Involving Nurses in Hospital Staffing Decision-Making

A qualitative study that looks at the experiences of nurses who have served on staffing committees.

When I am faced with challenging situations and issues that involve multiple stakeholders, I seek guidance or information from others to make the most informed decisions. This is a practice many health professionals and researchers emulate, and it makes sense to do this, yet when it comes to the topic of nurse staffing in hospital settings, nurses are not usually involved in the process. If they are involved to some degree, it is likely because of a hospital’s pursuit for nursing excellence recognition through shared governance and/or the external pressure of state laws, like mandated nurse staffing committees.

Nurse autonomy and engagement means better care.

Over the years, research has shown how increases in nurse autonomy and engagement can positively benefit patient care and support nurse retention, yet how do these concepts apply to nurse staffing? In what ways are those concepts translated into practice or policy efforts? These were the questions that initially guided me.

Seeking a real voice in nurse staffing policymaking.

In a survey exploring the concept of staff nurse involvement in hospital staffing policymaking, most nurses described feeling powerless. with little […]

2024-03-20T10:15:39-04:00March 20th, 2024|nurse staffing, Nursing, nursing research, patient safety|0 Comments
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Nurses’ Experiences on Staffing Committees: Recommended Reading in AJN’s February Issue

The February issue of AJN is now live.

“Original Research: A Real ‘Voice’ or ‘Lip Service’? Experiences of Staff Nurses Who Have Served on Staffing Committees,” explores nurses’ perspectives on staffing committee participation—including how they perceive their committee’s effectiveness, and how these committees can benefit patients, nurses, and organizations.

In this month’s CE article, “Our Journey to Pass a Surgical Plume Evacuation Law,” the authors describe their experience leading a grassroots coalition to address surgical plume evacuation in Illinois, and outline strategies nurses can apply to their own advocacy efforts.

New series! “Cultivating an Evidence-Based Decision-Making Mindset,” the first article in a new series on how to teach and facilitate learning about evidence-based practice and quality improvement, offers educators the content and tools needed to prepare nurses to be evidence-based decision-makers.

Read “Improving the Timing of Acute Care Insulin Delivery” to learn about an initiative to reduce both time to insulin delivery and percentage of bedtime insulin doses withheld.

See also the extensive health care news sections, the Journal Watch and Drug Watch sections, an editorial on Black nurses’ contributions to health care, a Viewpoint column on empowering NPs to […]

2024-01-25T13:11:25-05:00January 25th, 2024|Nursing|0 Comments
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Minimum Nursing Home Staffing Standards: A Good Start, But Not Quite There

Jasmine Travers

The pandemic shone a troubling spotlight on the unnecessary suffering resulting from substandard conditions in nursing homes. On Sep 6, 2023, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule for their widely anticipated minimum staffing requirements for long-term care facilities. A 2022 Nursing Home Staffing study that was convened to inform the development of these requirements followed an urgent plea from the Biden Administration and National Academies of Sciences, Engineering, and Medicine’s Committee on the Quality of Care in Nursing Homes for every nursing home to provide a sufficient number of staff so that the quality of care and safety in nursing homes might be addressed.

Tara Cortes

The proposed requirements.

An abundance of qualitative interviews, surveys, listening sessions, and comments from the public yielded the following staffing requirements:

  1. Minimum staffing hours per resident day (HPRD) for registered nurses (RNs)—0.55 HPRD—and nurse aides (NAs)—2.45 HPRD. Outside of these hours, sufficient additional nursing […]
2023-10-19T10:05:15-04:00October 19th, 2023|Nursing, Nursing homes|1 Comment
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Nurse Staffing Standards Act Is First Step in Solving Nursing Shortage

Nurses planning to leave the profession.

The nursing shortage continues, with no end in sight. In my current position as faculty in a university DNP program, I hear from students about caring for overwhelming numbers of patients and fearing for their patients’ safety and health. Nurses are suffering burnout because they are caring for so many patients they know nursing care is being missed. A recent survey found that job satisfaction has been dropping for nurses, while the percentage who say they may leave the profession is as high as 30% overall, with younger nurses most likely to say they may leave.

