Zeljko Ferencic‚MD
Zeljko Ferencic‚MD

Florence Nightingale, (12 May 1820 – 13 August 1910) was an English social reformer and statistician, and the founder of modern nursing. She came to prominence while serving as a manager and trainer of nurses during the Crimean War, in which she organized care for wounded soldiers. By giving nursing a favourable reputation she became an icon of Victorian culture, especially known as “The Lady with the Lamp” making rounds of wounded soldiers at night. Nightingale’s lasting contribution has been her role in founding the modern nursing profession. She set an example of compassion, commitment to patient care and diligent and thoughtful hospital administration. Since 1965, International Nurses Day has been celebrated on her birthday (12 May) each year.

The AACI International Standards for Healthcare Organizations is particularly focused on Nursing services subconsciously following the path established by Florence Nightingale more than 150 years ago.

The AACI set of standards for Nursing Service literally require:

  1. The nursing service shall have adequate numbers of licensed registered nurses, and other personnel to provide nursing care to all patients as needed. There shall be supervisory and staff personnel for each department or nursing unit to ensure, when needed, the immediate availability of a registered nurse for bedside care of any patient.
  2. The nursing service shall ensure that patient needs are met by ongoing assessments of patients’ needs and provides nursing staff to meet those needs. There shall be sufficient numbers, types and qualifications of supervisory and staff nursing personnel to respond to the appropriate nursing needs and care of the patient population of each department or nursing unit.
  3. There shall be a Registered Nurse (RN) physically present on the premises and on duty at all times. Every inpatient unit/department/location within the healthcare organisation-wide nursing service shall have adequate numbers of RNs physically present at each location to ensure the immediate availability of a RN for the bedside care of any patient.
  4. A RN would not be considered immediately available if the RN were working on more than one unit, building, floor in a building, or provider at the same time.

Why it’s so important? A recent published study (Griffiths P, Ball J, Bloor K, Böhning D, Briggs J, Dall’Ora C, et al. Nurse staffing levels, missed vital signs and mortality in hospitals: retrospective longitudinal observational study. Health Serv Deliv Res 2018;6(38)) showed that higher registered nurse staffing levels are associated with lower mortality increase in line with the extra registered nurse time spent supervising other staff. Also, increases in nursing skill mix, by having proportionately more registered nurses, may be cost-effective for improving patient safety. The two most amazing data from the study were:

  1. For each day that the registered nurses staffing level was below the average for that ward, the risk of death during the first five days of admission increased by 3%.
  2. The statistical model suggested that if there were a 0.32 increase in registered nurse staffing levels and similar decrease in healthcare assistants (so that the skill mix was in line with that planned by the Trust) this could reduce the death rate by 2%. It could avoid 50 deaths per year and prevent 4,464 bed-days. Though staff costs would increase by £28 per patient, overall costs would decrease due to fewer bed-days.


These results can help in discussions between AACI surveyors and hospital managers when implementing the Nursing Service Standards which for sure are in line with the aforementioned study confirming the main AACI mission: “Ruling Risks, Saving Lives”.