Why is nurse staffing important?

Nurses are an important part of the healthcare system. They provide critical care in our country's hospitals for patients in emergency departments and intensive care units, and prescribe medications and other basic necessities. Yet all too often, when hospital managers try to cut costs and raise income, nurses are overworked and under-supported. The level of treatment is growing at a remarkable pace in the current healthcare setting, the commitment to, and emphasis put on, treatment. This is focused on many factors: the expectation that institutions and plans in a dynamic or market-oriented healthcare sector will have to compete on more than price; the much greater capacity of those in the healthcare sector to accurately assess both procedures and patient outcomes than before and a significantly enhanced understanding of how effective quality assurance strategies can be implemented. Further work is also being aimed at recognizing the quality of programs and results for both people and populations.

Safe staffing practices improve patient care outcomes. Patients with more direct nursing time (30 to 40 minutes per patient daily) reported less pressure ulcers, acute care hospitalizations, urinary tract infections, urinary catheters and less decline in their ability to perform everyday living activities in long-term care facilities. Although increased nurse staffing significantly improves patient safety in hospitals with good work conditions for nurses, it has little to no impact in hospitals that otherwise have terrible working conditions for nurses. Healthy nursing work environments are characterized by supportive working relationships between doctors and nurses, active participation of nurses in hospital decision-making, management responsive to nursing issues, continuing nursing education initiatives and continuous improvement of the quality of patient care services.

Many evidence available shows that healthy working practices are cost-effective for hospitals. High turnover rates and over-reliance on temporary nursing workers raise the total cost per discharge (including health care costs), as well as overall operating costs. Safe staffing policies boost the efficiency of nurses and patient mortality rates, and rising turnover rates, liability, and staffing costs.

● One research in the Journal of Health Care Finance found that although increased nursing staffing increased hospital operating costs, it did not reduce the overall productivity of the hospitals.

● While nursing is often the largest line-item expense for hospitals, a 2013 study showed that higher nursing staffing rates led to positive financial results for hospitals on competitive markets as increased efficiency, reductions in secondary infections, and reductions in the average duration of patient stays lead to expense savings and long-term efficiency.

● A 2009 report showed that adding an additional 133,000 RNs to the healthcare workforce in the U.S. would produce total medical benefits of $6.1 billion in decreased cost of patient care. That does not include the added benefits of improved efficiency as nurses help patients heal faster, an approximate savings of $231 million per annum.

● Safe staffing ratios also reduce the increased costs of increased nurses and staffing companies, as retention of nurses continues to improve with secure staffing. Temporary nurses are costly to employ hospitals, and do not have the same standard of care compared to permanent nurses, as mentioned previously.

If staffing were overlooked, both nurses and patients could be endangered. The Bureau of Labor Statistics predicts that demand for registered nurses will rise by 15% between 2016 and 2026 and that 438,000 new nursing jobs will be generated during this ten-year period. This increase in demand only adds to the current nursing shortage and other staffing issues identified by the American Nurses Association (ANA):

● High patient-to-patient levels are closely linked to mental stress, work frustration and fatigue. A variety of symptoms can characterize nurse fatigue (sometimes called burnout). According to a report in the American Medical Association's Journal, every additional patient over four per nurse carries a 23 percent chance of heightened "burnout" and a 15 percent reduction in work satisfaction. The same study showed that a seven per cent rise in the risk of dying within 30 days of admission was associated with increasing additional patient per nurse.

● Working long hours with insufficient staffing often raises the risk that nurses can develop conditions such as musculoskeletal disorders, hypertension and depression. Registered nurses in 2017 had 24,540 confirmed sickness or injury events resulting in one or more days off work. A further 34,210 accidents in the same year were reported by nursing assistants, an occurrence rate surpassed only by law enforcement patrol officers.

● As a result of long work hours and overtime, cardiovascular health of nurses also declines. Studies have shown a strong correlation in a 2010 study between regular overtime work and heart disease events, with employees recording three to four hours of overtime a day being 60 percent more likely to have cardiovascular health issues.

Rapid shifts in the healthcare delivery system and the resulting dysfunctional environment fuel the nursing community's anxiety that there are substantial reductions in registered nurse staffing in hospitals, leading to declines in patient care and risks to nursing staff's safety and well-being. The Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine notes that the lack of accurate and credible data on the extent and distribution of temporary or permanent unemployment, reassignments of current nursing workers and related systemic changes in nursing job prospects significantly hampers attempts to recognize the issue and prepare for the future. In addition, answers to these questions are required for nursing staff at all levels. Hospitals should therefore not base their monitoring and assessment exclusively on the relationships between nurse staffing and quality of treatment, or on work-related illness and injury. Instead, hospitals should concentrate their attention on tracking and assessing staffing overhaul across their nursing staff's entire field.