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Telling Patients About Staffing Levels: Transparency or Self-Interest?

May 9, 2013

ethicsscreenshotIt’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?

The situation above is an ethical conundrum because values are in conflict. On one hand, transparency is good and patients have a right to know about administrative factors affecting their care. On the other hand, care should stay focused on a patient’s problems, not the nurse’s.

As the article excerpt above suggests, nurse staffing is a contentious issue having to do with both patient safety and job satisfaction for nurses. We’ve covered this issue many times in the past, most recently in a blog post that got quite a few comments back in January.

But should a nurse ever tell a patient about inadequate staffing? This is the ethical quandary posed by nurse ethicist Doug Olsen in his latest article, in the May issue of AJN (free until the first week of June). Having posed the situation described above, he goes on to pinpoint the ethical principles that come into play when making such a decision, explore the pros and cons of disclosing certain information to patients in various related situations, and emphasize both the need for awareness of the patient’s perspective and the necessity for nurses of engaging in honest self-examination.

As with many such situations, there’s not always a right answer; every situation is different, and gray areas do exist. What’s your take?—Jacob Molyneux, senior editor

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6 comments

  1. Whenever our unit is extra busy due to low staffing I never directly tell the patients that we’re understaff. I explain to them that yes it is extra busy right now and I may not respond as fast as I would like to, so let’s make a plan. For prn meds, like pain meds, I ask them to let me know earlier than usual when the pain is starting to climb, that will give me the extra 10-15 minutes I need to get to the cabinet and get the medication. I also will pop my head in more often to check pain levels and get a visual assessment for my more stoic patients.
    For most of my patients, they get the message and can tell just by hearing the increased noise level that it’s busy or we’re understaff. They appreciate alternative plans that keep the pain at bay, I remain informed of their status and they feel like the’ve been heard and are in control. When things go really wrong and I am not able to be more timely, I always apologize and am always open to renegotiation and alternative plans.

    If a patient directly asks about staffing levels, I am always honest. If they’ve been on the unit a few days or their family visits often, they are aware of our routines and hear staff talk anyway. I never use staffing as an excuse, that’s poor nursing practice IMHO.

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  2. I see both sides to this issue, as do most of us. I work in a small community hospital with one med-surg unit, (where I work), and the ER. We are expected to help out in the ER when it has increased census, which can make getting care done on med-surg problematical at times, to say the least. If the matter that the patient has called about is urgent, (needs pain meds, having difficulty breathing, and so on), I work to resolve that before going to the ER to help out, but there have been times that getting all meds passed and care done has happened after the patients would have liked. Because our hospital and our community is small, a lot of the time the patients themselves will ask if it’s been busy. At that time, I apologize about not getting back to them quicker, briefly explain the situation, (without giving any details), and immediately attend to their needs, (i.e.; “I’m sorry about the delay, but I had to respond to an emergency in the ER first, before helping you get ready for bed. Now, what can I do for you?”). To my knowledge, I’ve never had a complaint about lack of care, and if they are asking, I believe they have the right to know.

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  3. Another argument for telling patients about staffing levels is that it may prompt change in the future. If patients mention poor staffing on their HCAHPS surveys, something might happen. Because money talks.

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  4. The statement to not tell the patient because it’s the nurse’s problem and not the patient’s was incorrect. The problem of shortage affects the patients most of all. However, I do not think it appropriate to tell patients of the shortage. Like Debra said, apologize and get the job done.The patients often have enough on their mind. They don’t need the added anxiety of wondering if they will be cared for.

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  5. Patients don’t want to hear about staffing issues and this just adds fuel to the fire. Apologize….and get the meds to the patient a.s.a.p.

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  6. It’s an honest response and explanation, however, when my Dad was in agony, furthest from the med area, and short staffing made him wait- writhing in pain- for an incredible length of time, and an RN house supervisor I had paged for help came sauntering to the door of his room and explained that, I was furious. Unless she had retrieved the medicine from a pocket ot from her clipboard she was of Bo use to us. Explaining the situation to us as if that made all ok, unacceptable. The 20 min she stood outside my Father’s room telling me that as an RN myself, I should understand, without helping, was unacceptable. St. Joseph’s in Bellingham, WA. This is my observation. With a long history of management in nursing myself, I was even further upset at her management.

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