Treatment program effect and nursing patient classification as determinants of psychiatric nurse staffing

The influence of treatment programs of specialized psychiatric units of the need for nurse staffing was the problem area explored in this study. The major research question asked whether the treatment program of an inpatient psychiatric unit accounted for more variance in the need for nurse staffing than was attributable to a nursing patient classification system which measures patients' need for nursing care. The study was an extension of a larger research project completed for the Veterans Administration (VA). Six test hospitals in the VA system were used as the sample. The six test hospitals contained 30 impatient units with a variety of treatment programs. A nursing patient classification instrument developed as an outcome of the VA study was used to reclassify all 898 original study patients according to their need for nursing care. The direct care hours given to each category of patient were obtained by worksampling in the original study. The direct care hours were used to analyze the effect of treatment program in hierarchical regression analysis. The treatment program accounted for approximately 1% of the variance in direct care give to patients. The nursing patient classification instrument together with shift accounted for 17% of the variance in direct care. This finding was consistent with the original VA study in that other variable thought to influence the need for nurse staffing, such as amount of socialization groups or chronicity of patients, contributed 1% less to the variance in direct care. The nursing patient classification instrument is a valid indicator of the amount of nursing care required by patients in a wide variety of VA hospitals. A valid nursing patient classification instrument is particularly useful in determining staffing patterns and budget. Other applications of the data produced by a nursing patient classification instrument are in the areas of quality assurance and costing of nursing care services. With the advent of prospective payment systems for hospitals, it is crucial to the nursings' professional and economic survival to unbundle the costs of patients for nursing care from the daily hospital room rate. The outcomes of the VA study and this study will add to the knowledge base of the profession in the area of nursing patient classification and support the use of new nursing patient classification system, the MESA Psychiatric Patient Classification System (MEPP).