TheProblem of Nurse Staffing in Nursing Practice
Inany setting or role, nurses might experience various problems relatedto their practice. Such problems have a negative impact on the carethat is received by patients and their families. Not only do theseproblems affect the morale of nurses and cause tension betweencolleagues, but also they affect the relationships and productivitywithin a health institution in a negative way. Therefore, it isimportant for all of us to address these problems so that theclinical educators, administrators, managers, and other stakeholderscan develop ways of working with nurses in an effective andsupportive way, especially when they are faced with ongoing andsignificant problems related to nursing practice. One of theseproblems is nurse staffing. The Bureau of Labor and Statistics intwenty twelve, predicted a nationwide RN job vacancy of 1.2 millionnurses by the year 2020. This predication shows that nurse staffingis a problem that should be addressed before it is too late. Thepurpose of this assignment is to describe the problem of nursestaffing to health policy makers, governments, community, and nursingprofessions for them to understand the problems that nurses encounterduring practice, and give an illustration of how this problem can bechanged or solved for positive patient outcomes.
Registerednurses have for a long time emphasized and acknowledged that issuesrelated to staffing continue to be a concern (IOM, 2003). Not onlydoes the staffing problem influence the safety of the patients, butalso that of nurses. Saleh (2008) suggested that there has been astrong correlation between adequate patient to nurse ratios andpatient outcomes that are safe and of quality. Various challengeshave been contributed by shortened hospital stays and patient acuitythat is rising day by day. It has been a national challenge to find afavorable nurse to patient ratio (IOM, 2003).
Levelsof staffing that are adequate have proven to be very important asthey have led to reduction in medication and medical errors, adecrease in patient complications, a decrease in mortality, animprovement in satisfaction of the patients and their families, adecrease in burnout of nurses, a decrease in the fatigue of nurses,and also it has led to the improvement in job satisfaction and nurseretention in nurses (Saleh, 2008). Therefore, it is important toaddress and find a solution to the problem of nurse staffing.
Itis critical for healthcare institutions to identify and maintain asuitable mix and number of nurses for better and quality caredelivery. In my place of work, my employers fail to understand thatthere is an association between nurse staffing and the outcome ofcare we give as nurses. In this institution, the number of nurses whoare registered, vocational nurses and other healthcare workers is notadequate. Therefore, patients do not receive safe and quality care asrecommended, which means the care outcome is low. Such problems leadto the already few nurses becoming overworked, leading to fatiguehence low quality care given to patients and their families. For thisreason, states and healthcare leaders should come up with effectivestrategies that ensure appropriate nurse staffing that would offerand create an environment that is safe for both registered nurses andpatient.
Aproposed change in Nurse Staffing
Toensure effective nurse staffing, healthcare institutions must makesome changes in how they assess and monitor their staffing. Theyshould ensure that all healthcare practitioners including nurses aremonitored and assessed to know whether their staffing includes theappropriate number of caregivers with vital prowess and effectiveskill mix. According to Yang, hung, Chen, Hu, and Shieh (2012), withthe staffing levels being effective, the quality and safety of carewill improve.
Whenassessing the adequacy of nurse staffing, healthcare institutionsmust create standards that should be used to measure the competencyand staffing of their nurses. For example, such indicators shouldemanate from human resource department. There are various indicatorsas described by The Joint Commission that can be used to assess nursestaffing effectiveness such as patient falls, staff turnover rate,patient complaints, use of overtime, family complaints, staffinjuries, and adverse drug events (Armstrong, 2009).
Anotheralternative in meeting the needs of nurse staffing can be to hireskilled nurses from temporary staffing firms. 56 percent of hospitalsin America use travelling nurses or agencies to fill vacancies(Kristin, 2014). However, this is not the best solution because ithas negative impacts on staff nurses. Temporary nursing attracts moreincome and a nurse is able to choose his or her own schedule, whichmeans that the staff nurse in the same healthcare institution is paidless and has no ability to choose his or her schedule. Therefore,such a situation creates dissatisfaction for the staff nurse. Anothersolution to nurse staffing can be for the healthcare organizations toestablish and develop their own ratios regarding staffing, based ontheir experience and own evidence (Gerdtz and Nelson, 2007). Theseratios should be made mandatory to ensure appropriate levels of nursestaffing and nurse safety. In nineteen ninety nine, California passeda legislation to set minimum staffing levels, and in 2003, Californiaaffected a formula that was used in all hospitals in that state (IOM,2003).
Themost favorable way of solving the nurse staffing problem is fororganizations to endorse staffing ratios and appropriate skill mixthat would ensure quality care for patients and safety for nurses.For example, mandated staffing ratios for nurses are such as onenurse to three patient on surgical units, one pediatric nurse tothree children, one obstetric to two women in labor, one nurse tothree emergency patients , one nurse to one patient with a conditionthat needs critical care, and for every patient suffering fromtrauma, one nurse. All hospital units must have ratios designedspecifically for them such as psychiatric unit, telemetry and stepdown unit, burn units, post anesthesia unit, well baby andintermediate care nurseries, neonatal ICUS, and operating rooms. Notonly does failure to develop such measures affects the quality andsafety of care, but also it leads to high cases of adverse events andhigh risks of errors (Armstrong, 2009).
