Inadequate Nursing: Patient Safety in Today's Healthcare Marketplace - A Four Part Series

Last week, we talked about the issue of inadequate staffing ratios. In part two of this four part patient safety series, we’ll focus on another area that requires our attention - inadequate nursing staff skill mix.

Updated: Feb 24, 2023

Inadequate Nursing: Patient Safety in Today's Healthcare Marketplace - A Four Part Series

As nurses, we are bound by our oath to provide quality care for every patient. This means holding hospitals and other healthcare facilities accountable for sufficient numbers of experienced nurses to ensure patient safety and support inexperienced nurses. Unfortunately, this is often not the case.

WHAT'S THE ISSUE?

"I don't know how to do that" is something that experienced nurses are hearing more often from new hires, float pool and travel nurses. To their surprise, hospitals and staffing agencies are employing nurses with less than two years of experience more often than those who are more seasoned. In fact, some nursing units have up to 75% under-qualified nurses, which pose many patient safety concerns for two main reasons:

1 ) Less experienced nurses do not possess the nursing skills needed to handle the physical, mental and emotional demands of the job. Not even the best nursing programs can take the place of real-life, practical experience. Without the opportunity to gain real-life, practical experience before beginning a new nursing position, new hires often feel "thrown to the wolves", and this poses a major issue for retention and job satisfaction.

2 ) Burnout rates are increasing among more nurses. As the overwhelming need for training, coaching, and mentoring consumes much of the time and energy of the bedside nursing staff, seasoned bedside nurses are forced to take on a greater workload for insulting pay rates and a lack of additional incentive. At the same time, new hires who are in desperate need training and mentorship are finding themselves abandoned and without skilled guidance.

According to The American Nurse, "Research indicates that staffing numbers alone don't always tell the whole story or assure positive outcomes for patients in the absence of other considerations. Other factors related to staff expertise, including RN education level, employment status and skill mix, as well as collegiality of nurse-physician relations exert a positive impact on select patient outcomes, such as 30-day mortality and hospital readmission rates."

The Joint Commision echoes these concerns: "Nurses are the front line of patient surveillance-monitoring patients' conditions, detecting problems, ready for rescue. Spread too thinly or lacking the appropriate skill set, the nurse is at risk of missing early signs of a problem, or missing the problem altogether."

WHAT'S THE CAUSE?

There are several contributing factors that lead to nursing staff with inadequate nursing skills. One major factor is that hospitals continue to have strict budget constraints, which creates freezes on nurse salary increases, and low starting pay rates. Without room for growth, in terms of opportunity to learn new skill sets, and higher pay, more experienced nurses might look for work elsewhere. This results in increased job vacancies which are soon to be filled by lower paid, inexperienced nurses.

Another potential cause is poor efforts by facility administration to improve nurse retention. Without innovative nurse retention efforts, high staff turnover rates will continue to plague these facilities. If experienced nurses don't feel valued by an institution, they are less likely to stay at that particular job. In a recent article that highlights nurse retention efforts, it was stated that the average hospital loses $5.2 million to $8.1 million due to RN turnover, and each percent change in RN turnover costs or saves a hospital an additional $373,200. So why wouldn't hospitals be on board with improving retention efforts?

The bottom line is that nurses report that low job satisfaction is primarily related to heavy workloads, an inability to ensure patient safety, and insulting salaries.

WHAT ARE WE DOING ABOUT IT?

Many national healthcare efforts are in the works to enhance nurse retention programs and increase salaries and incentives for their nursing staff. Here are a couple solutions already in progress:

The Nurse Residency Program. To enhance nurse retention, many institutions have begun implementing nurse residency programs. Research shows that nurse residency programs are an essential strategy to retain new grad nurses. These programs are significantly longer than traditional orientation programs , which can range from 6-12 months or more, and involve much more mentorship and guidance from experienced nurses. Unlike the two day travel nurse orientation, or the two week new hire orientations that most facilities currently provide, they cover in-depth training that focuses on strong connections among workplace colleagues and work-life balance. It is also shown that other studies that focus on skill mix provide strong evidence that when nursing staff members do not have adequate time or training to carry out their work, patient safety and patient outcomes are put at risk. Understanding this fact by all parties involved in making staffing decisions is critical to assuring the effective, safe and reliable delivery of nursing care.

Nursing wage and incentive increases. The American Nurses Association has created a Bill of Rights, which states nurses have the right to fair compensation for their work, that is consistent with their educational preparedness, knowledge, experience and professional duties. As a result, many nursing leaders have begun research initiatives to prove that higher salaries for nursing will result in better outcomes for everyone. According to an article published by NCBI, staff of direct patient care nursing roles in hospitals and nursing homes have reported dissatisfaction with wages, as well as non-wage benefits such as: health care, tuition reimbursement, and retirement benefits. Wage rates and distribution should match nursing staff skill levels to encourage entry into the profession and retention within the institution. Competitive wages, combined with good benefits will recruit adequate numbers of nurses to meet the ongoing care demands of the upcoming decades and prevent cyclical shortages that have defined the past half-century.

As a result of such healthcare initiatives, you may find salaries and bonuses for nurses to be back on the rise as hospitals strive to attract more longevity within their nursing staff.

As we push forward in working hard to correct the disproportionate nursing skills within our healthcare facilities, I am confident that our devotion to upholding the highest standards for patient safety will lend itself to creating positive change for all.

For articles in this series, go to: