The importance of safe patient staffing for nurses and the benefit for grads

The recent pandemic has highlighted the importance of safe staffing for nurses. We have all known for quite some time that there is a shortage of bedside nurses, and there are many reasons for this. Anyone who works in healthcare knows that our healthcare delivery system isn’t really that healthy. The looming question is what are we doing about this problem?

Safe staffing

Many nurses believe that nurse staffing is a major issue. Many hospitals and administrators believe this as well. As of now, only one state (California) has laws that set forth a mandatory minimum staffing level. A handful of other states have passed some sort of legislation related to nurse staffing. Mostly just stating that healthcare facilities must have a staffing plan or staffing committee. Many facilities have staffing committees and other guidelines that suggest what the staffing levels should be. The problem that many have encountered with these guidelines is that they can easily be broken and have no ability to actually force minimum staffing. Plus, the majority of states have no legislation related to nurse staffing.

It seems that in today’s society we have legislation and an attempt to enact so many mandates related to healthcare. Those of us who have worked in long term care can especially attest to the high amount of regulation. Isn’t it a bit odd that the majority of states have not addressed the issue of safe patient staffing? We all know that we are caring for sicker and sicker patients in just about every setting, but staffing plans remain out of date and, oftentimes, have not kept pace with the changing landscape in healthcare. There is a large body of evidence that supports the benefits of safe staffing. There are benefits to safe staffing that range from better patient care and outcomes, higher nurse satisfaction, and decreased costs of care.

Key findings from recent research related to patient care include:

• Lower patient-to-nurse staffing ratios have been significantly associated with lower rates of hospital mortality, failure to rescue, cardiac arrest; hospital-acquired pneumonia, respiratory failure; patient falls (with and without injury); and pressure ulcers.
• Higher numbers of patients per nurse was strongly associated with the administration of the wrong medication or dose, pressure ulcers, and patient falls with injury.
• Short-staffing increases patients’ risk of death by between 4% and 6%. This risk is higher within the first five days of admission

Many nurses leave their jobs at the bedside due to chronic low staffing and being asked to do too much with too little. Burnout and nurse turnover are major issues for many hospitals and other healthcare facilities. Burnout and turnover can lead to many problems from a straight-up cost perspective but also the toll this could potentially take on a human life, which is more difficult to measure. I was recently talking with one of my students who was a very bright student. She works in a busy medical-surgical unit. One recent shift she was the most senior nurse on her unit and the most experienced. She graduated with her BNS just over two years ago. Now, I have the benefit of knowing this student and would feel comfortable with her taking care of myself or a loved one, but generally speaking, who do you want taking care of you or your family? A nurse with two years of experience who has worked on the unit for a short period of time or a nurse who has 15 years of experience and has worked on the unit for 10 years? We all know that burnout and nurse turnover are complex issues that have been studied numerous times. However, maybe there is a simple and obvious solution that may help the problem? From a patient perspective, we can easily see the benefits of safe staffing. I mean, who wouldn’t’ want a nurse caring for them that has fewer patients to care for? There are also benefits of safe staffing to view from a hospital or administrative perspective. Safe staffing has proven to be financially beneficial as well.

Key findings related to the financial benefit of safe staffing include:

• Safe staffing can lead to a decrease in hospital-acquired infections, decreased, decreased risk of readmission, shorter hospital stays, decrease falls and patient injuries
• It has been found that short-staffing increases the nurse’s risk of experiencing burnout which can lead to an increased turnover in employment. We all know this is costly, in 2012 the cost to replace one nurse was found to be $82,000
• High levels of nurse burnout and turnover lead to lower quality of care

Now, I bet I know what many of you are thinking, especially those of you who have worked in management like myself. Nurses are expensive and if I hire another nurse it will kill my budget! This is where we need to start to see things from the bigger picture. A recent national study found the financial costs and benefits of increasing nurse staffing for hospitals more or less evened out. The cost of increasing nurse staffing to safe levels had a less than 1.5% increase. The decision to increase or reduce staffing is largely based upon the value placed on human life. Sure, it will cost more to hire more nurses, but also remember the cost savings and benefits related to improved outcomes in care.

Reasons why we have less than safe staffing

We have just scratched the surface of the benefits of safe staffing so let’s discuss some potential reasons why we have less than safe staffing. First off, the term itself, “safe staffing” is subjective. What is the number of staff that would provide both safe and efficient care? I believe the answer to this question is in the research which has guided much of the proposed legislation and suggestions for mandatory minimum staffing, yet this question remains up for debate. Above I mentioned some of the financial implications for staffing and I often hear of the expense of nurses and organizations are reluctant to hire additional staff. However, most often I hear that organizations have trouble finding the staff they need to fill positions. Again, there are reasons for this. Sure pay, benefits, etc. all play a role, but there are other reasons as well. One question that was recently posed to me was, “Do we have a shortage of nurses or a shortage of nurses willing to work in areas where we see the shortage?” Hospitals and nurses are under enormous amounts of pressure as we see continue to deal with the rapid turnover of patients and staff. We are seeing sicker and sicker patients in every unit and in every setting.

As was discussed in this blog there are many things to think about when we are discussing safe staffing and nurse to patient ratios. However, one thing is clear. We must act to encourage more qualified nurses to stay at the bedside and improve our staffing levels in many areas of nursing. It is also clear that nurses must have their voices heard and have a bigger seat at the table when discussing staffing and issues that impact it. Nurses are the ideal advocates for our patients by the nature of our training. We must continue this advocacy when we examine important issues like staffing. Our advocacy can and does make a difference!