I have only been a nurse for a couple years and in that time I have found one issue that unites all nurses: a deep loathing for an under-staffed unit. We’ve all experienced it, we all hate it. So how does it keep happening? To understand the how, we must start with the what. Furthermore, to find effective solutions, we must start with the driving causes.
Talk to any nurse and they will have something to say about the staffing at their hospital or facility. More often than not, that something will be an unflattering depiction best summed up with three words: stretched too thin. Additionally, the COVID 19 pandemic, like a flare up of a chronic disease, has only exacerbated the issue. While the problems addressed here can be frustrating, the goal is to rationally examine the causes of under-staffed hospital units in order to then identify potential solutions.
The Problem: Defining Short Staffing
What is short staffing? That depends primarily on the defined nurse-to-patient ratios in each hospital and on each unit. Ask any hospital administrator and any nurse at the same hospital to describe the safe, ideal nurse-to-patient ratio on a given unit and they will be give completely different answers. Why is this? One likely reason is the perspective and roles of each side varies greatly. An administrator considers a completely different set of criteria than a nurse would for the same problem.
The Fix
If nurse-to-patient ratios are the foundation for safe, effective patient care then coming to an agreement on what those ratios should be is paramount. This requires open, honest communication between clinicians and administrators alike. Clearly defined and agreed upon criteria for what adequate staffing on each unit looks like gives everyone a solid foundation with which to start. Nurses are critical to helping define these standards in order to ensure that expectations are realistic.
The Problem: Accounting for Census Changes
There is no question that patient censuses can fluctuate dramatically in short periods of time. We've all left a shift with adequate staffing only to come back 12 hours later to twice the patients and half the staff. These variabilities are difficult to predict, although not impossible to prepare for.
While floating nurses to other units is a commonly used solution, it is a temporary fix and not always seen favorably with floor nurses. Why is floating such a dreaded event? There are many perspectives and reasons although most of these boil down to one common element- the unknown.
On any given shift, there is a lot a nurse can know ahead of time and a lot they cannot. We can know our units- where the supply room or code cart is or the policy for various unit specific procedures and processes, on the other hand we can't know our patients, their conditions, or what may happen over the course of a shift until we are there. Floating to new units takes away the piece of the shift we can know.
The Fix
One option is to give nurses to chance to choose two separate units to work on and then provide full orientations to both units. Allowing nurses the choice of an extra unit gives them some element of control, additionally the orientation gives them the chance to be more comfortable and therefore safe on the unit. Furthermore, this would have the added benefit of reducing potential burn out from being in are place too long.
Another option is to hire nurses specifically as float/pool nurses. Setting the expectation at the time of hire for their role and work expectations will allow the hospital and nurse alike to find and fill roles that fit both parties.
The Problem: Nursing Burn Out and Turn Over
It's a true "chicken or the egg" type question: does short staffing cause nurse burn out or does nurse burn out cause short staffing? There are good arguments for either side, however ultimately addressing both issues is crucial.
The Fix
Hospital administrators have many parameters they use to measure their hospital's success. There are internal considerations such as patient satisfaction surveys and even employee surveys as well as external influences such as various accreditations that can elevate a hospital's standing. Including safe nurse-to-patient staffing ratios as a unit of measurement for success and then getting "dinged" every time a unit operates without appropriate staffing aligns nursing priorities with administration priorities.
This alignment of goals puts everyone on the same page. Which, in turn, helps nurses feel protected by their hospitals leading to a reduction in nurse turn over. All in all, it is mutually beneficial to ensure safe nurse-to-patient ratios.
The Best Chance for Change?
While short nurse staffing can be difficult problem to address, it is not impossible manage. Ultimately, the best chance for change has everyone working towards the same goals: safe, effective, compassionate care for our patients.
What are some of the issues you've found that contribute to under-staffing at your hospital?
Many of us are learning that facilities just do not care. It the bottom line and the scores…the patient satisfaction with food was more important than the fact that we saved their life, they’re uninsured, they complain, we will never get paid- but don’t screw up their food- even though we have zero to do with it….yeah, over it.
