Nursing Synergy Model: Staffing Plan for Acute Care Units
This paper critically reviews five nursing studies to develop an evidence-based staffing plan for a 24-bed general medical unit in an acute care hospital. Topics examined include the AACN Synergy Model for Patient Care and its applicability to critical care transport and rural nursing, skill mix between registered nurses and nursing assistants, the effects of extended shift lengths on nurse burnout, and the relationship between nurse-to-patient ratios and patient outcomes. Synthesizing these findings, the paper proposes a staffing structure of sixteen registered nurses and eight nursing assistants working in staggered shifts, maintaining a one-to-three nurse-to-patient ratio and shift lengths not exceeding eight to ten hours, in alignment with the synergy model's emphasis on matching nurse competencies to patient characteristics.
- Literature Review: Synergy Model and Rural Nursing: AACN synergy model in transport and rural contexts
- Skill Mix, Shift Length, and Staffing Ratios: Nursing assistants, shift duration, and patient ratios
- Synthesis of Literature Findings: Combining evidence into acute care best practices
- Care Model and Staffing Plan Connections: Synergy model applied to 24-bed unit planning
- Total Number of Staff and Skill Mix Needed: 16 nurses and 8 assistants per staffing structure
- Congruence with Care Model and Staff Structure: Staff numbers aligned with synergy model requirements
- Safe Staffing Procedures: Scheduling, feedback, and nurse wellbeing policies
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What makes this paper effective
- Moves systematically from literature review to synthesis to applied staffing plan, demonstrating how evidence informs practice decisions.
- Draws on a range of sources covering care models, workforce composition, shift duration, and staffing ratios, showing breadth of evidence.
- Connects each literature finding directly to a concrete staffing recommendation, keeping the argument grounded throughout.
Key academic technique demonstrated
The paper exemplifies evidence-based practice synthesis: multiple independent studies on related but distinct topics are reviewed separately, then woven together into a unified argument that justifies specific operational decisions. Rather than treating each article in isolation, the author explicitly identifies how findings from nurse-to-patient ratio research, shift-length research, and skill-mix research all reinforce the requirements of the synergy care model.
Structure breakdown
The paper opens with an article-by-article critical review covering the synergy model in transport and rural contexts, skill mix, shift length, and staffing ratios. A synthesis section bridges the literature to practice. Three applied sections then specify the care model rationale, the exact staff numbers and skill mix required, congruence with the model, and safe staffing procedures. The references section follows APA formatting conventions. Total structure is approximately seven logical sections moving from evidence to application.
Literature Review: Synergy Model and Rural Nursing
The article by Swickard et al. considers the role of the AACN Synergy Model for Patient Care in relation to transporting patients between hospital settings for increased levels of care. It reveals that the synergy model is a patient-centric framework in which providers attempt to match a patient's characteristics with a particular nurse's competency in order to achieve patient goals (Swickard et al., 2014, p. 16). The article was insightful because it demonstrated the need for such an approach in situations in which the care provider may or may not be aware of all the factors influencing how successfully a patient can be transported.
The article by Montgomery et al. focuses on the applicability of the synergy model of care in rural settings. It deconstructs the theory behind this care model, rural theory, and rural nursing practices. Analysis of "the four major concepts of the metaparadigm" (Montgomery et al., 2017, p. 87) associated with these concepts revealed that they were congruent with one another and appropriate for use in conjunction with one another. The article used this analysis to determine that, although the synergy model is designed for critical care, it is worthy of expansion to rural nursing practices in general.
The information contained in this article and that by Swickard et al. is a testament to the utilitarian nature of this care model. It is adequate for use in rural settings and for determining modes of transportation between hospitals.
Skill Mix, Shift Length, and Staffing Ratios
The article by Shearer considers the variation in the mixture of skills among nurses in various states in Australia. Specifically, this work evaluates the influence of nursing assistants when paired with registered nurses in acute settings. The basis of the article is an open forum in which registered nurses discussed the merit of nursing assistants in the context of different facets of the profession. Some of the findings revealed that the workload of each of these groups was incommensurate. Registered nurses actually wanted nursing assistants to perform more tasks. The article also detailed the phenomenon of placing registered nurses alongside nursing assistants, and largely cautioned against it because of the latter's limitations in education and the stipulations governing their job functions.
