Abstract
This paper argues the importance of appropriate staffing in the clinical setting of a hospital. Topics of this research paper include: the impact on the patient census, the negative effect on the nursing staff, the influence of a shortage of staff, and the correlation on how an increased workload on the staff results in a threat to the safety of both the nursing staff and the patient are discussed.
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The Importance of Appropriate Staffing
“Short staffing is, in a way, like driving drunk,” (Paul McNamara, 2018). In my mind, interpreting this quote is straightforward in that it places the lives of everyone in danger. Overworking nurses can result in a decrease in the quality of care provided as well as threatening the safety of the patient and the nurses providing care. In 2010, both the Senate and the House of Representatives implemented the Registered Nurse Safe Staffing Act of 2010 which requires, “an appropriate number of registered nurses provide direct patient care in each unit and on each shift of the hospital to ensure staffing levels that: (1) address the unique characteristics of the patients and hospital units; and (2) result in the delivery of safe, quality patient care consistent with specified requirements,” (Capps, 2010). Through the implementation of this act, it has, “amplified the role appropriate nurse staffing has in healthcare value and defining the quality healthcare delivery as well as to open the discussion on how to best link individual nursing care and patient outcomes,” (Pearce et. al, 2018, p. 173). Inadequate staffing directly influences the safety of the patient census and the nurses providing care, which correlates with an increase in the percentage of nurses experiencing burnout, fueling the shortage of nurses. While it is important to remember the principles that are applicable to the role of a nurse, in instances where there is a poor work environment related to an increased workload from ineffective staffing, the lines become blurred between providing patient-centered care and becoming task oriented to ensure completion of what needed to be accomplished during the shift. “Safe staffing acts and the principle of nonmaleficence will only complement each other and allow the nurse to practice in the way that is best for the patient,” (Martin, 2015, p. 6) Despite the implementation of acts to promote improved ratios, confounding variables, such as absenteeism related to a lack of compassion and exhaustion, still threaten safety of the patients that are being cared for.
Patient Safety
McHugh et al, 2016, conducted a study to reveal the directly correlated relationship between an increased workload and poor patient outcomes. “As each additional patient added to the workload of a nurse in a medical surgical unit results in 5% lower odds of survival and 16% lower odds of survival for patients in hospitals with poor work environments” (McHugh et. al, 2016). The Quality and Safety Education of Nurses has compiled a list of competencies that every nurse should be consciously aware of. “The QSEN initiative encompasses the competencies of patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics,” (Potter et. al, 2013, p. 7). Along with ensuring that the focus of care is always patient centered, safety should be the leading consideration when providing care for patients. One of the primary intentions of nursing is to promote patient care and wellbeing, with an increased workload, there are instances where more harm than health promotion occurs in the hospital. Aseptic technique may not always be maintained which can lead to an increase in the number of hospital-acquired infections. An overwhelming workload from inappropriate staffing may influence patient safety by causing the nursing staff to “cut corners” which could potentially result in failing to verify patient identifiers or allergies and failure to scan medications to “save time”. As previously stated, it is important to maintain the priority of patient safety in all procedures and in all aspects of care; however, it is equally important for the nurses providing the care to maintain their own safety.
Nurse Safety and Self-Care
Nurses often work long hours, commonly twelve-hour shifts, which leads to feelings of exhaustion. Similarly, driving or working while exhausted is as dangerous as doing so if the individual were intoxicated. Various complications can stem from long shifts with an overbearing workload and over-exhaustion. “This leads to negative health consequences for nurses, including an increased risk of musculoskeletal disorders, hypertension, cardiovascular disease, and depression” (Maass, 2017, p. 141). In addition to the physical complications that can result from increased stress on the body, psychological complications can also result. The development of maladaptive coping mechanisms may occur. “Not only have higher nurse-to-patient ratios been shown to increase nurse burnout, it can have serious effects on health and well-being of the nurse…chronic fatigue, poor sleep patterns, absenteeism, and job dissatisfaction” (Martin, 2015, p. 4)
Providing self-care as a nurse is important as it has been conveyed that, “you have to learn how to leave work at work and home life at home, you have to take care of yourself” (B. Elrod, personal communication, March 2, 2020). It is important to de-stress to decrease the risk of experiencing burnout, which can be defined as, “a state of physical and mental exhaustion that often affects health care providers because of the nature of their work environment,” (Potter et. al, 2013, p. 6). Self-care should be emphasized to all those who provide care to others. An important concept to consider is that an individual cannot provide care to others if they do not take care of themselves first. A lack of self-care often occurs where there is a high acuity need but low staffing which results in higher patient to nurse ratios. This leads to an increased likelihood that the facility will experience a lower retention rate and an increased amount of staff who are experiencing burnout. “Burnout occurs when there is a lack of social support, organizational pressures influencing staffing, and the inability of the nurse to practice self-care” (Potter et. al, 2013, p. 6). Despite the continuing expansion of the healthcare field, there is an increasing shortage of nurses due to feeling “burned out” and both physical and emotional fatigue.
