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


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2016-11-21T13:08:46-05:00December 10th, 2012|nursing research|3 Comments
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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 […]

2016-11-21T13:08:50-05:00November 30th, 2012|Nursing|0 Comments
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More Evidence: Should We Get Rid of 12-Hour Nursing Shifts, Despite Their Popularity?

By Shawn Kennedy, AJN editor-in-chief

A new study in Health Affairs provides yet more support that reliance on 12-hour nursing shifts (or longer—we all know that shifts often extend a bit longer than scheduled) should be reconsidered. The study supports previous findings of increased burnout among nurses who work shifts longer than eight hours, but finds as well that longer shifts (13 hours or more) are associated with increased levels of patient dissatisfaction.

Despite these negatives for both nurses and patients, 80% of nurses surveyed across four states said they were happy with their hospitals’ scheduling practices.

I imagine that, with all the recent emphasis on patient satisfaction scores, this study will make nurse executives and hospital administrators take notice—especially as consumers become more aware of the research through coverage like this story at the U.S News & World Report site.

We’ve had evidence for a while that the 12-hour shift is not a best practice. For example, in 2004, Anne Rogers and colleagues also published research in Health Affairs. In their national survey of over 1,000 nurses, they found that most nurses generally worked longer than their actual shifts; nearly 40% of shifts were longer than 12 hours, and 14% of respondents had worked “16 or more consecutive hours at least once during the four-week period.” More importantly, they found that “the likelihood of making an error increased with longer work hours and was three times higher when nurses worked […]

2016-11-21T13:08:51-05:00November 27th, 2012|nursing perspective|19 Comments
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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 […]

2016-11-21T13:09:48-05:00June 26th, 2012|Nursing|54 Comments
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Bad Economy Breeds a New Era of Discontent Among Nurses

By Shawn Kennedy, AJN editor-in-chief

Nurses are taking to the picket lines, again. On Sept 22, an estimated 23,000 nurses in California struck at Kaiser Permanente facilities and also at Sutter Health hospitals and Children’s Hospital Oakland. The one-day strike was organized by the California Nurses Association/National Nurses United (CNA/NNU) to protest what they say are unfair rollbacks to nurses’ health coverage and retirement benefits, and was also intended as a show of support for striking coworkers.

But it’s not just U.S. nurses who are engaging in job actions—for example, in the United Kingdom, the 400,000 member Royal College of Nursing is contemplating the first strike in its nearly 100-year history and is soliciting the views of its members as to what action should be taken. The issue is nurses’ pensions and job cuts—according to Nursing Standard, “almost 10,000 NHS [National Health Service] posts in England alone have been earmarked for cuts.”

The poor economy is putting pressure on hospitals and health systems everywhere to reduce costs. One way to do this, of course, is to make cuts in what is traditionally the biggest expense in running the hospital—nursing. While this is a quick fix to the bottom line, it’s also one that doesn’t solve the problem. In fact, evidence shows that inadequate nurse staffing is linked to poor outcomes, which ultimately cost more in the long term—for the patients, for the health care system, and for nurses, who […]

2016-11-21T13:11:52-05:00September 26th, 2011|career, nursing perspective|5 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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