Accordingto Gerdtz et al., (2007), these ratios creates additional staffingcosts but saves lots of cash lost due to inadequate nurse staffing.However, appropriate levels of nurse staffing leads to increasedpatient outcomes and decreased nursing turnover, which means that thesociety and healthcare budget are relieved of some burdens. Due tosuch studies related to nurse staffing, some healthcare institutionsbelieve that numbers guarantee safety and have therefore campaignedfor mandated nurse to patient ratios (NTPRs) or NHPPD (Harding andWright, 2014). Back in two thousand and one, Australia introduces thefirst legislation that mandated NTPRS. The Victorian nurses wereengaged in a campaign that was proposing a model ratio of five nursesto twenty patients in surgical wards and acute medical in hospitalsthat were owned by the government (Gerdtz et al., 2007). Variousstudies show that high levels of nurse staffing are associated withlower decubitus ulcers, lower mortality, postoperative pulmonarycomplications, septicemia, lower incidence of infections, andpneumonia.
Achange in nurse staffing through nursing skill mix has proven to bebeneficial. A number of studies conducted about the relationshipbetween nursing skill mix and patient outcomes report that a decreasein a disease like pneumonia is associated with an increase inregistered nurse staffing (Kalisch, Tschannen, and Lee, 2012). Inaddition, an increase in registered nurse staffing might lead toreduced incidences of cardiac arrest, sepsis, deep vein thrombosis,and finally gastrointestinal bleeding.
Astudy that was conducted by Yang et al., (2012)on the impact of nursing skill mix on patient outcomes in arespiratory care center revealed that high nursing skill mix ishighly associated with a lower rate of both urinary tract infectionand patients dying in ventilators.
Useof clinical and human resource indicators to assess and monitor nursestaffing in healthcare institutions have been studied by variousresearchers. Kalisch et al., (2012) conducted a research on therelationship between staffing, missed nursing care, and patientfalls. The aim of their study was to determine the mediating effectof missed nursing care on the relationship of patient falls andstaffing levels. They used a sample of one hundred and twenty patientunits in eleven hospitals. The research revealed that inadequatestaffing levels were associated with the rise in patient falls(Kalisch et al., 2012).
Forappropriate nurse to patient ratios and nurse skill mix to beachieved, timely, regular, and reliable collection of data isimportant for assessing and monitoring nurse staffing levels (Yang etal., 2012). Information for various indicators like patient fall,staffturnover rate, patient complaints, use of overtime, familycomplaints, staff injuries, and adverse drug events can be retrievedfrom administrative reports from the human resource department andother related departments (Gerdtz et al., 2007). This type of datacollection method is easy to retrieve, hence saves lots of time.Moreover, routine collection of data through survey questions shouldbe done to determine the relationship between nurse staffing, jobsatisfaction, and patient outcome. The participants should be nursesand their assistants, and they should have a one year nursingexperience. The survey questions should address the participant’scurrent experiences with job dissatisfaction and nurse to patientratios. Questions about the number of staffs assigned to each nurse,if the number of patients assigned to each nurse leads todissatisfaction, and thoughts about quitting the job, should beincorporated in the survey questions to determine the effects ofnurse staffing to quality care delivery (Harding et al., 2014).Answers to these survey questions will determine the effects ofadequate levels of nurse staffing.Inconclusion, nurse staffing has proven to be a practice problem thatmany nurses are facing today. Various studies conclude that adequatenurse staffing leads to positive patient outcomes, therefore thisissue should be addressed critically by healthcare facilities. Notonly does adequate and effective nurse staffing beneficial to nurses,but also it is beneficial to patients and their families. Thereforepositive changes should be encouraged in nurse staffing by ensuringthat the nurse to patient ratio is appropriate, and nurse skill mixis done effectively in all healthcare institutions. In addition, datacollection methods that might be appropriate in exploring nursestaffing have been discussed such as survey questions andadministrative reports. Therefore, it is important for allstakeholders in healthcare system to address the issue of nursestaffing for safe and quality healthcare outcomes, and improvedproductivity.References
Harding,T., & Wright, M. (2014). Unequal staffing: A snapshot of nursestaffing in critical care units in New South Wales, Australia. AJournal for the Australian Nursing Profession, 47(1), 7-15.
Armstrong,F. (2009). Ensuringquality, safety and positive patient outcomes: Why investing in nursing makes $sense. Melbourne,VIC: Australian Nursing Federation.Retrievedfrom http://anf.org.au/documents/reports/Issues_Ensuring_quality.pdf
Kalisch,B. J., Tschannen, D., & Lee, K. H. (2012). Missed Nursing Care,Staffing, and Patient Falls. Journalof Nursing Care Quality,27(1), 6-12. doi: 10.1097/NCQ.0b013e318225aa23
Instituteof Medicine (2003). Keepingpatients safe.Retrieved from http://books.nap.edu/openbook.php?record_id=10851&page=R1
Kristin,H. J. (2014). Nurses` Perceptions of Nurse Staffing and the Impact onPatient Falls. Masterof Science in Nursing.Retrieved from http://digitalcommons.ric.edu/school_of_nursing/45
Yang,P., Hung, C., Chen, Y., Hu, C., & Shieh, S. (2012). The Impactof Different Nursing Skill Mix Models on Patient Outcomes in aRespiratory Care Center. WorldviewsEvid Based Nurs,9(4), 227–233. doi: 10.1111/j.1741-6787.2012.00246.x
Saleh,A. (2008). The effect of nurse staffing on selected outcomes of care.USA: ProQuest.
Gerdtz,M. F., & Nelson, S. (2007). 5–20: A model of minimumnurse-to-patient ratios in Victoria, Australia. Journalof Nursing Management, 15(1),64–71.