Nursing Survey: How is Your Hospital Staffed, and Do You Feel it is Safe?

[allnurses]

Unsafe nurse staffing is a problem that occurs in hospitals across the United States. Decades of research shows that when nurses have too many patients, outcomes are worse and mortality is higher.[1]

Some states have staffing legislation in place requiring hospitals to staff their units according to a staffing plan developed by a committee made up of at least 50% direct care staff nurses. States with this legislation include Texas, Ohio, Illinois, Oregon, Washington, Nevada, and Connecticut. Other states have regulations that address nurse staffing in some other manner; these include California, Massachusetts, Minnesota, New Jersey, Rhode Island, Vermont, and New York. Many states have no legislation or guidelines on nurse staffing.[2]

Some hospitals use staffing committees or acuity systems. Others use nurse-to-patient ratios for different units, with limits on the number of patients any nurse can have. Some hospitals use a combination of staffing methods. You can help us find out what type, if any, of staffing methods or plans exist in the nation's hospitals. As to date there is no research that shows the effectiveness or compliance of staffing by acuity plans in hospitals. Despite that factor, professional organizations only recommend this approach to staffing.

We are doing a survey of nurses to determine what bedside nurses are experiencing in their hospitals and to see whether nurses feel that staffing is safe where they work. Please help us by completing this short survey to help us collect data that will help indicate compliance, effectiveness and safeness of the working conditions that you the bedside nurse experience.

SURVEY LINK: If you are a direct care staff nurse who holds an active RN license, work in the U.S. and wish to participate in the survey, click the following link to help determine How is your staffing determined and do you feel it is safe?

Participate In Our Survey

Please share your stories in the comments below as we look forward to hearing what you the working bedside nurse have to say.

References

1. Curtin LL. A conversation about the ethics of staffing. 2016;11. Accessed August 29, 2018.

2. Buppert C. What's being done about nurse staffing? Accessed August 29, 2018.

[meadow230]

I am an LPN and would have liked to take this survey. Why is it only limited to RN's?

[tallnurseguy]

I am an LPN and would have liked to take this survey. Why is it only limited to RN's?

Good question. I'm guessing that they may be using the info for study purposes and are therefore narrowing the input. To me, if the goal is to determine safety, input from all nursing staff (including CNA's) would be informative. I.e., anyone involved in providing "nursing" care.

[tallnurseguy]

Nurse staffing is such a complex question. I think setting minimum ratios is a good start, but it is not a complete solution. It's a foundation to build on. The next level of building on that foundation would be an object acuity scale. And that's really hard, and sometimes impossible, because patient acuity is not static, it's fluid. Especially in a critical care setting where one minute your patient is laughing and eating ice cream and the next minute you are calling a rapid response for her. You cannot predict that, which is why there must be minimum nurse patient ratios as a foundation.

Factors that i've experienced that effect nurse/patient safety often revolve around mid-shift staffing changes. DC's are happening, census goes down and management is scrambling to send nurses home. Often, it seems, there is little to no regard given to the nurses remaining when this happens. One may be down 2 patients because they have done 2 DC's and now are facing getting two new (to them) patients, often towards the end of a 12 hour shift. This should be taken into account. There are actual studies that show a nurse becomes less able after the fatigue of already working 8 or 9 hours, not a great time to tax their reserves with 2 new patients. I actually had a staffing manager tell me once when taking another nurses patient that: "it's easy, all you have to do is baby sit them for a couple of hours, all the charting has been done." As a kid i never baby sat an 87 year old with COPD, CHF exacerbation, DM2 and chest tubes (all in one person). Then of course, the other patient will be a new admit, total roll of the dice.

Beginning and end of shift (where lots of change is ocurring) has almost always been when i encounter dangerous situations because that is when a nurse has to climb that mountain of getting familiar with their patient. An existing patient being transferred to a new nurse, is still in many respects a "new" patient. Better systems rating acuity need to be used, especially under new assignment conditions.

Also, all acuity systems are not equal, and they are only as good as the people using them. And most importantly, acuity often change throughout the shift.

way complicated. sigh

[Elaken]

I agree that patient assignment is ridiculously hard. Nurses want their patients back. A lot of times they would rather have heavier patients that they know than 2 "lighter" ones to balance acuity. Nurses want their patients clustered and don't want to walk half the unit because spread apart. Sometimes at the beginning of the shift you learn 3 of your patients are discharging but then things happen and turns out no one leaves.

For the most part, other then egregiously heavy patients who you don't want with one nurse you can't really assign by acuity. You can't assign by who is leaving because I think 80% of the time we don't know. So the best thing to do is keep ratios at a level that can be handled with heavier patients.

And for unhelpful charge nurses to be gotten rid of but that can't really be legislated. Same with CNA/PCT. I'd rather have more patients with an awesome CNA working. So much of our job can be made more manageable if companies made a comittment to only keeping quality staff.

