nurse staffing shortages and quality of patient care

Mandatory overtime is a symptom of a larger problem, inappropriately low nurse staffing.  The American Nurses Association has long held that the safety and quality of care provided in the nation’s health care facilities are directly related to the number and mix of direct nursing staff.  More than a decade of research shows that nurse staffing levels and skill mix make a difference in the outcomes of patients.  Studies show that where they are more nurses, there are lower mortality rates, shorter lengths of stay, better care plans, lower costs, and fewer complications.  Four HHS agencies recently sponsored a study on this very topic.  The resulting report (Nurse Staffing and Patient Outcomes in

In addition to the important relationship between nursing staff and patient outcomes, several studies have shown that one of the primary factors for the increasing nurse turnover rate is dissatisfaction with workload/staffing.  The American Nurses Association’s 2001 survey states that 75 percent of nurses surveyed feel that the quality of nursing care at the facility in which they work has declined over the past two years. Out of the nearly 7,300 respondents, over 5,000 nurses cited inadequate staffing as a major contributing factor to the decline of quality of care. 

More than half of the respondents believed that the time they had available for patient care has decreased.  This survey reflects similar findings from a national survey taken by the Henry J. Kaiser Family Foundation (1999) that found that 69 percent of the nurses reported that inadequate nurse staffing levels were a great concern.  The public at large should be alarmed that more than 40 percent of the respondents to the ANA survey stated that they would not feel comfortable having a family member cared for in the facility in which

Adequate staffing levels allow nurses the time they need to make patient assessments, complete nursing tasks, and respond to health care emergencies.  It also increases nurse satisfaction and reduces turnover.  The VHA, much like private health systems, continues to struggle with the development of valid, reliable and implementable nurse staffing guidelines.

The development of nurse staffing guidelines has always been a sensitive topic to bring up.  Nurses provide the front line of patient surveillance, monitoring patients’ conditions, detecting problems and initiating life-saving interventions.

The American Nurses Association Magnet hospital program has had a proven success in raising the standards of nursing practice and improving patient outcomes.

In 2002, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) released a report on the nursing shortage that recommended that facilities adopt the characteristics of Magnet hospitals to foster a workplace that empowers and is respectful of nursing staff.

A growing body of research indicates that the Magnet program is making a positive difference for nurses, its patients and employers.  For example, studies indicate that patients experience lower mortality rates, shorter lengths of stay and increased satisfaction in Magnet facilities, while nurses also have increased satisfaction, as well as increased perceptions of productivity and the quality of care given.  Employers benefit too, as studies indicate that Magnet facilities have lower incidence of needlestick injuries, lower nurse burnout rates and higher retention rates, increased ability to attract new nurses, and higher JCAHO scores. Average nurse retention at Magnet hospitals is twice as long as that of non-Magnet facilities.

The first Magnet hospital, the University of Washington was designated in 1994.  Today, there are 85 organizations that are designated Magnet hospitals in the United States and England, including the James A. Haley Veterans’ Hospital in Tampa, FL.

Characteristics of a Magnet facility include:

•     Strong administrative and organizational support for nursing practice

•     Nurse autonomy and accountability

•     Control over nursing practice and practice environment

•     Paramount focus on the patient and patient’s family

Magnet hospitals are living evidence that creating professional nursing practice environments is the solution to the flight of nurses from hospital practice.

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