Purpose and scope
The purpose of this best practice guideline (BPG) is to inform staffing and workload recommendations that can be implemented to benefit patients, nurses and other health-care providers, and organizations, as well as research, education, health-care policy, and systems. The goal of this guideline is to assist nurses, nursing leaders, and senior management groups across practice domains and settings to create healthy work environments through safe, effective staffing and workload practices.
This guideline is aimed at all categories of nurses in all roles and practice settings, including:
- administrators at the unit, organizational, and system levels,
- clinical nurses,
- researchers, and
- members of the interprofessional team.
It may also be used by
- patient groups,
- professional organizations,
- labour groups, and
- federal, provincial, and territorial standard-setting bodies and policy organizations, such as Accreditation Canada.
Registered Nurses’ Association of Ontario. (2017). Developing and Sustaining Safe, Effective Staffing and Workload Practices (2nd ed.). Toronto, ON: Registered Nurses’ Association of Ontario.
Do you want to learn about and implement the most- up-to-date evidence-based recommendations on this topic with your colleagues? Download and share the full best practice guideline (BPG), Developing and Sustaining Safe, Effective Staffing and Workload Practices.
See below for a snapshot of the recommendations from this BPG. We strongly suggest you review the full BPG before implementing the recommendations and good practice statements. The BPG also includes further resources to support implementation and evaluation.
Recommendation 1.0: Organizations develop a workforce plan in order to ensure staffing that facilitates the delivery of safe, competent, culturally sensitive, and ethical care, and positive patient outcomes.
Recommendation 1.1: Safe nursing staffing processes are conducted by unit/operational nurse leaders who possess the requisite knowledge, professional judgment, skills, and authority, in collaboration with nursing staff at the point-of-care.
Recommendation 1.2: The board, administrative leadership, and human resources work collaboratively with point-of-care leaders to ensure that effective staffing processes, appropriate models of care delivery, and sufficient nurses in appropriate categories are in place in order to provide safe, quality, patient-centred care.
Recommendation 1.3: Organizations budget to provide sufficient nurses in appropriate categories to support the delivery of quality, safe patient care and positive patient outcomes, and to reduce the financial costs associated with overtime.
Recommendation 1.4: Organizations and those responsible for staffing create and employ a clear communication strategy to address staffing needs in unplanned situations, such as pandemics; code whites, browns, and blacks; and other situational disasters.
Recommendation 1.5: Organizations develop a comprehensive framework, such as the patient care delivery systems model (PCDSM), to help them understand staffing needs and their impact on intermediate and distal outputs.
Recommendation 2.0: Organizations utilize reliable and valid tools to help determine patient needs and workload in order to support personalized care and provide sufficient numbers of nurses in appropriate categories to provide safe, quality patient care.
Recommendation 2.1: Organizations use electronic health records (EHRs) and other integrated systems as appropriate to support safe, effective workload processes.
Recommendation 3.0: Nursing leaders make evidence-based decisions when conducting nurse staffing planning to provide sufficient numbers of nurses in appropriate categories required to safely and effectively meet patients’ needs.
Recommendation 4.0: Nurses, including charge nurses, responsible for day-to-day staffing decisions for their unit or team demonstrate skills and knowledge that support a comprehensive approach to staffing, including the following: knowledge of patient needs; knowledge of the team, including an understanding of individual skill levels, communication skills, flexibility, competencies, and scopes of practice; and an understanding of the organization.
Recommendation 4.1: All nurses understand and apply the processes for reporting and documenting unsafe staffing practices as per the requirements of regulatory bodies and organizational policies.
Recommendation 4.2: Point-of-care-nurses participate in staffing decisions at the strategic, operational, and day-to-day levels utilizing processes of shared governance.
Recommendation 4.3: Point-of-care nurses demonstrate an understanding of organization and unit staffing policies and processes through the following: regular attendance, proactive vacation planning, appropriate sick time notification, and knowledge of interprofessional and intra-professional team members’ roles.
Recommendation 4.4: Nursing leaders support the development and operation of a staffing committee with representation from all units/teams/areas, including administration, and with a majority of members consisting of point-of care registered nurses.
Recommendation 5.0: Accreditation and approval bodies incorporate evidence-based indicators that reflect best practices in patient experience and safe, ethical, and high quality of care related to nurse staffing.
Recommendation 6.0: Governments commit to developing legislative protection for nurses and other health-care staff who report staffing practices that compromise the safety and quality of care.
Recommendation 6.1: Governments commit to providing financial resources and leadership specifically earmarked to create healthy work environments that support safe staffing practices, promote nurse retention, and contribute to positive patient outcomes.
Recommendation 7.0: Funding agencies actively support nurse researchers to continue to study the impact and outcomes of staffing on nurses, patients, organizations, and systems.
Disclaimer: These guidelines are not binding for nurses, other health providers or the organizations that employ them. The use of these guidelines should be flexible and based on individual needs and local circumstances. They constitute neither a liability nor discharge from liability. While every effort has been made to ensure the accuracy of the contents at the time of publication, neither the authors nor the Registered Nurses’ Association of Ontario (RNAO) gives any guarantee as to the accuracy of the information contained in them or accepts any liability with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work.