Nurse educators do our best, but we know that we are sending new graduates into the fire. Retired nurses worry about our family members (and ourselves) when we need nursing care.

Congress recently reintroduced the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act. This bill would mandate direct care registered nurse-to-patient staffing ratio requirements in hospitals. It has been introduced in several prior congressional sessions with little progress. We cannot let this window of opportunity pass.

Nurse staffing and patient outcomes.

Linda Aiken’s two decades of research demonstrate the effects of nurse staffing on patient outcomes. Despite legislative efforts in Massachusetts and […]

2023-06-13T06:57:19-04:00May 11th, 2023|health care policy, Nursing, Public health|5 Comments
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November Issue: Nurse Vaccine Hesitancy, the Staffing Crisis, Palliative Care, More

“As nurses, we must push back on public health misinformation where and when we can, so that we don’t return to the days when viruses such as polio thrived and spread, and human health needlessly suffered.”—AJN editor-in-chief Carl Kirton in this month’s editorial

The November issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

Original Research: COVID-19 Vaccine Hesitancy Among Southern California Nurses

This study aimed to elucidate the characteristics of vaccine-hesitant nurses at two large medical centers where rates of COVID-19 vaccination were lower than expected, and to understand the reasons for such hesitancy.

Viewpoint: Reframing Hospital Nursing as a Specialty to Address the Staffing Crisis

In light of the current shortage of hospital nurses, the authors propose recasting the role as a specialty—instead of as an entry-level position—and call for an overhaul of nursing education, particularly clinical experiences.

CE: What COVID-19 Can Teach Nurses About Liability Risks

This article explores key nursing liability issues associated with the pandemic, including immunity, documentation, crisis standards of care, delegation and assignment, scope of practice, floating, travel nursing, telehealth, and misinformation and social media.

[…]

2022-10-21T08:14:54-04:00October 21st, 2022|Nursing|0 Comments
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October Issue: Substance Use Among Nurses, RN Involvement in Staffing Policymaking, More

“Under my leadership—like that of the editors before me—these pages will serve to document and transform clinical practice and provide a space for nurses to contribute their voices to matters affecting our world today.”—AJN editor-in-chief Carl Kirton in this month’s editorial

The October issue of AJN is now live. Here’s what’s new. Some articles may be free only to subscribers.

CE: The Impaired Nurse

A guide to early recognition, diagnosis, and treatment of substance-related disorders among colleagues in the workplace.

Original Research: ‘It Would Be Nice to Think We Could Have a Voice’: Exploring RN Involvement in Hospital Staffing Policymaking

This qualitative study examined staff nurses’ perceptions of factors that hinder or support nurse involvement in hospital nurse staffing policymaking—and how nurses are, or would like to be, so involved.

Historical Feature: A Long History of Abortion

In response to the Supreme Court’s decision ending the nationwide right to abortion, the author takes a close look at abortion in American history and AJN’s archives, including the various roles played and challenges encountered by nurses.

[…]

2022-09-26T08:56:14-04:00September 26th, 2022|Nursing|0 Comments
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Staffing Tops ECRI 2022 Top 10 Patient Safety Concerns List for First Time

Staffing: the problem has ‘grown exponentially.’

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.” Over the years, some repeat offenders have made the cut, for example managing behavioral health, patient falls, and issues related to infection control.

Some of these concerns again appear on the 2022 top 10 patient safety concerns list, but the list also has some notable first-time offenders—a fact that reflects the conditions in which we’ve been living over the past two years during this global pandemic: These include COVID-19’s effect on clinicians’ mental health, vaccine coverage gaps, and supply chain disruptions, to name a few.

However, the number one concern this year is one that has been a central and unrelenting issue for nurses, even before the pandemic—staffing shortages.

