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Ronda Hughes

Ronda Hughes

Associate professor
Marquette University


Dr. Hughes received a B.S. in nursing from Boston University, a M.H.S. in health policy with a minor in biomedical ethics from Johns Hopkins University, and her PhD. in Health Policy and Health Services Research from Johns Hopkins University. Dr. Hughes is a fellow in the American Academy of Nursing. She is an associate professor at Marquette University. She has published more than 60 articles and book chapters in reputed journals and books. She has and continues to serve on several national nursing and health committees and boards.

Research Interest

Midnight census is commonly used to determine registered nurse staffing. Unit-level workload increases with patient churn, the movement of patients in and out of the nursing unit. Failure to account for patient churn (i.e., the inflow and outflow of patient admissions, discharges and transfers) in staffing allocation impacts nurse workload and may result in adverse patient outcomes. An analysis was conducted to compares the staffing implications of three measures of nurse staffing requirements: midnight census, turnover adjustment based on length of stay, and volume of admissions, discharges and transfers. This analysis was done using unit-level data from a nationwide sample of 32 hospitals, where nursing units were grouped into three unit-type categories: intensive care, intermediate care, and medical surgical. Key findings indicated that the Midnight census alone did not account adequately for registered nurse workload intensity associated with patient churn. On average, units were staffed with a mixture of registered nurses and other nursing staff not always to budgeted levels. Adjusting for patient churn increases nurse staffing across all units and shifts. Based on this analysis, the use of patient admission, discharges and transfers to adjusted the midnight census may be useful in adjusting RN staffing on a shift basis to account for patient churn. Nurse managers and leader should understand the implications to nurse workload of various methods of calculating registered nurse staff requirements.