We have always been short staffed. Agency nursing only utilized if absolutely necessary and the cost is much higher than a staff nurse so another kick in the teeth for those of us that work their. I did it for 18 years and finally said- screw it. Found a new nursing job, scary changing specialties that far into a job, but if the system can’t fix itself in almost 20 years, I wasn’t going to waste another 20 years waiting. I love what I do now. Best choice I ever made. Got the heck away from an abusive environment looking to place the blame on nursing for their poor outcomes-a person can only do so much- we cannot be in two places at once and we’ve yet to clone ourselves to make labor ‘cheaper’ to the overpaid bean counters. A bit of sarcasm there- but I don’t see any great changes happening soon….I’m still getting text/call/email bombed for local travel nurse positions in my area for day all shifts….beware of a high offer- it’ll likely be 13+ weeks of hell on earth.
Agreed! I want it for the whole year round. The stupid kitschy gifts they can keep. For those of us who got nothing, I would settle for safe staffing and fair compensation for the risks I take being a nurse.
That costs a lot more than a lunch bag with the company logo. ?
It's not rocket science. But if nurses continue to work under difficult circumstances the poor working conditions will go on.
The only way I see to improve working conditions here is through striking. "
Not all hospitals are unionized. That leaves some nurses with their only option being to vote with their feet.
In short, the businesses know that people aren't well off enough to not work. People need to eat. If people have enough money not to starve, I wonder who will do the work.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
On 6/11/2021 at 7:57 AM, ThursdayNight said:
It will not get any better. Our older population is higher versus the healthcare providers. Don't know if I'm talking out of my anal cavity. Please correct me if I'm wrong.
Read this article: Nursing and Pandemic 19. It's really interesting. Some nurses I know have been decreasing their work hours because they'd rather be with their families. They no longer feel the need to work extra hours.
This would be me. I have reduced my hours and spend less so as not to deal with the stress as much.
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
On 6/15/2021 at 9:23 PM, NurseSpeedy said:
Many of us are learning that facilities just do not care. It the bottom line and the scores…the patient satisfaction with food was more important than the fact that we saved their life, they’re uninsured, they complain, we will never get paid- but don’t screw up their food- even though we have zero to do with it….yeah, over it.
We have always been short staffed. Agency nursing only utilized if absolutely necessary and the cost is much higher than a staff nurse so another kick in the teeth for those of us that work their. I did it for 18 years and finally said- screw it. Found a new nursing job, scary changing specialties that far into a job, but if the system can’t fix itself in almost 20 years, I wasn’t going to waste another 20 years waiting. I love what I do now. Best choice I ever made. Got the heck away from an abusive environment looking to place the blame on nursing for their poor outcomes-a person can only do so much- we cannot be in two places at once and we’ve yet to clone ourselves to make labor ‘cheaper’ to the overpaid bean counters. A bit of sarcasm there- but I don’t see any great changes happening soon….I’m still getting text/call/email bombed for local travel nurse positions in my area for day all shifts….beware of a high offer- it’ll likely be 13+ weeks of hell on earth.
In short, the businesses know that people aren't well off enough to not work. People need to eat. If people have enough money not to starve, I wonder who will do the work.
