Make nursing changes at the bedside to ensure patient safety

Healthcare organizations struggle with staffing ratios and competency issues as novice nurses outnumber experienced ones, putting safety at risk.

In the post-pandemic environment, healthcare systems are feeling the squeeze, struggling to staff an adequate number of nurses for patient care. Simply put, there currently aren’t enough experienced nurses available at the bedside to provide quality care to people who need it. As a result, several states have proposed minimum patient/nurse ratios for healthcare systems within their jurisdiction.

The evidence is clear: the more patients a nurse cares for, the worse the patient outcomes and the increased risk of mortality. Recent research reveals that new graduates are not practice-ready, with the NCLEX® pass rate as one indicator, declining by 10% since 2019. Often new nurses don’t recognize when a patient is in trouble, and they are involved in more than 50% of medical errors. According to Benner’s Model, from novice to expert, nurses take 2 to 3 years to become competent.

What can healthcare systems and academic nursing programs do to manage this issue without relying on state or federal government oversight? Institute a safety net system for new nurse graduates.

What being practice-ready really means

Nurse leaders recognize that not all new nurses are practice-ready. It is important to recognize that a new nurse's competencies differ vastly from those of a proficient or expert nurse. We need to stop thinking that a nurse is a nurse — all nurses are not equal, based on their experience, clinical judgment, and skill proficiency.

Healthcare organizations must also come to grips with the fact that less-experienced nurses now outnumber experienced nurses at the bedside. To close this experience-complexity gap, they must invest in preceptor programs and other safety net programs for newer nurses. One option to bridge the gap is the adoption of clinical resource nurses, who can coach newer nurses once their orientation and nurse preceptorship ends. This is a good solution for tenured nurses who can no longer handle the physical demands of bedside nursing but aren’t ready to retire or leave the field. Expert nurses are also a good choice for filling virtual nurse programs, and healthcare organizations can benefit beyond the bedside, utilizing their knowledge in admissions and discharge. Although clinical resource nurses and virtual nurses will require additional funding, the return on investment (ROI) is well worth it as these programs have the potential to aid nurse retention and drive quality outcomes.

Match patient acuity with nurse competency

While research reveals that having the right number of competent nurses at the bedside is necessary to deliver safe, quality care, patient acuity is also a key consideration. As measured by the average length of stay (ALOS), patient acuity rose almost 10% between 2019 and 2021, a 6% increase for non-COVID-19 Medicare patients as the pandemic contributed to delayed and avoided care. For example, ALOS rose 89% for patients with rheumatoid arthritis and 65% for patients with neuroblastoma and adrenal cancer. In 2022, patient acuity, as reflected in the case mix index, rose 11.1% for mastectomy patients, 15% for appendectomy patients, and 7% for hysterectomy patients. At these rates, it is no longer just about patient/nurse ratios alone. To close the experience-complexity gap, staffing models must consider nursing competency, patient severity of illness, and safe patient/nurse ratios. It’s crucial that scheduling and staffing technology solutions have access to patient acuity and nurse competency data in order to recommend safe staffing levels.