NUR 621 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

NUR 621 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

NUR 621 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?

Healthcare workers are the backbone of any healthcare organization. “Staffing is the cornerstone of human resource management” (Theriault et al., 2019). For healthcare organizations to thrive and function at their best, adequate, qualified employees must provide continuous, high-quality, safe patient care. Competent and adequate staffing in healthcare facilities increases and promotes positive patient outcomes, decreases readmissions, decreases errors and safety events, improves the patient experience, and improves facility ratings. “Healthcare is labor-intensive, requiring the expertise and efforts of nurses and other health care providers to assess and manage the care of consumers needing health care services” (Penner, 2017). Staffing and scheduling sometimes present as a complex issue due to the challenges faced by different healthcare organizations, such as short staffing, patient acuity, patient capacity, budgeting, and lack of adequate finances.

Staffing varies between a skilled-nursing facility versus a medical-surgical unit in a hospital. Both units require staffing for twenty-four hours per day for seven days per week, but the medical-surgical unit is an acute setting with more rapid patient turnover while the nursing facility is more chronic and long-term. Based on the acuity and services required, an acute inpatient hospital unit requires more nurses, such as RNs, while a skilled-nursing facility requires fewer nurses and more support staff such as nurses’ aides.

There are three types of staffing models budget base, nurse-patient ratio, and patient acuity (My American Nurse 2014). Some facilities use a combination of staff models depending on the unit’s needs or the facility. Staffing has been and continues to be a considerable challenge for many healthcare facilities and organizations worldwide. Quality patient care and patient safety should be one of the top priorities when staffing is considered. Other factors to be considered when addressing staffing needs are call-offs, sick leave, emergencies, admissions, discharges, patient capacity, and patient acuity.


My American Nurse. (2014). What every nurse should know about staffing.

Penner, S. J. (2017). Economics and Financial Management for Nurses and Nurse Leaders (3rd ed.). Springer Publishing Company. ISBN: 978-0-8261-6001-0

Theriault, M., Dubois, C., Silva, B. and Prud’homme, A. (2019). Nurse staffing models in acute care: A descriptive study. Nursing Open, 6(3).

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NUR 621 What are some of the key differences for a staffing model in a skilled nursing facility as compared to a medical-surgical unit in the hospital?:

 When my hospital opened as a new hospital back almost twelve years ago, we had trialed a staffing program that would help give scores to patients according to their acuity which was obtained by how and what nursing staff would chart on their assessments as well as the medications they were on, diagnosis, labs, providers notes, etc. However, like you mentioned these acuity numbers can change dramatically from the beginning of the shift till the end of the shift sometimes, making staffing challenging. At our organization we need to have staffing numbers for the next shift determined at least three to four hours prior to the start of the new shift. Not only does scores affect the acuity and how we assign nurses to patients but also drives the acuity-based system that impacts the cost and can affect reimbursement (Nguyen, 2015). We must let travel agencies know if we need them or not at least two to three hours prior to start of shift or we get charged their first four hours for breaking their travel agency rules. For our own staff we must know two and a half hours prior to the start of the shift for call-ins and if we are placing our nursing staff on-call and/or LOA for the shift or part of the shift or else we will have to pay the nurse two hours pay.   According to Igram & Powell (2018) goals for acuity tools are to help increase satisfaction for nurses with their patient assignments and to increase the nurse’s perception of patient safety by assigning patients with high acuity scores equally and appropriately. There are a lot of factors that go into the staffing metrics and is a challenging role many days especially since most patients that are admitted to the hospital have higher acuities in general. It is essential for organizations to find a balance and metric to help monitor acuity to ensure patients are receiving safe quality of care along with nurse having time to educate patients to help reducing hospital readmissions prior to discharge.


Ingram, A., & Powell, J. (2018). Patient acuity tool on a medical-surgical unit

Nguyen, A. (2015). Acuity-based staffing reducing cost, increasing quality. Nursing Management, 46(1), 35-39.

