safe Harbor. Another tool,  questions about staffing suggests questions you may want to ask about staffing practices when interviewing for a nursing position.



Excellence and Evidence in Staffing, March 2008, Concerro, Inc.


2008 TNA Staffing Committee Report to the House of Delegates


2008 TNA Resolution on Staffing

Safe Staffing/Patient Outcomes (2008), American Nurses Association.

Utilization Guide for the ANA Principles for Nursing Staffing, American Nurses Association, 2005


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