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News — The American Association of Critical-Care Nurses () has published “,” the first staffing standards for this growing specialty.

Appropriate staffing is one of the “AACN Standards for Establishing and Sustaining Healthy Work Environments” (), published in 2005 and updated in 2016. It has also been one of the most complex areas to address.

On every national survey AACN has conducted to measure the health of clinical work environments between 2005 and 2019, nurses consistently gave lower ratings for survey items related to the appropriate staffing standard than for items related to the other HWE standards. In the most recent national survey, conducted in 2021, the item labeled “ensuring an effective match between patient needs and nurse competencies” received the lowest mean rating of any element on any of these surveys conducted to date.

Besides the HWE standards, the progressive care staffing standards build on similar standards that AACN developed for adult critical care and published in 2024, while recognizing the commonalities and responding to the differences between the two specialties. The new standards are also informed by AACN’s other influential resources related to nurse staffing, including AACN Synergy Model for Patient Care and its 2018 “Guiding Principles for Appropriate Staffing.”

In addition, the standards respond to recommendations from the Partners for Nurse Staffing Think Tank and the Nurse Staffing Task Force, national work that AACN co-led with other professional organizations. Both groups called for specialty nursing organizations to define staffing standards for the patient populations they serve.

“Staffing in progressive care presents unique challenges because patient acuity and admission criteria vary widely,” said Vicki Good, AACN chief clinical officer and co-editor of the staffing standards document. “There are no easy answers or quick fixes, but we must continue to seek solutions to ensure appropriate nurse staffing, for the benefit of patients, nurses, other healthcare professionals and their organizations.”

Developed with input from progressive care nurses who responded to a survey and/or participated in focus groups, “AACN Standards for Appropriate Staffing in Adult Progressive Care” outlines seven standards to incorporate appropriate staffing into everyday operations and patient care. Each standard includes actions for organizational leaders, clinical leaders and direct care nurses, as well as exemplars, tools and resources.

The seven standards are as follows:

• Direct care nurses participate in all aspects of staffing: planning, implementation and evaluation.
• Hospital patient care areas establish, evaluate and refine unit-specific staffing guidelines based upon their impact on patient and nurse outcomes.
• For every shift, patient assignments are based on an accurate assessment of the current nursing workload generated by each patient’s needs and align nurse competencies with patient characteristics.
• Clinical leaders such as charge nurses, educators and nurse managers do not take a patient assignment, except in rare crisis situations.
• Staffing plans and patient assignments support the unique needs of nurses who are new to the unit.
• Organizational staffing plans are designed to prioritize the health of the work environment and thus drive nurse retention and optimal patient outcomes.
• Organizational staffing plans anticipate that progressive care generally requires a ratio of one nurse for every three or four patients.

The document also includes a section with answers to common questions that arose during the development of the standards, a glossary and references.

Progressive care nurses provide direct care based on the needs of patients. These patients are often in hospital units named progressive care units or in other areas such as telemetry, stepdown, intermediate, adaptable acuity, emergency departments and long-term acute care hospitals. Progressive care nurses can also provide virtual nursing support by monitoring acutely ill patients from remote locations.

AACN introduced the term progressive care more than 20 years ago to describe the care of acutely ill patients who are moderately stable with a high risk of instability. In recent years, AACN published a clinical guide with progressive care nursing essentials and launched PCCN certification – AACN Certification Corporation’s fastest-growing credential. A new publication, “AACN Scope and Standards for Progressive Care Nursing Practice,” was published earlier this year.

“AACN Standards for Appropriate Staffing in Adult Progressive Care” can be downloaded at no charge on the AACN website after signing in. A print version of the 38-page document can be purchased from .

The document joins developed to describe the level of practice or performance expected by the nursing profession in order to provide excellent and compassionate care. In addition to the HWE standards and staffing standards, AACN has published guidelines specific to clinical nurse specialists, acute care nurse practitioners, tele-critical care nurses, and progressive care and critical care nurses.

About the American Association of Critical-Care Nurses: For more than 50 years, the American Association of Critical-Care Nurses (AACN) has been dedicated to acute and critical care nursing excellence. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with about 130,000 members and nearly 200 chapters in the United States.

American Association of Critical-Care Nurses, 27071 Aliso Creek Road, Aliso Viejo, CA 92656; 949-362-2000; www.aacn.org; facebook.com/aacnface; x.com/aacnme