Health care organizations must always be committed to delivering quality care. Achieving this goal requires adequate and skilled staffing to ensure that health care providers can address patient needs as situations obligate. Staffing models are effective tools for measuring work and determining the labor hours needed in a facility. They differ according to the facility and workload, among other factors.

A staffing model for a skilled nursing facility and a medical-surgical unit in a facility differs in numbers and the overall approach to health care delivery. Regarding numbers, the nurse-patient ratio is the primary reference, and the optimal ratio for a medical-surgical unit in the hospital is 1:4 or 1:5 (Assaye et al., 2020). The ratio changes in skilled nursing facilities since they deal with different patient groups whose complexity of illnesses differs profoundly. The ratio is higher, and health care providers can monitor more than five patients.

The other difference between the staffing models is the approaches used in patient care. Typically, primary nursing is highly effective for staff in medical-surgical units. Primary nursing is characterized by commitment to providing continuous care and ensuring that health care providers assigned to a particular patient are not changed within the care duration (Moura et al., 2020). A skilled nursing facility can apply other approaches for staffing, such as the acuity-based approach. Here, the number of staff required depends on the care intensity that a patient demands (Long, 2020). The maximum number of patients that a nurse can handle does not apply in skilled nursing facilities.

Nurse staffing models are frameworks for guiding health care organizations on the number of nurses required in a facility. They ensure that roles are assigned as situations necessitate and according to nurses’ skills and availability, among other factors. Nurse-patient ratio and patient care approaches differentiate a staffing model for a skilled nursing facility and a medical-surgical unit in a hospital.


Assaye, A. M., Wiechula, R., Schultz, T. J., & Feo, R. (2020). Nurse staffing models in medical‐surgical units of acute care settings: A cross‐sectional study. International Journal of Nursing Practice26(1), e12812.

Long, N. (2020). Acuity-based staffing: Improving patient outcomes and staff satisfaction. The University of Texas at Tyler.

Moura, E. C. C., Lima, M. B., Peres, A. M., Lopez, V., Batista, M. E. M., & Braga, F. D. C. S. A. G. (2020). Relationship between the implementation of primary nursing model and the reduction of missed nursing care. Journal of Nursing Management28(8), 2103-2112.

First, I would like to differentiate between a skilled facility and a surgical unit hospital. A surgical unit is where patients who are suffering from an acute ailment or injury go to seek treatment. This means that patients who go to a surgical unit normally go there to receive treatment for a acute diseases that normally last for a short period of time. A nursing home or a skilled facility is where patients go to seek treatment for chronic diseases. This means that they normally go there for a long duration of time, where treatment involves managing the condition of an ailment for the long-term (Cassidy et al.,2019).

Some of the things that one needs to consider when staffing a facility include; determining the patients’ level of acuity and care needs, determining the necessary staffing needs to meet the residents care ,and finally determining the necessary staffing level according the acuity of the patients. Research has showed that RNs provides a higher quality of care than the other nursing staff like LPNs and NAs. In most part due to their higher training and education level. Most medical and surgical units in the hospital where most of the patients require a higher quality of care hire RNs to take care of their patients. Most of the nursing staff that work in skilled facilities are RNs and NAs. The RNs are normally assigned to patients with higher acuity, while the LPNs are normally assigned to patients with lower acuity. Research has showed that most healthcare facilities are short-staffed which negatively impacts the care their patients receive in these facilities. Numerous studies have shown that the number of staffing in a facility reflects the quality of care the patients receive in that facility (Healthcare risk management, 2019). In other words, a facility that is adequately staffed provides a better quality of care to its patients than the one that is poorly staffed.


Cassidy, Jessica, Munari, Dana, Forbes, Damon, Remick, Kyle & Martin, Matthew. (2019). Surge or submerge? Predicting nurse staffing, medical hold capacity, and maximal patient care capabilities in the combat environment. Journal of Trauma and Acute Care Surgery, 87, S152-S158.

Staff fatigue can be a compliance risk, too. (2015). Healthcare Risk Management, 37(3), 28.