By Shawn Kennedy, AJN editor-in-chief
If there’s one universal complaint by nurses, it’s that there aren’t enough of them on a shift to provide the care their patients need. We have a lot of data linking nurse staffing to patient outcomes and revealing the deleterious effects of missed care because of insufficient staffing. Yet, according to many hospital nurses I’ve spoken with, they still find themselves stretched to the breaking point by high patient acuity, rapid patient turnover, and increasing documentation requirements.
These nurses see no end in sight to this situation as hospitals argue that they have insufficient reimbursements and revenues to increase staffing. Ironically, as hospitals invest in pricey, cutting-edge new technologies that haven’t been shown to improve patient outcomes, the evidence about nurse staffing continues to be ignored.
In November, the ANA released a white paper, “Optimal Nurse Staffing to Improve Quality of Care and Patient Outcomes.” The paper summarizes and updates the research on staffing and outcomes, linking staffing to Medicare initiatives to reduce costs, adverse events, and readmissions. The report notes:
“Existing nurse staffing systems are often antiquated and inflexible. Greater benefit can be derived from staffing models that consider the number of nurses and/or the nurse-to-patient ratios and can be adjusted to account for unit and shift level factors. Factors that influence nurse staffing needs include: patient complexity, acuity, or stability; number of admissions, discharges, and transfers; professional nursing and other staff skill level and expertise; physical space and layout of the nursing unit; and availability of or proximity to technological support or other resources.”
The report offers some specific evidence-based examples and rationales for a variety of staffing models. It’s a good review and resource for nurses who are looking to support staffing increases.
However, for me, one model—incorporating internal “float” pools—is disheartening to see. While certainly more cost-effective than outside staffing agencies, and advantageous in that the nurses are already familiar with the hospital policies and systems, this model still hearkens back to the premise that nurses are interchangeable warm bodies.
Yes, there can be some matching of skill sets—but the bottom line is that the nurse is not familiar with the patients he/she will be assigned to care for that shift. CNOs want to keep staffing lean for budget reasons, and that’s understandable. But too lean means frequent use of floaters, which may mean patients see different nurses each shift. How does that leave time for developing a nurse–patient relationship or support patient-centered care?
Another year, more data, no changes? We’ve published numerous articles on this blog (see below for a partial listing) highlighting research and issues around nurse staffing—they’ve stimulated many comments. Have a look:
January 29, 2013 – “What’s So Hard to Understand: Patient Safety, Quality Care Linked to Nurse Staffing”
June 26, 2012 – “Nurse Staffing: Are the Brits on the Right Track?”
July 10, 2009 – “What’s It Gonna Take to Improve Nurse Staffing?”
May 20, 2010 – “‘Go Home, Stay, Good Nurse’: Hospital Staffing Practices Suck the Life Out of Nurses“