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What Our Readers Had to Say About RN Staffing in Nursing Homes

By Maureen Shawn Kennedy, AJN editor-in-chief

Earlier this month, AJN’s managing editor Amy Collins wrote a post about nursing homes, basing her discussion on a New York Times article by Paula Span at the paper’s New Old Age blog that examined efforts to address the inadequate number of registered nurses (RNs) in nursing homes. While federal regulations for agencies that receive Medicare or Medicaid require 24-hour nursing services, they only require an RN to be on site for eight hours daily. According to Span, 11.4% of nursing homes did not meet this requirement.

Collins found confirmation of this information in her own experiences visiting her grandmother in nursing homes:

“There always seems to be a lack of staff—and with so many residents these days suffering from varying levels of dementia and memory problems, staff are needed more than ever.”

We linked to the blog post on our Facebook page and received a tremendous number of comments on both sites. While both Span and Collins emphasized that increases in all levels of nursing personnel are needed, some LPNs responded to our post to assert that they too have valuable skills, as well as extensive experience, in this setting—and that a broader underlying problem is inadequate staffing tied to corporate cost-cutting.

Few people would argue with these assertions. Most LPNs do the best […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2016-11-21T13:03:52-05:00September 24th, 2014|career, healthcare social media, Nursing, nursing perspective, Patients|6 Comments

Staffing and Long Shifts – Some Recent Coverage

By Shawn Kennedy, AJN editor-in-chief

by patchy patch, via flickr

The March issue will soon be published and be featured on the home page of our Web site, so before the February issue is relegated to the archive section, I want to highlight two articles. Knowing that some readers of this blog may not be regular readers of AJN (I know, hard to believe), I wanted to bring them to your attention.

I don’t usually blog about my own editorials, but the February editorial (“It All Comes Back to Staffing”) has apparently resonated with many readers. I’ve received several letters and a request to reprint it from a state nursing association. (The editorial includes a portion of a poignant letter I received from a reader in response to an editorial I’d written for the December 2013 issue, “Straight Talk About Nursing,” in which I discussed missed care—that is, the nursing care that we don’t get to but is often at the heart of individualizing care.)

The February editorial ties in with a special report, “Can a Nurse Be Worked to Death?”, by Roxanne Nelson from Van Insurance, which addresses the recent death of a nurse who was killed in a car accident while driving home […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2017-05-11T21:22:34-04:00February 24th, 2014|nursing perspective, nursing research, patient engagement, patient safety, safe staffing|2 Comments

A Report from the ANA Safe Staffing Conference

Katheren Koehn, MA, RN, AJN editorial board member and executive director of MNORN (Minnesota Organization of Registered Nurses), reports from last week’s ANA conference on staffing held in Washington, DC.

Click image for source page at ANA staffing site.

The ANA Safe Staffing Conference ended on Saturday. There were almost 700 registered nurses from all over the country in attendance—nurses in management, direct care, and leadership—all gathered to try to discover new strategies for how to solve the most challenging issue in nursing: safe staffing.

Not a new issue. This has long been the most challenging issue for nursing. Teresa Stone, editor of Poems from the Heart of Nursing: Selected Poems from the American Journal of Nursing, told me that, as she was searching the archives of 113 years of AJN issues for her book, she found that staffing issues were a frequent theme. Today, as the work of nurses has become more complex, the need to create sustainable solutions to ensuring appropriate staffing is our most critical issue—hence the ANA Staffing Conference.

The body of evidence supporting the idea that appropriate nurse staffing makes a difference in saving patients’ lives has grown exponentially in the past 20 years. This evidence—paired with the new federal financial incentives for hospitals to improve patient outcomes and experiences—makes it seem inevitable that increasing nurse staffing would be […]

Guest Author2016-11-21T13:06:06-05:00November 11th, 2013|career, health care policy, nursing perspective, nursing research, safe staffing|0 Comments

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

It’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 […]

Jacob Molyneux, senior editor/blog editor2018-03-13T10:49:19-04:00May 9th, 2013|Ethics, Nursing, safe staffing|7 Comments

AJN’s May Issue: Telephone Follow-Up After Myocardial Revascularization, Hemodynamic Monitoring, Staffing Levels, Nurses Week, More

AJN’s May issue is now available on our Web site. Here’s a selection of what not to miss.

Coronary heart disease afflicts more than 16 million American adults. Myocardial revascularization has long been considered an effective treatment for this disease. Findings presented in our May original research article, “Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review,” support the use of telephone follow-up intervention after hospital discharge to assess patient knowledge, discuss patient concerns, and encourage behavioral and lifestyle changes. This article can earn you 2.6 continuing education (CE) credits.

Recently, there’s been a shift toward less invasive or noninvasive hemodynamic monitoring methods, and the use of “functional” indicators that more accurately predict fluid responsiveness. “Using Functional Hemodynamic Indicators to Guide Fluid Therapy,” a CE article that can earn you 2.6 credits, reviews the physiologic principles of functional hemodynamic indicators, describes how these indicators are calculated, and discusses when and how nurses can use them to guide fluid resuscitation in critically ill patients.

Celebrating Nurses Week. May’s In Our Community article describes how nurses from one hospital decided to forego traditional gifts during National Nurses Week and instead implemented a “Nurses Give Back” program in their community. How does your hospital celebrate? If you’re reading AJN on your iPad, you can listen to a podcast interview with the authors by clicking on the podcast icon on the first page of the article. The podcast is also available on our […]

Amy M. Collins, managing editor2016-11-21T13:07:43-05:00April 26th, 2013|career, nursing research|0 Comments

What’s So Hard to Understand: Patient Safety, Quality Care Linked to Nurse Staffing

The evidence linking nurse staffing and patient safety is strong.

