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Nurse Staffing Matters at the Shift Level—Evidence-Based Scenarios Illustrate How to Apply What We Know

December 10, 2012

We know that staffing matters. Studies have shown that hospitals with lower proportions of RNs have higher rates of death overall, death following compli­cations (that is, failure to rescue), and other adverse events. But how do such data on staffing translate into what the average hospital nurse experiences on a shift?

That’s the question posed by Gordon West and colleagues, the authors of this month’s CE, “Staffing Matters—Every Shift.” To address it, they reviewed findings from the Military Nursing Outcomes Database (MilNOD). MilNOD, a quality improve­ment and research project conducted in four phases between 1996 and 2009, encompassed data from 111,500 shifts on 56 inpatient units in 13 U.S. military hospitals. The project explored “the effects of staffing levels and skill mix on the probability of patient falls, medication errors, and needlestick injuries to nursing staff.”

As the authors explain, the MilNOD data showed that the number, mix, and experience of nurses on a shift—not just on a unit—were associated with adverse events for patients and needlestick injuries to nurses. West and colleagues offer several realistic, descriptive scenarios to illustrate the potential effects of staffing changes and to show how such knowledge can be applied to daily decision making.

To learn more, read the article, which is free online.—Sylvia Foley, AJN senior editor


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3 comments

  1. American Journal of Nursing
    October 23rd, 2014

    Dear Editor,

    I recently read your article on “Staffing Matters- Every Shift,” December 2012 and I must say; I am grateful to be writing this letter to you. As a nurse, myself, that has worked in a facility for four consecutive years, I know the major issues that surround nurse staffing and the effect it has on patient care. In this article, the authors, Gordon West, Patricia A. Patrician and Lori Loan, expound on the relationship between nurse staffing and the impact that it has on patient care outcomes. According to the authors, staffing can be defined in a variety of ways: inadequate staffing, level of education and level of experience. When there are fewer nurses to care for patients, inadequate staffing can cause ineffective patient care. Nurses holding a bachelor’s degree or higher are known to provide substantial care as opposed to their counterparts. Patient care outcomes are positively impacted with a high level of expertise. When there is inadequate staffing, a limited level of educated nurses or inexperienced nurses on duty, it makes it difficult for the nursing staff to provide good quality patient care.

    Hospitals are usually the facilities to encounter these problems. There is a high mortality rate in hospitals that have inadequate nurse staffing, nurses with limited education and inexperienced or novice nurses. These nurses find it challenging to meet the demands of the high volume of patients. In return, the patients’ care becomes compromised. Nurses holding an associate’s degree or diploma are considered to be technical or practical nurses and do not have the overall theory necessary to provide efficient nursing care which can also compromise patient care. The nurses’ level of expertise influences patient care as well. A novice nurse has the theory behind her nursing practice but cannot immediately effectively apply it until years of practice have been applied. An inexperienced or novice nurse can certainly affect the quality and safety of patient care.

    In order to meet the high demands of patient care and to provide safe, quality nursing care on duty, there should be adequate staffing, a well-rounded number of bachelor degree nurses and nurses with a high level of expertise to help facilitate patients in their recovery process.
    Sincerely,

    Linda Obasa, A.A.S, RN
    BSN Nursing Student
    Brooklyn, NY

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  2. Does anyone really care? I’m beginning to feel no one cares. Why so many nurses are now looking for their exit door out! Can only do this for so long?

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  3. When are we going to get this info out in front of the public??? Your local hospital could be one where short staffing is consting lives!!!

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