According to the ECRI:

“The number one topic on this year’s list has been steadily growing throughout the COVID-19 pandemic and impacts patients and staff on all levels: staffing shortages…Prior to 2021, there was a growing shortage of both clinical and non-clinical staff, but the problem has grown exponentially. In early January 2022, it was estimated that 24% of US hospitals were […]

2022-03-24T10:04:38-04:00March 24th, 2022|Nursing|0 Comments
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Understaffing: A Policy Oblivious to the Unforeseen Swerves of Life and Nursing Shifts

The Roads of Life and Nursing 2019 by Julianna Paradisi

Neither life nor nursing shifts develop in a linear fashion. Both roads are full of unforeseen swerves. I was reminded of this over the weekend while sitting with a relative in an emergency department. Our weekend plans had been put on hold to accommodate this unforeseen swerve in health.

An ED staff under stress.

I couldn’t help but notice the emergency department staff were experiencing their own set of unforeseen curves this particular shift. Although it was early in the evening, to my experienced nurse’s eye they were already exhausted.

When we arrived, the triage nurse was being verbally accosted by two people who’d walked in off of the street, ranting and high, until a trio of security officers intervened. Another nurse hustled between triage and the bay area. A photograph of her young daughter on the reverse side of her ID badge dangled from the lanyard around her neck. Everyone looked tired.

The tricky ambiguities around nurses calling in sick.

Once my relative was confirmed as stable, I revealed to the other nurses that I was a nurse and said I’d noticed how busy they were that shift. The […]

2020-01-09T10:53:17-05:00January 9th, 2020|Nursing, nursing career, wellness|2 Comments
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As a Long-Predicted Nursing Shortage Gets Real, Staffing and Retention Issues Get Urgent

Is the nursing shortage finally here?

In her June issue editorial, AJN editor-in-chief Shawn Kennedy notes that in her recent visit to the annual National Student Nurses’ Association (NSNA) conference, many of the senior students she spoke with already had jobs lined up.

She surveys some recent indicators pointing to the possible arrival at last of a long-predicted nursing shortage, and some of the possible implications this is having or may have in the coming years for patient care and the health of organizations. For example:

“A survey of 233 chief nursing officers conducted last July conducted last July by national staffing company AMN Healthcare found that 72% said their shortages were moderate to severe, and most expected shortages to worsen over the next five years. They also acknowledged that the shortage was having a negative effect on patient care, patient satisfaction, and staff morale.”

Bonuses for new hires.

She notes that, with hospitals in some regions paying signing bonuses to new nurses, the question of staff retention and development remains the elephant in the room.

The class of 2018, it seems, is entering a job seeker’s market. . . . Organizations that can invest in new nurses with programs that provide support and training will have a leg up in recruitment. But […]

2018-06-04T12:21:33-04:00June 4th, 2018|Nursing|2 Comments
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International Health, Nurse Staffing, the Power of Social Media

I previously posted on this blog in anticipation of attending my first international nursing meeting—the  2017 International Council of Nurses Congress in Barcelona—and wrote about it later in a joint post with AJN‘s editor-in-chief Shawn Kennedy. There will also be a full report in the August issue of AJN.

Based on subsequent reflection, here are some lasting takeaways:

International health is an American nursing problem.

“Shamian asked what American nurses do for their fellow nurses around the world.”

There was a lot I didn’t know about global health. I was thankful that I’d taken some time to study a few key concepts, especially the sustainable development goals (SDGs).

In the opening session, ICN president Judith Shamian charged all nurses to take seats at policy tables and draw upon their expertise. Through her passion, I began to see a part I could play in policy making simply by keeping abreast of issues and sharpening my nursing voice.

From the plenary speech by former Secretary of U.S. Health and Human Services, Mary Wakefield, I began to see the necessity of grounding policy work with reliable, relevant evidence. And in our interview with Shamian, policy and evidence met collaboration as […]

2023-01-30T10:35:53-05:00June 30th, 2017|Conference reports, Nursing|7 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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