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Institute for Patient Care Departments

At Massachusetts General Hospital (MGH) decisions about Registered Nurse staffing and scheduling occur at the unit level and involve input from the professional clinical nurses directly providing patient care. On all patient care units, there are mechanisms to assure that clinical nursing staff have input into creation of the time plan schedule, while ensuring that there are adequate numbers of direct care staff to meet patient needs. Unit clinical staff nurses collaborate with the Nursing Directors and/or Registered Nurse delegates who are identified as Resource Nurses for the shift to make day-to-day, shift-to-shift or hour-by-hour staffing decisions. Staffing decisions and patient care assignments are based on patient needs, such as current volume including turnover, projected admissions, as well as patient acuity (a patient’s need for nursing care) and nursing care requirements, in addition to Registered Nurse attributes such as skill and experience levels, work schedules and availability, and minimum staffing requirements.

MGH Registered Nurses use the QuadraMed AcuityPlus™ Inpatient Methodology as a tool for measuring acuity or patients’ requirements for nursing care. MGH has been using an acuity tool since 1985 and the voice of the staff nurses has been captured over the years in the development of the tool as it has evolved. The QuadraMed AcuityPlus tool supports the work of the nurses, but does not replace the Registered Nurse’s clinical judgment about the care needs of the patient.

MGH has been publicly reporting staffing level information via the PatientCareLink website since 2006. As such, the budgeted annual staffing plans for MGH ICUs, as well as the planned staffing versus actual staffing provided for each unit can be found at In addition, in accordance with the State of Massachusetts regulations 958 CMR 8.00 "Patient Assignment Limits for Registered Nurses in Intensive Care Units (ICUs) in Acute Hospitals", the data below demonstrate the actual staffing ratios for MGH ICUs.

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