The Effects of Staffing Levels on Nursing Quality and Care

Over the last decades both public and private hospitals have been experiencing severe financial situations (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The financial shortage is associated with delay or even lack of governmental sponsorship and competition from their rivals. Enacting the policy will mount financial pressure on these hospitals that are on cost-cutting strategies. The salaries and wages of nurses are dominating the costs of operation in the hospitals and therefore adding more staff to correct the understaffing will be like creating another problem (Goddard, 2003). Contrary, Empirical studies prove that adequate nurse staffing produces better outcomes for both the staffs and the patients (Donaldson & Shapiro, 2010). These do not mean that the financial performance of the health centers will be at stake. Quality is associated with profitability. Understaffing leads to increased workloads, fatigue and job dissatisfaction. These situations that can be corrected on the implementation of proper staffing policies (Everhart, Neff, Al-Amin, Nogle, & Weech-Maldonado, 2013). The policy aims at offering quality service, reasonable patient-doctor ratios, reducing high mortality rates, improving the health of patients through proper examination and disease diagnosis among other

According to Suzanne Gordon “ whether young or old, nurses are disillusioned because they believe that health care systems guided by bottom-line concerns simply don’t recognize the specificity of their work” (234). Nursing is more demanding than many other professions or occupations, due to the combination of difficult patients, exhausting schedules and arduous physical work (Gordon 235). It can take a significant emotional toll on many, hence the higher levels of burnout. Job dissatisfaction as a result of increased workloads and unreasonable demands, such as inappropriate nurse staffing levels, was cited as the number one reason that drives many experienced nurses to leave the profession (Sanford 38+). Studies have shown that such working conditions also affected the retention of new graduate nurses by leaving their first hospital jobs within two years of graduating (Sanford 38+).

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

Nurse-to-patient ratios is not a new topic of debate for all of us who deliver care to patients every day. Only lately it has been a big issue that have caught the attention of many. Demands by the medical community for changes concerning staffing, asking for the government interventions in minimum staffing laws. Registered nurses have long acknowledged and continue to emphasize that staffing issues are an ongoing concern, one that influences the safety of both the patient and the nurse. (ANA, 2015) .nowadays hospitals are running for profit and the emphasis is not put on job burnout, stress, and endangerment of patients. Nursing shortages is a very pertinent problem, it will be optimum to have laws in place to help with the issue, however meanwhile leadership and management methods to the matter can help to mend the nursing situation and avoid many of the damaging effects of unfitting nurse-to-patient ratios.

The purpose of this article is to discuss appropriate nurse staffing and staffing ratios and its impact on patient care. Although the issue is just not about numbers as we discuss staffing we begin to see how complex the issue has become over the years. Many factors can affect appropriate nurse staffing ratios. As we investigate nurse staffing ratios we can see the importance of finding the right mix and number of nurses to provide quality care for patients.

Nursing to patient ratio can have a direct impact on patient safety. Studies have been done that show that these ratios impact patient outcomes and mortality rates when nurses are understaffed and are given a larger patient load than they can handle safely. Nursing education level has also shown to play a role in patient outcomes. Whether they are an unexperienced nurse or the patients are at a higher acuity and require more time for care, these larger ratios can be detrimental to the nursing quality of care that can be provided. These larger nurse to patient ratios can also play a part in nurse burnout leading to medical errors, negative patient outcomes, and higher health care costs in the future.

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.

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).

Significance: Because nursing is the largest health care profession and nurses provide most of the patient care, and as an acute nurse, I can relate to how unsafe nurse staffing/low nurse-to-patient ratios can have negative impact on patient satisfaction and outcome, can lead to medical and/or medication errors and nurse burnout. It can also bring about anxiety and frustration, which can also clouds the nurses’ critical thinking. Most patients might not know the work load on a particular nurse and can assume that her nurse is just not efficient. Doctors also can become very impatient with their nurses because orders are not being followed through that can delay treatments to their patients. There is also delays in attending to call lights resulting in very unhappy patients who needed help.

Inconsistent nurse-patient ratios are a concern in hospitals across the nation because they limit nurse’s ability to provide safe patient care. Healthcare professionals such as nurses and physicians agree that current nurse staffing systems are inadequate and unreliable and not only affect patient health outcomes, but also create job dissatisfaction among medical staff (Avalere Health, 2015). A 2002 study led by RN and PhD Linda Aiken suggests that "forty percent of hospitals nurses have burnout levels that exceed the norms for healthcare workers" (Aiken, Clarke, Sloane, Sochalski & Silber, 2002). These data represents the constant struggle of nurses when trying to provide high quality care in a hospital setting.

The issue of healthcare personnel scarcity continues to be an ongoing challenge across the globe. Invariably, nurses are at the pinnacle in the delivery of quality care in any healthcare setting. The ever-increasing demands for care stem from a patient populace that is emergent, growing older and needing more care due to the escalating shift in their disease process. Hence, nurses are torn between balancing an overloaded schedule, working extra hours and maintaining astuteness and professionalism. This transcends to compromised patient care, nursing burnout makes it difficult for them to experience the rewards of caring for patients in the way they had expected; thereby, adding to the shortage of

Research Critique, Part 1: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction

Nurses, always involved in patient care, sometimes experience detrimental effects with prolonged stress or “burnout” during their career throughout the years. Burnout is defined as an extended response to physical or emotional stressors. Some examples of these stressors are; memories of witnessing death, patient and family suffering, emotional stress of losing patients, feeling emotionally and physically drained, or emotional disconnect from staff which can all contribute to burnout. As a result, nurses can experience; exhaustion, anxiety, dissatisfaction and low capacity. Overall, burnout can have negative effects not just on the emotional and physical health of nurses but also on; patient satisfaction, outcomes and mortality of nurses and patients. Although, there are ways to reduce or prevent these negative effects of burnout from manifesting. For example, nurses can apply interventions to reduce these risks including; staff support, onsite counselors and psychiatrists for nurses and salary increases and reimbursement opportunities for nurses through clinical ladder programs. Nurses can also start by just saying no to certain requests, being aware of their tolerance level, by taking care of themselves and having fun outside of work. On the other hand, others do not think nursing burnout is fatal and nurses just need a break from their job to initiate change. Although, the issue of burnout is prevalent in nurse’s careers which need to be addressed more in society in

One of the many goals of the nursing profession is to provide high-quality, safe patient care. There are many responsibilities that come with a nursing career and when the nurse to patient ratio increases, there is a possibility that it may hinder the safe care that patients deserve, and this may result in negative patient outcomes and level of satisfaction. Staffing is one of the many issues that healthcare facilities face. In many facilities, there never seems to be enough nurses per shift to provide high quality, thorough patient care which often leads to burnt out staff, and frustrated patients and families. This review discusses the findings of quantitative studies and one systematic review that involves patient outcomes in relation to nurse staffing.