The Effects of Nurse Staffing on Quality of Care

Nursing responsibilities

Registered nurses are responsible for a lot but one of their main responsibilities is providing hands-on care to patients. Caring for people is not something that should be taken lightly and usually is not. It can be very rewarding but it can also cause a lot of stress so nurses need support wherever they can get it. Which is why teamwork and relying on colleagues and other staff for support and help is important. However, whenever a facility is understaffed there are not as many “team members” to rely on or collaborate with which could lead to higher levels of stress and mistakes.

The demand for nurses is continuing to grow and according to Deborah Wood, author of What Will the Demand of Nurses be in 2018?, it is because people are living longer and their illnesses are becoming more treatable (2018). This demand for nurses consequently leads to employers having to make do with the nurses that they have available which unfortunately is not enough right now and is causing facilities to be understaffed. Understaffing can negatively affect quality of care, financial downfall, nursing burnout, and quality of life.

Crystal Martin, author of The Effects of Nurse Staffing on Quality of Care, explains that not having enough staff members correlates to an increase in a nurses workload and job dissatisfaction which then leads to a decrease in patient care (2015, p. 4). Martin continues to develop the argument that the ethical principle nonmaleficence is being jeopardized. Nonmaleficence is a nurse’s duty to not cause harm to patients. Whenever a nurses nonmaleficence is called into question or is compromised then so is a patient’s safety and care.

The argument is also made that whenever a patient’s quality of care is decreased so is their overall outcome and it is “directly related to low nurse staffing” (2015). The main one illness that are associated with poor patient outcomes include pneumonia, shock, cardiac arrest, and urinary tract infection and it is said that hospitals with higher RN staffing do not have as many poor outcome and their quality of care along with patient satisfaction is higher (2015). If a nurse is overloaded with her responsibilities due to not having enough staff members for support or assistance then the overwhelming feeling of being able to care for all of their patients could set in and mistakes could be made inadvertently or advertently either due to stress or fatigue.

Those mistakes could be as simple as not taking out a patient’s Foley catheter in time. Something like that very well could lead to a urinary tract infection. If a patient contracts an infection while they are in the hospital that they did not have prior to admission that is not enjoyable for the patient and it does not reflect well on the hospital, or the nurses/personnel caring for the patient. Martin agrees that “poor staffing places undue burdens on nursing staff and can put patients in harm’s way” (2015).

Along with patient safety Martin (2015) explains how poor patient outcomes can also cost facilities, such as hospitals, millions in money. Apparently, hospitals have been charger over $ 9 billion a year for poor patient outcomes such as pneumonia and pressure ulcers (2015). If hospitals are continually charged for these poor patient outcomes then they will not have the funds to higher more nurses so the issue of being understaffed will not be corrected and the cycle will not be stopped.

Nursing burnout is a common phrase within the nursing profession. According to Lilia de Souza Nogueira, Reginia Marcia Cardoso de Sousa, Erika de Souza Guedes, Mariana Alvina dos Santos, Ruth Natalia Teresa Turrini, and Dina de Almeida Lopes Monteiro da Cruz, authors of “Burnout and nursing work environment in public health institutions”, burnout is in response to chronic work stress (2018). De Souza Nogueira and et al. explore the factors that lead to burnout in nursing in Brazil. Although the study was done in another country they found that burnout was linked to the work environment (de Souza Nogeira, et al., 2018). It is explained that interventions can increase a better work environment and potentially decrease the presence of burnout. The article suggests. Interventions in America could be more RN’s hired at facilities because de Souza Nogeira and et al., have agreed that “burnout is mainly determined by inadequate organization of work, which can result in work overload, lack of autonomy and lack of support for tasks” (2018). Those outcomes are also caused from understaffed nurses.

A study was done in regards to midwives in Uganda. Again, although the study focuses on a sample from a different country it is still relatable to the United States. Ultimately the article “Professional Quality of Life and Associated Factors Among Ugandan Midwives Working in Mubende and Mityana Rural Districts” written by Rhoda Suubi Muliira and Vito Bosco Ssendikadiwa agrees that factors similar to a shortage of nurses leads to burnout and a decline in a quality of life for nurses (2015). The relationship between job satisfaction and burnout are highly related and are associated with “frustration, powerlessness, inability to meet work goals and less engagement in work” (Muliira, Ssendikadiwa, 2015). These feelings and issues can also be associated with understaffing of nurses.

Muliira and Ssendikadiwa (2015) agree that burnout is a result from job dissatisfaction and Kathleen Rice Simpson, Audrey Lyndon, and Catherine Ruhl directly relate inadequate staffing to job-related stress and dissatisfaction (2016). Simpsons, Lydon, and Ruhl came to this conclusion by producing a survey for the Association of Women’s Health, Obstetric and Neonatal Nurses that allowed for them to provide their input for staffing guidelines and thoughts on the result of inadequate staffing of nurses (2016).

If staffing is limited it makes it difficult for a floor or a facility to work as a team. Critchley D., Edwards C., and Fallon R. explain the importance of teamwork in “The importance of good teamwork” (2007). The article explains how performance support teams are made up of people of many different backgrounds and are to take on issues within hospital or workplace setting. Members are usually composed of “chief executives and directors of nursing with board level experience, operational managers from clinical and non-clinical backgrounds, and healthcare professionals who continue to practice part time” (Critchlet, Edwards, Fallon, 2007). These teams have been known to solve issues from hospital acquired infection rates to financial problems (2007).

These findings are important because it shows how crucial and beneficial teamwork can be. However, if a facility is understaffed the ability to work as a team is harder to do. If nurses were not understaffed and they had each other to use as resources and were able to rely on each other and work as a team then incidences of burnout would decrease, and quality of life, and patient care would probably increase.

Shortage of nurses is not being ignored. The American Association of Critical-Care Nurses (AACN) produced an article “Hospitals Step Up Recruitment Efforts to Address Nursing Shortage” in 2018 and acknowledged the shortage of nurses and stated that “hospitals nationwide accelerated their recruitment and retention efforts”. According to the AACN hospitals are beginning to offer higher salaries, signing bonuses, student loan repayment, free housing, and mentor programs. Foreign nurses are also being utilized to rectify the shortage of nurses. They blame the shortage of nurses to be due to a lack of available spots in nursing school, however by 2020 hospitals are expected to meet the goal of having 80 percent of their nurses to have a four-year degree (2018).

Hospitals are relying on outside sources and they are also requiring their nurses to have more of an education. Relying on outside sources and nurses from other countries will help provide hospitals with more variety and more options to staff their facilities. Requiring nurses to have more of an education could potentially lead to a decrease in burnout and job dissatisfaction. It will allow for students to be sure if nursing is the correct path for them. Four-year degrees provide a student with more learning and clinical experiences than a two-year degree.

Understaffing of nurses can cause patient and nurse dissatisfaction. It is an issue in the United States as well as other countries. However, it is not an issue that is going unnoticed or ignored. There are responses and plans in play to help rectify the issue.

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