The article by Stimpfel et al. focuses on the length of nurses' shifts. It reveals that it is not uncommon for nurses to work longer than eight hours, and that in most cases nurses are satisfied with their scheduling (Stimpfel et al., 2012, p. 2501). However, the article also draws attention to the numerous drawbacks realized over the long term when nurses routinely work 12-hour shifts — or longer. These lengthy shifts directly correlate with career dissatisfaction and burnout, disadvantageously affecting both nurses and their employers in the long run. Nurses working 12-hour shifts or longer naturally have fewer shifts scheduled during a pay period than those working eight hours or less.
The article by Driscoll et al. indicates that there is a correlation between nurse-to-patient ratios and patient outcomes. This work denotes that in certain instances, lower nurse-to-patient ratios lead to decreased mortality rates (Driscoll et al., 2018, p. 6). The findings were based on a review of existing literature from 2006 to 2017. The authors sought to discern the effects of nurse-to-patient ratios on both patients and nurses. It was determined that higher staffing levels — resulting in lower nurse-to-patient ratios — contributed to decreased numbers of "medication errors, ulcers, restrain use, infections, and pneumonia" (Driscoll et al., 2018, p. 6).
Synthesis of Literature Findings
A synthesis of the information gathered from each topic reveals that it is possible to amalgamate these findings into a series of best practices regarding nursing in acute care settings. The focal point of this synthesis is the model of care appropriate to acute care settings — the synergy model. In order to best match patients with nurses whose traits yield the most value, it is necessary to provide those nurses with what they need in terms of scheduling and patient ratios. Nurses should not work 12-hour shifts or regularly exceed 10 hours consecutively, nor should the nurse-to-patient ratio be so high that nurses cannot focus adequately on the patients best suited to their qualities.
Additionally, to sufficiently staff for this particular care model, it is necessary to utilize nursing assistants as a vital resource to keep those ratios low and prevent nurses from working more than 10 hours in a row. Research on nurse-to-patient ratios consistently supports the value of adequate staffing levels in reducing adverse patient outcomes.
Care Model and Staffing Plan Connections
As described in the preceding synthesis section, the care model selected for a 24-bed general medical unit in an acute care hospital will revolve around the synergy model. It is imperative to pair patients with nurses who have the characteristics most beneficial to the attainment of each patient's objectives. To successfully implement this model, however, one must account for the staffing needs required to ensure nurses are able to function at their maximum capacity.
The primary considerations of the staffing plan for this care model are the mixture of nursing professionals involved, the length of shifts these professionals work, and the number of patients assigned to each nurse. The synergy model is best suited to a staffing situation in which nurse-to-patient ratios are relatively low, so that patients can optimize their interactions with their nurses and best achieve their care goals. It is equally critical that nurses work shifts of modest length — specifically not exceeding 10 hours, and ideally no more than eight hours at a time — in order to maintain their stamina, professionalism, and capacity to provide tailored care. Additionally, by supplementing registered nurses with nursing assistants, this care model can deliver optimum utility by ensuring nurses are not overworked.
References
Driscoll, A., Grant, M. J., Carroll, D., Dalton, S., Deaton, C., Jones, I., Lehwaldt, D., McKee, G., Munyombwe, T., & Astin, F. (2018). European Journal of Cardiovascular Nursing, 17(1), 6–22.
Montgomery, S. R., Sutton, A. L., & Pare, J. (2017). Online Journal of Rural Nursing and Health Care, 17(1), 87–99.
Shearer, T. (2013). Getting the mix right: Assistants in nursing and skill mix. Australian Nursing & Midwifery Journal, 21(5), 24–27.
Stimpfel, A. W., Sloane, D. M., & Aiken, L. H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs (Millwood), 31(11), 2501–2509.
Swickard, S., Swickard, W., Remier, A., Lindell, D., & Winkelman, C. (2014). Adaptation of the AACN synergy model for patient care to critical care transport. Critical Care Nurse, 34(1), 16–28.
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