[tallnurseguy]

I agree that patient assignment is ridiculously hard. Nurses want their patients back. A lot of times they would rather have heavier patients that they know than 2 "lighter" ones to balance acuity. Nurses want their patients clustered and don't want to walk half the unit because spread apart. Sometimes at the beginning of the shift you learn 3 of your patients are discharging but then things happen and turns out no one leaves.

And for unhelpful charge nurses to be gotten rid of but that can't really be legislated. Same with CNA/PCT. I'd rather have more patients with an awesome CNA working. So much of our job can be made more manageable if companies made a comittment to only keeping quality staff.

I think you make some great points.

I work in a hospital where we choose our own patients. Our CC unit has 4 sections. If you were here yesterday, the general rule is you get to take your patients back... a plus in my book. I'm one of those nurses who would rather take high acuity patients i know back vs learning a new patient. I also have a rule for myself not to give a 'difficult' patient to someone else the next day. I let the gods decide, then go with it for as long as the patient is there. Not sure how wise that is, many have a "one and done" policy with "difficult" patients. That has wisdom too. The last hospital i was at, the charge selected your patients. Honestly, i like the choose your own method better, no one knows your patients as well as someone who has actually cared for them. Where this doesn't work well is if 4 out of 5 nurses are back and the new nurse gets stuck. It happens. The nurses i work with are nothing short of amazing, i don't have a critical word for one of them, but add exhaustion and being at the end of 3 or 4 12 hour shifts, it may be easier for them to look the other way when they know you're getting stuck with all the crazies lol.

I have to say our charge nurses are also right up their in the amazing category. We have 4 CC units and the charge nurses end up having to cover 2. Wasn't always that way and they're stretched. Ditto CNA's. Our CNA's are angels. They have brought me to tears on more than one occasion with their stalwart dedication. I love and appreciate these people.

I think in large part, the quality of the people i work with is because of the 2 department managers responsible for hiring. They both have hearts of gold and "get it." They know how to hire people who get it, and they do. That's pretty remarkable given they have little power. They have to implement policy vs make it. I think this is one of the big flaws in the system when it comes to staffing or any other management issue. Any typical hospital (read: "Corporation") is set up in tiers: "Executive, upper, middle, floor managers," then the actual doers like nurses, CNA's, doctors, housekeeping, PT, OT, RT, etc.. For me, the middle and floor managers are accessible, and i believe they generally know what's going on. Above that, not so much. The trouble is, the managers who know what's happening are rarely empowered to make policy, they usually have to implement policies of folk who are disconnected from what it takes to do the work. I think middle management often buffers upper from reality. I think if the wall came down, things would be more apt to change.

[Dsmcrn]

Yes the comment about research is correct.

We worked on perfecting this survey for almost 3 years and we learned a lot. In order for the data to be valued and able to be used as research the questions had to mirror the current staffing bills being used in a handful of states currently. It is nothing personal, it doesn't mean we don't feel LVNs are of value. That isn't it at all! We had to word the questions to mirror the staffing bill(s).

[Dsmcrn]

The goal is to prove effectiveness of the current staffing bills.

[catstks, BSN, RN]

Quote from meadow230

I am an LPN and would have liked to take this survey. Why is it only limited to RN's?

Hi Meadow, we didn't include LPNs only because we need to have specific demographic information. There are many research questions to investigate with regard to unsafe staffing. Research into unsafe staffing in facilities is best to focus on similar characteristics. Otherwise the data is not measurable or significant.

We do value LPNs and their role so please don't let it upset you that this is steered towards RNs.

[herring_RN, ASN, BSN]

I couldn't vote because I no longer work in a hospital.

As one of thousands of nurses who worked for the California bill I hope to see the results some day.

[Dsmcrn]

Thank you!! We need the support!

[Buckeye.nurse]

Our large nursing unit is divided into 3 "pods" to make assignments more clustered for the nurses and PCAs. Our base nurse to patient ratio is 4:1, but we can increase our staffing to a 3:1 nurse to patient ratio based on our acuity tool. The tool takes into account factors like intermediate care patients, new diagnosis (I work on a hematology floor, and first cycle chemo is time intensive with regards to teaching), comfort care pathways (end of life care), airways, and admits/discharges (we actually staff up if we are having high patient turnover which is very nice!). Our acuity tool also accounts for nurse interns in their first few weeks of orientation because the preceptor spends so much time teaching. And then there's the super handy "charge nurse discretion" line that lets us adjust the numbers for patients that require a lot of nursing time.

Overall I think my employer gives nurses a lot of latitude to determine the staffing we need. We don't always have enough staff scheduled to match what the acuity tool calls for (that's a whole different animal). Often the float pool comes through for us, but not always. I'd say though that when we are staffed according to acuity, I believe that we are delivering safe care, and have the time to give our patients the attention they deserve and need.