Safe Staffing Saves Lives

Heather Radder, BSN

Have you ever been in a hospital where finding a nurse to help the patients was difficult? The feeling of not having enough nurses and nurses' aides to care for yourself or a loved one can be very scary. Adequate staffing is pertinent to quality patient care. Nurses have reported inadequate staffing for at least two decades. California was the first state to implement safe nurse-to-patient ratios in 2004. As a nurse who has worked in Florida and California, I have seen firsthand how adequate staffing impacts the quality of nursing care. Let's address the negative occurrences when a unit is not adequately staffed.

Poor Patient Outcomes

Pressure injuries, medical errors, and increased falls are a few complications that can occur when a hospital does not have safe nurse-to-patient ratios.

Medical errors

Reports of inadequate staffing were associated with medications not being given at the correct time or an even bigger problem- not given at all. Administering the wrong medication was another incident that occurred. One possibility is that higher workloads are causing nurses only to complete some of the medication administration verification processes- right patient, right medication, right dose, right route, right time. Inadequate staffing can lead to nurses cutting corners because they lack time to complete each task.

Pressure injuries

Patients who are immobile need to be turned every two hours to offload pressure and prevent pressure injuries. Some patients are more prone to pressure injuries and require special medical devices to prevent wounds. Studies indicate that hospital-acquired pressure injuries (HAPIs) increase the length of hospital stay by about 4.3 days. When nurse staffing is limited, getting assistance to turn patients every two hours can be more challenging.

Increased falls

Experiencing a fall in the hospital can lead to prolonged hospital visits and unnecessary injuries. When the nurse-to-patient ratio is increased by 0.5, the likelihood of a fall is increased by 10%. There are different measures used to help prevent falls, such as turning on a bed alarm, yellow non-slip socks, a yellow fall risk wristband, and a yellow fall risk sign on the door. These measures can be easily missed when not enough nurses work in a hospital unit.

Mental Health Issues for Nurses

The Future of Nursing 2020-2030 states that nurses commonly have mental health issues. Burnout, stress, and depression can impact the professional well-being of a nurse.

Burnout consists of three components: emotional exhaustion, a low sense of personal accomplishment at work, and depersonalization. It is estimated that 35-45% of U.S. nurses have experienced burnout. Two main causes of burnout are staffing shortages and high workloads. Possible consequences of burnout include poor patient outcomes, high turnover rates, and mental illness and suicide among clinicians.

Compassion Fatigue occurs when a nurse has a diminished capacity to empathize with people due to consistent exposure to the suffering of others. Organizational factors that impact this include lack of support, increased workloads, and time constraints that affect the quality of care. Personal factors include the inability to set professional boundaries (ex., not feeling obligated to pick up extra shifts), personal trauma history, and lack of self-care.

Moral Distress or injury can occur when the nurse knows the right thing to do but does not have the resources or support to do what is right. Organizational structures, such as unsafe staffing, can increase moral distress.

Conclusion

There is significant evidence that safe staffing saves lives. When nurses feel well supported in their role, they can give more quality care to their patients. In nursing evaluations, California nurses had higher percentages of a reasonable workload, adequate support to allow the nurse to spend time with the patients, increased quality of care, and 30-minute mandatory breaks during the workday. Hospitals should mandate safe nurse-to-patient ratios across the United States. Let's do better and make a difference for our patients and nurses.

Support for the Nurse

If you are a nurse, know that you are not alone. Check in with your colleagues and talk about the challenges you are going through. Many nurses experience burnout, moral injury, compassion fatigue, and mental health conditions secondary to their work conditions. If your unit is short on staffing, speak up! We must all collaborate to make a difference in the nursing profession. We need adequate staffing to help our patients feel safe, and our nurses feel supported.

References/Resources

Implications of the California Nurse Staffing Mandate for Other States: National Center for Biotechnology Information: National Library of Medicine

The Contribution of Staffing to Medication Administration Errors: A Text Mining Analysis of Incident Report Data: Sigma Theta Tau International Honor Society of Nursing: John Wiley & Sons, Inc.

A comparison of hospital-acquired pressure injuries in intensive care and non-intensive care units: a multifaceted quality improvement initiative: National Center for Biotechnology Information: National Library of Medicine

Association between Nurse Staffing Levels and Inpatient Falls: Society of Hospital Medicine

The Future of Nursing 2020-2030: National Academy of Medicine: National Academy of Sciences