Appropriate Nurse Staffing : Not Just About Numbers

Stanton, M. R. (2004, March). Hospital Nurse Staffing and Quality of Care. Research in Action. Rockville, MD, USA: Agency for Healthcare Research and Quality.

Dr. Linda Aiken is the leading researcher in nursing staffing rates within the United States (Kerfoot & Douglas, 2013). She suggests that each state follows California’s example of conducting research to determine a minimum staffing ratio and making it a law (Kerfoot & Douglas, 2013). The California legislation enhanced nurse staffing in hospitals across the state and improved the patient care results of millions of patients (Kerfoot & Douglas, 2013). After the bill went into effect, job satisfaction increased, and the nursing shortage ended (Kerfoot & Douglas, 2013).

Mandatory staffing ratios have been suggested as a way to meet nursing staffs’ concerns of high nurse to patient ratios. Mandatory staffing ratios are used as a way to reduce workload and patient mortality and are aimed at addressing the perceived imbalance between patient needs and nursing resources. (American Nursing Association, 2014). However, issues have been raised on applicability of staffing ratios since it could lead to increased costs without the guarantee of improvement in the quality of health care and could also lead to unintended consequences including unit closures, limited infrastructural development and limited access by patients (American Nursing Association, 2014).

Mandatory nurse-patient ratios have been a controversial topic facing nurses for decades. Nurses, patients, physicians, nursing organizations, researchers, hospitals, federal government, and state governments have opposing views in regard to mandatory nurse-patient ratios. Those that support the idea of mandatory nurse-patient ratios believe that there would be an improvement in quality of patient care, decreased nursing shortages, increased job satisfaction, decreased client hospitalization, and increased nurse recruitment (Pamela Tevington, 2012). Groups that oppose mandatory nurse-patient ratios believe that mandatory staffing laws ignore factors such as the level of care a patient requires from a nurse, treatments, length of hospitalization, improvements and differences in technology, the expense of an increased nursing staff, and nurse experience and education (Tevington, 2012).

The American Nurses Association supports a legislative model in which nurses are encouraged to create staffing plans specific to each unit. This approach will aide in establishing staffing levels that are flexible and can be changed based on the patients needs, number of admissions to the unit, discharges and transfers during each shift (“Nurse staffing plans,” 2013). This model will assist in keeping the unit staffed appropriately and organized in need of a change during each shift. Without an organized plan like this, a nurse may be required to take on a new admission and already have too big of a workload.

Two major forms of staffing guidelines will be discussed, nurse-to-patient ratio and staffing by acuity. This paper will discuss the history of each staffing form. It will point out the benefits and negative features of both practices, describe how hospitals deal with staffing and discuss the states that have laws requiring certain guidelines be followed.

In the past two decades, there has been a push for appropriate staff to client ratios. However, measuring client needs and nursing efforts have been around since 1922 (Lewinski-Corwin, 1922, pp. 603-606). The earliest recorded effort was by the New York Academy of Medicine. Superintendents and nurses from ten training schools documented the time spent providing bedside care. From complied information, the researchers revealed each client required an average of five hours and four minutes of care in a 24-hour period. From these observations, they evaluated staffing issues in New York City. At that time, none of the hospitals were sufficiently staffed (Lewinski-Corwin, 1922, pp. 603-606).

In recent years, the healthcare industry has seen a significant decline in the quality of patient care it provides. This has been the result of reduced staffing levels, overworked nurses, and an extremely high nurse to patient ratio. The importance of nurse staffing in hospital settings is an issue of great controversy. Too much staff results in costs that are too great for the facility to bear, but too little staffing results in patient care that is greatly hindered. Moreover, the shaky economy has led to widespread budget cuts; this, combined with the financial pressures associated with Medicare and private insurance companies have forced facilities to make due with fewer

Mandatory staffing has been a major problem across the nation for many years. As a result, of such practices, nurses are over worked, and therefore, patients lives are at risk. For example, working in the emergency room (ER), the patient ratio sometimes are 26 patients to one nurse. As a result of such practice, nurse licenses

Purpose of a literature matrix grid help organize the data extracted from research studies for examination. Rationale for choosing the five articles noted within the literature matrix grid (see Table 3) was for their relevancy to the PICO. All five research articles were published within the last 10 years and spoke specifically to staffing, missed cares, and critical access hospitals. Search quality included only the data based mentioned in Table 1. The most attractive research article I found is the one entered into the literature matrix grid in Table 3.

Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses (Jooste, 2013). The nurse manager has to explain to the management of the benefits of change in providing adequate staffing all the time. Adequate staffing helps staff retention. Staff retention saves a lot of money in terms of orienting new people to the unit. Safe staffing always helps in the reduction of falls, infection rates, pressure ulcers, decrease hospital stays and death. Flexible and creative scheduling is essential for retaining staff and promoting a positive work climate (Grohar-Murray & Langan, 2011). Adequate staffing with good staffing ratio will help nurses to concentrate on their patient care which may help in a reduction in medical errors and lawsuits to the hospital.

One professional organization that has been stepping up to the plate in regards to this issue is the American Nurses Association (ANA) and its Constituent & State Nurses Associations (C/SNA). The American Nurses Association (n.d.) role in this issue is to promote legislation that holds hospitals responsibility for developing and executing valid and reliable staffing plans. These plans are not to be confused with mandated ratios, which require fixed nurse to patient ratios. These plans are strictly based on each hospital’s unit unique circumstance and should evolve as the unit grows and changes.

As a nursing student I haven’t thought a lot about staffing issues, but it is a huge deal in nursing. Without the right amount of staff member’s patients cannot get the care they deserve. Not having enough help on the floor also makes life as a nurse more stressful. This problem can lead to burnout and multiple other issues like patient satisfaction rates. “Staffing decisions should be based on the number and needs of the individual health care consumer, families, and population served” (Weston et al, 2012, p. 250). Since the clinical site I attend is a small community hospital they don’t have as many employees as say Children’s Mercy would because it’s a larger facility. Nurse staffing depends on numerous items, which we came to learn more

Nurse staffing and how it relates to the quality of patient care has been an important issue in the field of nursing for quite some time. This topic has been particularly popular recently due to the fact that there is an increasing age among those who make up the Baby Boomer era in the United States. There will be a greater need for nurse staffing to increase to help accommodate the higher demand of care. Although nursing is “the top occupation in terms of job growth,” there are still nursing shortages among various hospitals across America today. The shortage in nurses heavily weighs on the overall quality of care that each individual patient receives during their hospital stay (Rosseter, 2014).

A changing economy and dwindling finances in the United States have created a challenge for healthcare funding, thus creating the need for amendments to the original Public Health Service Act (Public Health Reports, 1994). The proposed National Nursing Shortage Reform and Patient Advocacy Act (§ 864, 2015-2016) mandates that nurse staffing requirements will be sent to the Department of Health and Human Services (HHS) to guarantee minimum nurse/patient ratios. The proposed legislation gives precise numbers for nurse/patient ratios. Examples for direct care registered nurses include: one direct care registered nurse for every patient in an emergency trauma unit; one registered nurse for every two patients in critical care and intensive care units; one registered nurse for every three patients in the emergency room and telemetry units; one registered nurse for every four patients in intermediate care units and psychiatry units; one registered nurse for every five patients in rehabilitation units; etc. (§ 864, 2015-2016). Not only are nurse-to-patient ratios addressed, differentiation is made between ratios acceptable for registered nurses versus licensed practical nurses. Bill § 864 gives precise allowable ratios for licensed practical nurses. The bill also mandates exact numbers of nurse-to-patients ratios that are to be used and stipulates that averaging by hospitals is prohibited. Moreover, if persons requiring extra staffing are Medicare eligible, it will be the