Edited by Ayodele Nwosu
Published on August 27th, 2014
A close friend of mine and a recent nursing school graduate started her new job as an RN in her home town. Intelligent, motivated, and excited, she began practice. As the months went by, the staffing was low and the patient ratios were at 5:1. She was stressed, but still passionate about her career. One night shift, there was a severe shortage of staff, with this new six-month RN caring for 10 patients. She gave her resignation letter the next time she came in for work and searched for another RN position.
Short staffing has been a long time issue for the nursing field for several years. This is especially true with the ever growing population of baby boomers, longer life expectancy, and more health complications. Although this creates an issue of high patient-nurse ratios and fatigued nurses, it also affects something larger: the safety of the patient and health care professional.
With fatigued nurses caring for multiple patients, the chance to deeply know about the patient and their particular ailment decreases. This leads to decreased quality of care and a brewing pot for medication errors from exhaustion. The risk for infection, such as pneumonia and UTIs related to catheters, shock, and gastrointestinal bleeds increases with hospitals who are short staffed, according to the American Healthcare Research and Quality (AHRQ). Most importantly, it can also increase the suffering and hospital stay of the patient for whom the nurse is caring.
Short staffing also affects individual hospitals and the larger health care system. The rise of adverse patient outcomes increases hospital billing significantly, with more health complications, longer stays, and more healthcare personnel needed for the patients affected. While adequate nurse staffing initiatives would be helpful for a hospital staff, the financial side of the hospital system is concerned for the cost of more employees, particularly nurses, will burden on the institution. However, sufficient nurse staffing will lead to decreased risk in adverse patient outcomes, including fewer nosocomial infections and shorter hospital stays, leading to less cost for the hospital, healthier and higher quality care for patients, and more job satisfaction in nursing.
The well-being of the nurse is also at risk, with high fatigue, stress, and increased job dissatisfaction related to short staffing. Research conducted by Kovner, C. et al (1990-1996) looked into the relationship between nurse dissatisfaction and acuity of patient care. It was found that there was a significant increase in patient acuity of care needed, and also a higher rate of job dissatisfaction in nursing compared to other occupations. The majority of nurses reported that there was insufficient staffing on their units, and this contributed to discontent in the work place. A longer life expectancy brings an expected increase in patient acuity of care, with more problems that can occur with advanced age. Therefore more nurses may be needed for high acuity cases; and with the association of RNs being unhappy in the workplace, it can contribute to burnouts which decrease the amount of nursing staff even more, becoming more harmful to the patient, hospital, and the entire health care system.
The most disconcerting issue about nurse staffing compared to other issues is its impact on other aspects of nursing and health care. A massive detrimental domino effect on patients, nurses, costs, hospital personnel, and health care exists. It is an issue that requires efforts from the business side of the health care system to put efforts towards increasing nursing staff. There is government initiative needed in relationship to hospitals and health care systems’ efforts, as well as combined efforts nursing education. Accredited nursing institutions should address the issue and promote nursing in a way that will make future RNs strong advocates for the safety of themselves, fellow employees, and most importantly, the patients in need of high quality care.
Hospital Nurse Staffing and Quality of Care: Research in Action, Issue 14. March 2004. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/factsheets/services/nursestaffing/index.htm
Kovner C, Jones C, Zhan C, et al. Nurse staffing and postsurgical adverse outcomes: analysis of administrative data from a sample of U.S. hospitals, 1990-1996. HSR: Health Serv Res 2002; 37(3):611-29