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Health Services Research & Development

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HSR&D In Progress

September 2020

In This Issue: How Research Helps Combat COVID-19
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Rapid Assessment of National Surges and Variations in COVID-19 Inpatient Nurse Staffing

Feature Article

Takeaway:This study will help track changes in staffing levels and workload, which will be essential in developing the appropriate responses to pandemics and other catastrophic stresses across healthcare delivery systems.

Hospitals are developing plans for handling the surge of patients seeking care for COVID-19 and corresponding strains on healthcare resources, including staff, personal protective equipment (PPE), and respiratory support equipment. New approaches are needed to respond to the outbreak, as well as efficient strategies for expanding or shifting staff capacity, and models for dealing with staff shortages due to illness/quarantine. Difficulty in determining how many staff members are in direct patient care roles at the hospital level – and at the inpatient unit level – has been an ongoing challenge for both research and operations applications.

As part of another HSR&D study that is examining how inpatient resources and burden affect outcomes, Dr. Laura Petersen and colleagues have developed methods to assess nurse staffing and workload using staff activity data in VA’s electronic health record (EHR). These data allow for identification of staff (e.g., registered nurses [RNs]) in direct patient care roles – and where in the hospital staff are located at specific times. The EHR data are consistent across all hospitals in the VA healthcare system and are collected as part of routine care, making comparisons across the entire system possible. Thus this ongoing HSR&D-funded study (June 2020 – March 2021) aims to:

  • Adapt methods for assessing inpatient staffing to real-time or near-real-time data and provide reports to operational leaders; and
  • Obtain input from operational leaders on their preferences for staffing report features and incorporate prioritized and feasible items into staffing reports.


This project will utilize VA electronic health record data for all VA acute-care inpatient units, as well as the Nurse Unit Mapping Application (to link bed locations with nursing units) and Human Resources Information Service data (to link staff with their respective occupations). Investigators will use this data to determine the number of unique nurses administering medications each day and the number of nurses administering medications scheduled for the ‘peak scheduled medication time’ each day. They also will determine the number of patients to whom nurses administered medications. In addition, they will determine the total time it takes for nurses to administer medications to all of their patients during the peak time. In addition, investigators will estimate direct-care RN hours worked and will prepare reports using (near) real-time data for operational leaders for monitoring staffing. Data for reports will be aggregated at the unit and facility level and will show trends in daily and/or shift-level nurse staffing and workload. Investigators plan to then virtually convene or correspond on at least a monthly basis with operational partner representatives to determine their needs for the rapid development of predictive models related to inpatient staffing.


None at this time.

Anticipated Impact

Monitoring and modeling of temporal and regional variation in direct-care nurse staffing and workload can support the deployment of resources to areas in the VA healthcare system that will most help Veterans. Tracking changes in staffing levels and workload also will be essential in developing appropriate responses to pandemics and other catastrophic stresses to the healthcare delivery system.

Principal Investigator: Laura Petersen, MD, MPH, leads HSR&D’s Center for Innovations in Quality, Effectiveness and Safety (IQuESt) in Houston, TX.


None at this time.

View study abstract

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