The data linking nurse staffing as well as shift length with patient outcomes and satisfaction with care continue to roll in. The latest report on nurse staffing, published in the January 13 issue of Medical Care by McHugh and MA, links higher nurse–patient ratios and good work environments to reduced 30-day readmission rates. Read the abstract here.

Most nurses seem to support better nurse–patient ratios, but there’s continuing ambivalence about reducing shift length, as seen in the comments we received on a recent blog post asking whether it’s time to retire the 12-hour nursing shift.

In August, researchers reported a link between nurse staffing and hospital-acquired infections. Publishing in the American Journal of Infection Control, the authors noted a “significant association” between nurse–patient staffing ratios and both urinary tract infections and surgical site infections. Further, they noted that reducing nurse burnout was associated with fewer infections. (Read our news report on the study here.)

Health Affairs published a report in November called “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction.” The findings were there, loud and clear—researchers Stimpfel, Sloane, and Aiken found that “extended shifts undermine nurses’ well-being, may result in expensive turnover and can negatively affect patient […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-03-13T10:41:13-04:00January 29th, 2013|nursing perspective, nursing research|20 Comments

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

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

Guest Author2016-11-21T13:08:46-05:00December 10th, 2012|nursing research|3 Comments

AJN’s December Issue: Staffing Issues, Wandering in Dementia, Type 2 Diabetes Meds, More

AJN’s December issue is now available on our Web site. Here’s a selection of what not to miss, including two continuing education (CE) articles, which you can access for free.

Data from the Military Nursing Outcomes Database project demonstrate that inadequately staffed shifts can increase the likelihood of adverse events. But what does this mean for the average nurse on a shift? In “Staffing Matters—Every Shift,” the authors present common dilemmas hospitals face in nurse staffing, illustrating the potential hazards for patients and nurses alike. This CE article is open access and can earn you 2.1 CE credits.

People with dementia are at risk for both missing incidents and wandering. In “Missing Incidents in Community-Dwelling People with Dementia,” the authors differentiate between these two risks, describe personal characteristics that may influence the outcomes in missing incidents, and suggest strategies for preventing and responding to missing incidents. This CE article is open access and can earn you 2.1 CE credits. For more information, listen to a podcast with the authors.

There is a growing consensus that primary care providers can better address patients’ needs by using different models of care, such as the patient-centered medical home. “The Patient-Centered Medical Home” discusses the guiding principles of this model, nurse care coordination, reimbursement and implementation, cost-effectiveness and quality improvement, and the need for greater nurse advocacy.

Being unaware of the realities of licensure can damage a nurse’s career, even […]

Amy M. Collins, managing editor2016-11-21T13:08:50-05:00November 30th, 2012|Nursing|0 Comments

Nurse Staffing: Are the Brits on the Right Track?

By Maureen Shawn Kennedy, AJN editor-in-chief

hazard/jasleen kaur, via Flickr

According to an article at Nursing Times, hospitals in England may be required to publish “nurse-to-bed” ratios as part of an overall “dashboard” of indicators to measure performance. While some say this is a step forward, UNISON, the public service union that represents nurses, argues that the better ratio to measure is nurse-to-patient and that variables in patient acuity should also be considered.

Nurse staffing has become an issue in National Health Service hospitals and in April UNISON released results of a survey of over 1,500 nurses and other health care workers about their shifts during the 24-hour period of March 6. The vast majority of respondents (73%) felt they did not have “enough time to spend with patients to deliver dignified, safe, compassionate care.” The Royal College of Nursing also supports mandatory safe-staffing ratios that take into account the skill mix of RNs to “health care support workers” or nursing assistants.

Here in the United States, California is the only state to achieve any legislation for mandatory hospital staffing and it is a “minimum” nurse-to-patient ratio. While similar legislation has been introduced in a few other states and nationally, it hasn’t advanced.

The ANA does not support mandatory minimum ratios per se, noting in its Principles for Nurse Staffing (2nd edition), released earlier this […]

Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2016-11-21T13:09:48-05:00June 26th, 2012|Nursing|54 Comments

Staffing: Hot Topic as Usual for Nurses

Karen Roush, MS, RN, FNP-C, clinical managing editor

Our recent Facebook post on an article on nurse staffing at the NPR Shots blog (“Need a Nurse? You May Have to Wait”) got a lot of responses. Staffing is a hot topic for nurses—from both a personal and a patient care perspective. And I say “hot” because it never fails to raise emotions.

Everyone agrees that adequate nurse staffing is essential for safe, high quality patient care and nursing job satisfaction. Research has shown that it significantly improves patient outcomes.

Yet we—nurses, as well as the larger health care community—continue to debate how to determine what “adequate staffing” is and how to best achieve it. Acuity-of-care measures? Unit-by-unit mandated staffing plans? State-mandated staffing ratios? What do you think?

We’ve published numerous articles and news pieces on this topic in recent years; here are a few examples:

News, reports, and analysis (open access articles)

“Nurse Staffing Matters—Again”

“California Mandated Nurse–Patient Ratios Deemed Successful”

“Nursing Shortage—or Not”

Feature. Requires subsciption or purchase; abstract only

“Nurse Staffing and Patient, Nurse, and Financial Outcomes”

And here are some blog posts that deal either directly or indirectly with issues related to nurse staffing.

Guest Author2016-11-21T13:10:00-05:00May 31st, 2012|nursing perspective|1 Comment

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