The Staffing Shortage

In a different review of literature on staffing and patient outcomes, Heinz (2004) describes the relationships between staffing and mortality, length of stay, and complications of patients. At first the article paints a clear picture of the future of nursing as it starts to feel the shortage which is approaching due to aging of present nurses, lowered nursing school admissions, and other hospital issues including financial hardships. In looking at the impact of ratios on mortality there were five different studies identified that showed that the lower the ratio, the lower the risk of mortality of patients. A patient's length of stay was also influenced negatively with higher nurse-to-patient ratios and positively with specialized units and care from nurses. The impact of staffing on patient complications also showed that there was an inverse relationship between the two. Heinz concludes that the key to solving these problems in nursing and reducing negative patient outcomes is nursing recruitment and retention (Heinz, 2004).

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.

According to L.H. Aiken et al., there is strong evidence that supports a connection between better nurse staffing and better patient outcomes. Scientists argue that a higher amount of nurses on staff allows for a lower rate of overall patient mortality. The reasoning behind this point is the fact that higher nurse rates correlate with “better nurse care environments.” Patient to nurse ratio, highly educated nurses, and increased nurses on staff during a single period of time effects the environment that allows for proper patient care. If there are too many patients assigned to a single nurse it will lead to increased patient complications (medical care/ medication errors, mortality rates, etc.) increased nurse fatigue, and decreased nurse retention/job satisfaction. Scientists argue that these issues must be looked at immediately because there are “numbers of lives that would be saved through improved care environments.” Scientists also argue that the way to improve care environment is by having hospitals become “magnet

For over a decade researchers have been performing studies examining the effects patient-to-nurse ratios have on adverse outcomes, mortality rates, and failure-to-rescue rates of patients and on job dissatisfaction and burnout experiences of nurses. Aiken, Sloane, Sochalski, and Silber (2002) performed a study which showed that each additional patient per nurse increased patient mortality within 30 days of admission by 7% and increased failure-to-rescue by 7% as well. This same study also showed that each additional patient per nurse resulted in a 23% increase in nurse burnout and a 15% increase in job dissatisfaction. Additionally, Rafferty et al. (2007) performed a study in which the results showed that patients in hospitals with higher patient-to-nurse ratios had a 26% higher mortality rate and nurses were twice as likely to have job dissatisfaction and experience burnout. Blegen, Goode, Spetz, Vaughn, and Park (2011) performed a study where results showed that more staffing hours for nurses resulted in lower rates of congestive heart failure morality, infection, and prolonged hospital stays. The same study also showed that increased nursing care from registered nurses resulted in lower infection and failure to rescue rates and fewer cases of sepsis.

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

One of the external threats that were present during the survey is the patients’ condition, which could have influenced the work of the nurses. Since there are different conditions of patients, one of these could have influenced patient cases, teamwork and hence the study was not considerate enough. In addition, the study failed to integrate the participation of the nurses and instead focused on other staffs (Kalisch & Lee, 2011, p. 86). This could have triggered any negative relationships between the selected staffs and the nurses.

In an article published by Applied Nursing Research the authors point out that nurse staffing is related to patient outcomes, “lower levels of RN staffing are associated with higher rates of OPSN (Outcomes Potentially Sensitive to Nursing) in both medical and surgical patients treated in hospitals, U.S. Medicare, and other publically available administrative data” (Duffield et al., 2011, p. 245). The writer of this paper researched 5 relevant articles regarding the relationship between nurse to patient ratio, morbidity, and mortality, every article related similar information. “A systematic review of 102 studies concluded that increased RN staffing levels are associated with lower rates of morbidity and mortality” (Ball, Murrells, Rafferty, Morrow, & Griffiths, 2013, p. 2).

I could not agree with you more. I also believe that Mrs. Wallace is not receiving the care that is warranted. People trust health care personnel to do what is right, and to assist in the recovery process. In this day and time, more and more cuts are being made in the health care field. I actually wrote about this same subject in my journal this week. The employees are expected to do more with less, and the care is suffering. I don’t believe that administration wants the care to suffer, but their hands are tied as well. A facility cannot remain open if the bills are not being paid, but at the same time, the staff will not idly stand by and allow patients to suffer harm because of the staffing constraints. It is becoming a no-win situation for all of those involved. I am

The research article was written by MacPhee, Dahinten, and Havaei (2017) shared their aim of study which was to understand the effect of the unit. The job and task-level workload factors on three adverse patient outcomes (medication errors, urinary tract infections, and patient falls) and two nurse outcomes (emotional exhaustion and job dissatisfaction). These higher workloads to show adverse outcomes due to staffing ratios.

Extensive research has shown that there is a correlation between staffing and patient ratio and patient outcomes. Better outcomes particularly are shown with lower patient to nurse ratio. However staffing issues remain an ongoing concern which greatly impacts the safety of the nurse and their patients, and also impacts cost of healthcare. Evidence shows that adequate staffing causes reduction in mortality, nurse burnout and job satisfaction, and reduction in medical errors.

This nurse is interested in the affects administrative decisions surrounding nurse staffing in regards to patient outcomes and nurses work satisfaction. This nurse began her research with a question in mind; “How do RN to patient ratios affect patient outcomes?” The search returned greater than 2000 articles related to Nurse Staffing and patient outcomes. Although, many of the abstracts supported the relevance of the topic the amount of material was excessive and the subject too broad. In an effort to create a list that would be more manageable, this nurse concluded her topic needed to be refined and constructed a much more concise and limited search until finally she constructed a PICOT question which yielded less results within a limited topic.

"Results of this study point to the need to enhance nursing teamwork on patient care units. If nursing staff are not satisfied, like workers in general, they will be more likely to leave their position/occupation and/or to have a lower level of productivity. Moreover, increased teamwork would lead to safer and higher quality of care."

The case loads from these RNs had to be covered by the remaining staff. Staff started working even longer hours (twelve to sixteen hours) on several days weekly. Staff felt like they did not have the opportunity to provide care that was quality and meaningful. They were not able to use the knowledge and skills they acquired to make an impact on another’s health status as they thought would be. The job became more of completing assigned tasks rather than using nursing knowledge and judgment. According to Chan (2009) “When nurses perceive a lack of autonomy in their job, this is a leading cause of job dissatisfaction for nurses and a major factor when deciding to leave the job” (p. 21).

We hear nurse’s talk about how rewarding their profession is but what they seldom talk about is how it can be very challenging as well. There seems to be many issues existing in the nursing profession. One of the most affective issues in nursing is the decreasing number of staff nurses. With inadequate staffing, nurses are demanded to have more responsibilities thus causing more stress on the nurse. This increase in responsibility causes nurses to neglect many aspects of their patients’ care. Patient care is suffering from the shortage of nurses as there is an increase in adverse patient outcomes due to the shortage. Also, there is evidence that there is a positive relationship between the number of staff and the effectiveness of their teamwork. The more staff available the more likely nurses will work together as a team. A new act is being implemented to help with the nursing shortage. This act is called the National Nursing Shortage Reform and Patient Advocacy Act. The purpose of this paper is to discuss the issue of nursing shortage and how the National Nursing Shortage Reform and Patient Advocacy Act is an example of evidence-based practice.

Staffing deficits pose a direct threat of manifesting negative outcomes associated with the delivery of patient care. Anything or anyone that compromises patient care should be eradicated immediately. This author believes that staffing deficits remain a consistent issue due to lack of solutions that actively address the issue. This author believes that inadequate staffing is a major concern due to the degree of harm it can impose on patients. Adverse events associated with