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Running head: SAFE STAFFING

Safe Staffing: A Cry for Help


Mariah Smith, RN & Mollie Sanner, RN
Kettering College
NRSA 439: Nursing Leadership and Management

Abstract

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This is an investigation of safe nurse staffing in regards to nursing leadership and


management issues. This issue will be based off nursing experience on an oncology/medical unit
and others experiences in supporting research. The staffing issue being investigated is one that
has forced nurses to work in unsafe clinical settings and has forced patients to have unmet needs
and increased concern for safety. With tight budgets and worry for proper hospital
reimbursement, the workload of nurses is being pushed to the limit. This unit staffs based off a
census grid that is compliant with budgetary concerns and a particular nurse-to-patient ratio.
Unfortunately, that does not mean that staffing is always adequate and that patient acuity is
appropriate. Here, we will investigate this issue further and discuss a way in which we can
accommodate our nurses, remain within budget, and provide excellent patient care.

Safe Staffing: A Cry for Help

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Today, there is a much greater emphasis on maintaining a particular budget, ensuring


proper hospital reimbursement, and keeping nurses around to do their work. Unfortunately these
three things have not been going hand in hand. Were glad that health care is focused on these
different aspects, but nurses are constantly coming in last. The Agency for Healthcare Research
and Quality (AHRQ) released a report that stated, Staffing is a matter of major concern because
of the effects it can have on patient safety and quality of care (Stanton, 2004). Nurses must be
priority for this reason alone. If our care is not exceptional and we do not have the resources and
staff to do the job, our patients ultimately suffer. When the patients suffer, satisfaction decreases,
when patient satisfaction is not optimal, hospital reimbursement is held, and when that happens a
hospitals budget is greatly affected.
Many nurses across the country are forming opinions on this issue of safe staffing. On
review of annual evaluations, management is seeing this single problem affect nurses across the
board. On a medical/oncology unit, we house twenty, private rooms. The unit operates based off
of a unit census grid that gives nurses, at max, four to five patients to care for (includes the
charge nurse at night). This grid is based off of patient care hours that designate how many
nurses and nursing assistants can work in a twelve hour period to accommodate budget. While it
sounds simple, there is always a factor that causes one to be understaffed. Staffing is a difficult
concept to perfect and unfortunately, will probably never be perfected. But with issues like nurse
fatigue and the decrease in patient satisfaction related to safety and care, management needs to
address the issue and find solutions to make nurses better equipped to do their jobs.
The fatigue that nurses feel in correlation with a higher patient workload, longer hours,
and more shift work can directly affect the care a patient is given. The Online Journal of Issues in
Nursing reported that if the environment of care is toxic, nurses will leave, patients will suffer,

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and in the end, hospitals will lose the money they are trying to save (Curtin, 2003). If nurses are
consistently placed in situations that require them to work when they are one or more nurses
short, fatigue will happen, but with that will also cause high turnovers. With a greater focus on
budget concerns, hospitals cannot afford to lose their nurses and overwork them to the point of
no return. There are times when the majority of the patients on a unit are total cares, stage
four/terminal cancer patients, with treatments and care that are incredibly involved, maybe even
consisting of a one-to-one chemotherapy/biotherapy patient. There are also times when our unit
gets overflow from other medical-surgical units where we are not only taking on more patients
than we should, but out of those patients we have more demands than what one nurse should
handle. It is not that we cannot handle these things, the problem lies in how attentive we can be
towards all of our patients needs.
There is a general consensus that lower staffing levels are directly correlated with poor
patient outcomes. Like mentioned before, the issue produces health concerns for both nurses and
our patients. Our patients cannot afford to develop more issues and it is our responsibility as
nurses to give them the care they deserve, and meet their needs with each shift. The AHRQ
reported many different findings proving the hard effects that poor staffing has on patient
outcomes that include a decrease in hospital acquired infections if staff were to increase by a
certain percentage and a decrease in hospital readmissions (Stanton, 2004).
The research is out there and not stopping in regards to what poor staffing does to our
patients. The research is also not stopping in regards to what an increase in staffing can do for
our patients in a positive way. Its important to remember, whether in management or working as
a staff nurse, that our patients do see our stress. When our workload is heavy, regardless of how
well composed we are, they know, and that not only makes them resist calling out for their needs,

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but makes them uncomfortable in their care. Patients depend on us, as nurses, to fulfill their
needs to the best of our abilities and frankly, we arent able to do this when staffing is decreased.
While safe staffing is an issue that will need time and effort to make positive moves in, what can
we do as nurses in management and leadership to help our staff and help our patients?
That question has been asked a time or two lately without much change in the workplace.
There are new ideas to tackle national and state legislation with mandatory nurse-to-patient
staffing ratios, which California has already adopted in some ways. There are also ideas forming
to change the way we create a patient care assignment- which is what we want to consider today.
The creation and use of patient care assignment tools are a way in which we as nurses can
approach our staffing cries in a positive way. We tend to be burdened not only but the short staff
but the enormous workload we get when that happens. If we can reduce nurse fatigue in just one
way, our nurses and patients can enjoy some of the benefits. A patient care assignment tool is one
that rates the patient census based on diagnosis, care needed throughout the shift,
lines/tubes/airways the patient may have, diagnostic treatments, medications and frequency, and
high risk patients that may include ones on a medication drip or a chemotherapy regimen. By
looking at our patients in this particular way, we can divide them amongst the nurses to make
their shiftwork as easy as possible, regardless of staffing of issues. While some weeks the patient
acuity on a medical/oncology unit remains high across the board, a tool such as this could help
when it comes to decreasing the demands of the nurse and ensuring safe delivery of care.
While this technique has not been implemented on such a unit, it is important to consider
our options as nurses, especially when the demand for our work is so high. If such a tool were to
be perfected to a particular unit and the care provided, the nursing staff would be able to provide

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frequent evaluations of the success or failure that a patient care assignment tool would have for
the unit.
Safe staffing is an issue that is going to haunt us for the years and years to come, but its
not an issue to keep quiet about. At the end of the day, its our patients lives that our affected.
While we can move on in most cases after a long day or week, our patients health status and
mortality are directly changed by how well our care and attention was to them. Focusing our
attention on patient acuity may help us decide how many nurses a unit truly does need and may
force budgets to shift a little in our favor. If we also continue to focus our assignments on patient
acuity, it may allow our nurses to breathe and get their work done without wanting to leave the
next day and never come back. If we, as nurses, can begin adopting new ways to make our
assignments and shiftwork easier on us, regardless of how well our staffing is, we may still be
able to provide that exceptional care that we aim to give towards each and every patient.
(Sent to the American Nurses Association journal American Nurse Today)

References
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