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Discussion

Staffing Issues

I am still a nursing student that is nearing graduation, but I currently work as a CNA in a skilled nursing facility and behavioral unit. As the reality of being a nurse is quickly approaching, I often ponder how I will handle inadequate staffing issues like I see in my line of work now.

What is the best way to lead a change in unsafe staffing? Would it be appropriate for me to also fight for safe CNA staffing, even after I become a nurse?

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    • Featured Replies

    This is a mighty big issue for someone new to 'seeing the BIG picture' of healthcare and its realities. And I'm impressed that you have the concern and interest to tackle such a problem. But as a newbie, I'd recommend focusing on your adjusting to the new nurse role that you'll be taking on.

    Which brings me to question, might this request be a HOMEWORK request??? What has been your experience at your place of employ?

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    Sounds like homework. What ideas to you have in attempting to lead a change with staffing?

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    • Author

    The posting of a question of interest on a nursing forum was the homework assignment. This is a topic I am concerned about, especially with being unfamiliar in the nursing practice. I am concerned that upon my graduation and with beginning a nursing career I will be pushed into starting off overwhelmed because of staffing. As I do not have experience as a nurse, I am wondering what the best way to go about expressing my concerns is.

    With my current employment, I have expressed the concern to the nurses, and nothing is ever done about it. Is there a better way to deal with unsafe staffing?

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    • Guides

    Many members have posted regarding safe staffing in these threads:

    https://allnurses.com/nursing-activism-healthcare/fight-for-mandated-1164542.html

    https://allnurses.com/ccu-nursing-coronary/unsafe-assignment-long-304735.html

    https://allnurses.com/nursing-issues-patient/forced-to-take-807707.html

    A few links:

    https://www.nationalnursesunited.org/sites/default/files/nnu/files/pdf/nursing-practice/advo-alerts/prtotect-your-licensemar2309.pdf

    From JAMA surg June 2016

    Hospitals with better nursing environments and above-average staffing levels were associated with better value (lower mortality with similar costs) compared with hospitals without nursing environment recognition and with below-average staffing

    Comparison of the Value of Nursing Work Environments in Hospitals Across Different Levels of Patient Risk | Nursing | JAMA Surgery | JAMA Network

    Medical Care, November 2014

    The study findings provide support for the value of inpatient nurse staffing as it contributes to improvements in inpatient care; increases in staff number and skill mix lead to improved quality and reduced length of stay at no additional cost.

    Examining the value of inpatient nurse staffing: an assessment of quality and patient care costs. - PubMed - NCBI

    Agency of Health Research and Quality, AHRQ Healthcare Innovations Exchange, Sept. 26, 2012.

    Higher nurse workloads are associated with more patient deaths, complications, and medical errors - "State Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction,"

    State-Mandated Nurse Staffing Levels Alleviate Workloads, Leading to Lower Patient Mortality and Higher Nurse Satisfaction | AHRQ Health Care Innovations Exchange

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    • Experts

    OP: one thing to keep in mind when you become a nurse is that your state Board of Nursing will expect you to refuse an assignment if you feel it's unsafe for you to perform, such as taking on too many patients or you're unfamiliar with the specialty (i.e., psych nurse floated to work in peds med-surg). If you take on what you feel is an unsafe assignment and (God forbid) something happens to a patient, the BON will hold you--not your employer--accountable for your role in it.

    So even if staffing ratios are in place, it's up to you to say "thanks but No" to assignments that you feel may be unsafe for you to perform.

    Also, refusing an assignment can result in disciplinary consequences at work. BONs will stay out of those matters as well.

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    Following this post, Very interesting.

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    As you already work in a LTC facility you are obviously aware of the staffing issues and unfortunately I really don't have any words of wisdom to contribute. Sadly it's one of those get used to the realities of nursing answers. As it is staffing is the number one expense for LTC and reimbursement for medicare/medicaid residents doesn't generate the funds needed to increase staffing in most cases. Even if there were more funds for staffing I doubt if it'd be increased unless there is a desperate need as staff costs money, the fewer staff that need to be paid the more money that can go to profit for the owner.

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