Make sure you have the right number of staff on any given day

Step three in your cancer staffing makeover

Progressive cancer programs are also rethinking their approach to the thorny day-to-day challenge of ensuring that they have the right number of staff at any given time. This is a particular concern in the infusion center, where operations are complex and patient needs are unpredictable.

Build a team that can to adapt to inevitable daily fluctuations in patient volume and acuity.

It’s difficult to know how many patients will come to the infusion center on a given day, let alone how much time they’ll require from your nursing staff . In addition, because patients are usually assigned to nurses on a “next-available” basis, it’s not unusual for one nurse to have four patients across the day and another to have 10.

The result? Tough staffing decisions that often result in wasted resources—or overworked staff , lower patient satisfaction, and potential safety risks.

Develop an acuity-based staffing plan that fits your center

After years looking at acuity-based approaches to staffing in the infusion center, we’ve identified four main lessons for programs looking to make the switch.

This is easier said than done, but we've seen institutions apply these lessons with great success.

Several years ago, managers at St. Cloud Hospital—a 489-bed facility in Minnesota—started to hear rumblings from the infusion center nursing staff about inequitable patient assignments amid growing patient volumes. Patients were assigned to nurses on a first-come, first-served basis.

In response, the cancer director assembled a task force of nurses, LPNs, and schedulers to develop an acuity scale for the organization.

The tool lists all regularly administered treatments, their duration, and an “acuity level” expressed on a scale of one to five that reflects the nurse time required for the treatment.

The tool itself is simple, but developing it was not. Each member of the task force independently referenced evidence-based guidelines and literature to map out the duration of the individual treatments and the nurse time required. They then compared, debated, and adjusted their findings.

They also enlisted a nursing assistant to validate their research by conducting a time study. She worked as a “secret shopper,” randomly selecting RNs and tracking time spent on specific procedures.

Calculate the appropriate workload for a single nurse

Then the team set out to calculate an appropriate workload for any one nurse. Across several months, the nurse manager collected data on the patients seen in the infusion center and their acuity using the new tool.

She calculated that a reasonable workload for one day ranged from 16 to 24 acuity points per nurse.

Plan, adjust, and adjust again

St. Cloud now uses a three-stage process to balance staffing supply and demand

  • Each month, St. Cloud’s nurse manager runs a report on the previous month’s patients and looks for acuity and volume trends, using that information to extrapolate the number of staff needed across the coming month. She communicates any changes to the center’s RN scheduler.
  • Then each day, she pulls the patient schedule for two days out, totals the acuity points, and divides by 16 (the minimum workload for one nurse). That gives her the total number of nurses needed on that day.
  • The center doesn’t assign individual patients to nurses until the day of treatment, but schedulers do try to make consistent assignments so that nurses and patients can get to know one another. Nurses with cancellations that day are the first to receive add-on patients.

The results are encouraging. St. Cloud saw a 10% increase in patient volumes in 2010 and an additional 18% increase in the first half of 2011. The director credits the acuity tool with enabling them to manage this growth without adding staff . At the same time, staff engagement has been increasing and overtime declining.

Collect volumes, acuity data over time to justify additional FTEs

St. Cloud also has since used the acuity scale to add staff. Because the nurse manager had been using the tool to collect data on acuity and volumes, it was easy for her to make the case to add FTEs.

  • Acuity-Based Infusion Center Staffing Tool
    Start developing an acuity scale for your organization with this step-by-step guide offering preprogrammed reports for quick analysis, metric definitions, sample acuity systems, and implementation guidance. Use the tool.

Don't Stop Here

We have a variety of resources to help your program turn this plan into action. Access these resources and more at

Next: Additional resources 

Previous: Focus your staff on high-value activities