The Impact of a Shortage of Nurses
Advances are continuously occurring in the healthcare field which allows for growth of resources that can be utilized by patients and medical staff alike. Discussing a chief complaint with your primary care provider can now be as simple as reporting your symptoms through an app. There continues to be a development of more facilities to respond to an increased demand for healthcare access, likewise, there continues to be a shortage of staff to fulfill the rising demand. “Nursing shortages and low staffing ratios are associated with unmet patient needs and negative nurse-sensitive outcomes, such as mortality, failure to rescue, cardiac arrest, patient falls, pressure injuries, nosocomial infections, and readmission rates,” (Cho et. al, 2016).
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An increasing number of nurses experiencing burnout leads to a lower retention rate in acute care facilities which circles back to the threat against both patient and nurse safety. A stressful work environment, which may include a lack of cohesiveness and delegation between staff, decreases staff retention as new nurses are graduating and entering the field. As a result, a shortage of nurses leads to a negative impact on the care provided to patients. “Better hospital work environments and adequate hospital nurse staffing levels are important strategies in improving patient survival rates,” (Hill, 2017). A lower number of nurses available in units can impact the direction of a patient’s recovery as well as increase the chance of mortality while in the hospital. “Better work environments and decreased patient-to-nurse ratios on medical-surgical units are associated with higher odds of patient survival after an in-hospital cardiac arrest” (McHugh, 2016). It can be observed that an increased workload on nurses ultimately leads to a shortage of staff and an increase in the occurrence of adverse outcomes in patients. Despite the occurrence of burnout leading to nursing shortages worldwide, attempts are being made to promote lower ratios to improve staff morale and decrease the likelihood of sentinel events and hospital-acquired complications in patients.
Conclusion
The importance of adequate staffing cannot be understated. Safety of the patients and the nurses remains of the highest importance. Through the utilization of suitable staffing, staff retention rates improve and allow for a decreased workload which directly decreases feelings of “burnout”. Nursing involves providing care for those who cannot care for themselves; however, it is critical that nurses remember to participate in self-care to promote overall well-being of themselves. Self-care can also decrease the prevalence of burnout and to reduce feelings of both physical and emotional fatigue. There is a direct correlation between lower nurse-patient ratios and improved recovery and survival rates of patients. In conclusion, it is important that appropriate staffing is implemented to promote holistic care of the patient census as well as the staff providing the care.
Resources
- Capps, & Lois. (2010, June 15). H.R.5527 - 111th Congress (2009-2010): Registered Nurse Safe Staffing Act of 2010. Retrieved from: https://www.congress.gov/bill/111th-congress/house-bill/5527?s=1&r=8
- Cho, E., Chin, D. L., Kim, S., & Hong, O. (2016). The Relationships of Nursing Staffing Level and Work Environment with Patient Adverse Events. Journal of Nursing Scholarship 48(1), 74-82. Retrieved from: https://doi.org/10.1111/jnu.12183
- Hill, B. (2017). Do Nurse Staffing Levels Affect Patient Mortality in Acute Secondary Care? British Journal of Nursing, 26(12), 698-704 Retrieved from: https://doi.org/10.12968/bjon.2017.26.12.698
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- Maass, K.L., Liu, B., Daskin, M.S., Duck, M., Wang, Z., Mwenesi, R., Schpiro, H., (2017). Incorporating Nurse Absenteeism into Staffing with Demand Uncertainty. Healthcare Management Science – Springer 20, 141-155 Retrieved from: https://doi.org/10.1007/s10729-015-9345-z
- McHugh, M., Rochman, M., Sloane, D., Berg, R., Mancini, M., Nadkarni, V., Merchant, R.,& Aiken, L. (2016). Better Nurse Staffing and Nurse Work Environments Associated withIncreased Survival of In-Hospital Cardiac Arrest Patients.Medical Care, 54(1), 74-80 Retrieved from: https://doi.org/10.1097/MLR.0000000000000456
- McNamara, P. (2018, November 16). "Short staffing is in a way like driving drunk.".Retrieved from: https://twitter.com/meta4rn/status/1063378911273205762
- Pearce, P.F., Morgan, S., Matthews, J.H., Martin, D.M., Ross, S.O., Rochin, E., & Welton,J.M.(2018). The Value of Nurse Staffing: ANA Principles Redevelopment andDirection for the Future. Nursing economic$, 36(4), 169-176. Retrieved from: http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edb&AN=131366441&site=eds-live&scope=site
- Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2013). Fundamentals of nursing (9th ed.) St. Louis, MO: Mosby Elsevier.
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