The thing is , there are so many financial opportunities outside healthcare I was shocked when I decided enough is enough. How many people are willing to pay to have their houses cleaned , this obviously varies on location. There’s people who own Summer homes or luxury rentals paying more than I would make in a nursing shift . There’s tons of wealth out there. Too much attention to the media and they’ll have you thinking everyone is poor and your lucky your employed , truth is nursing is a service that many people can’t do on their own so they seek out hospitals but their are tons of services people can’t or aren’t willing to do on their own and are willing to pay for it . The well off people made their wealth and it’s not all about killing your self to get there . I’m at the point where I only work the bare minimum to get benefits and a pension I’m in a nursing specialty I enjoy greatly I work part time and I’m off all summers and holidays but to supplement my income I have decided to use my talents for profit at my own rate on my own time. I think what many nurses should consider is not striking or asking for more pay (won’t make the job less miserable ) stop picking up extra shifts , switch to part time or per diem , dry them out the way the are drying out the staff. Make the working conditions so bad the CEO has to step on the floor and pass trays . Live your life on your terms
The thing is , there are so many financial opportunities outside healthcare I was shocked when I decided enough is enough. How many people are willing to pay to have their houses cleaned , this obviously varies on location. There’s people who own Summer homes or luxury rentals paying more than I would make in a nursing shift . There’s tons of wealth out there. Too much attention to the media and they’ll have you thinking everyone is poor and your lucky your employed , truth is nursing is a service that many people can’t do on their own so they seek out hospitals but their are tons of services people can’t or aren’t willing to do on their own and are willing to pay for it . The well off people made their wealth and it’s not all about killing your self to get there . I’m at the point where I only work the bare minimum to get benefits and a pension I’m in a nursing specialty I enjoy greatly I work part time and I’m off all summers and holidays but to supplement my income I have decided to use my talents for profit at my own rate on my own time. I think what many nurses should consider is not striking or asking for more pay (won’t make the job less miserable ) stop picking up extra shifts , switch to part time or per diem , dry them out the way the are drying out the staff. Make the working conditions so bad the CEO has to step on the floor and pass trays . Live your life on your terms
Frankly, no matter how you circumvent it, you won't find well-off people who work in the denominator. Poor people are exploited. They cannot afford to strike. If you've never slept in the street, don't talk to me. Be "grateful" that you've never been there. I wouldn't wish it for anyone, especially for the girls.
Nursing is not a joke. One example is depressing enough to see people who are suffering because of immobility. And people have wild dreams that the nursing facilities don't struggle filling up the spots. People have emotions. Calling people a martyr is inappropriate. If everyone leaves the residents or patients, then who does it? I could just walk away during the lockdown. Should I leave my coworkers, especially those people I cared for regularly? I didn't resent those who walked away. I understood.
That's why saving is good on top of the retirements.
Frankly, no matter how you circumvent it, you won't find well-off people who work in the denominator. Poor people are exploited.
Nursing is not a joke. And people have wild dreams that the nursing facilities don't struggle filling up the spots.
We must accept that you can’t be exploited unless you allow yourself to be . Although there are a lot of steaks involved when deciding what is worth fighting for
We must accept that you can’t be exploited unless you allow yourself to be . Although there are a lot of steaks involved when deciding what is worth fighting for
We're all exploited in different ways whether you like it or not. If you can't see it, don't dig deeper.
I'm not the one who is exploited. I answered the post about why there's short staff. Some of those people pay extra bills for their parent or child who has cancer and for whatever reasons they have.
NurseSpeedy, ADN, LPN, RN
1,599 Posts
Many of us are learning that facilities just do not care. It the bottom line and the scores…the patient satisfaction with food was more important than the fact that we saved their life, they’re uninsured, they complain, we will never get paid- but don’t screw up their food- even though we have zero to do with it….yeah, over it.
We have always been short staffed. Agency nursing only utilized if absolutely necessary and the cost is much higher than a staff nurse so another kick in the teeth for those of us that work their. I did it for 18 years and finally said- screw it. Found a new nursing job, scary changing specialties that far into a job, but if the system can’t fix itself in almost 20 years, I wasn’t going to waste another 20 years waiting. I love what I do now. Best choice I ever made. Got the heck away from an abusive environment looking to place the blame on nursing for their poor outcomes-a person can only do so much- we cannot be in two places at once and we’ve yet to clone ourselves to make labor ‘cheaper’ to the overpaid bean counters. A bit of sarcasm there- but I don’t see any great changes happening soon….I’m still getting text/call/email bombed for local travel nurse positions in my area for day all shifts….beware of a high offer- it’ll likely be 13+ weeks of hell on earth.