Healthcare organizations face a big problem now when it comes to nurse staffing and scheduling. There appears a big scarcity problem in the number of nurses when assigned per patient. Researches done during the past decades have established the importance of having enough nursing staff or registered nurse staffing as they play a huge role in achieving positive patient outcomes, safety, and satisfaction. This means an adequate nurse to patient ratio promotes reduction in patient mortality, enhances outcomes, and improves nurse satisfaction when it comes to their work. For instance, one study pointed out that for every patient assigned to a nurse, there is a 7% chance for the patient to die within 30 days of admittance to the hospital and another 7% possibility of failure to save the patient (Mensik, 2014). Thus, to eliminate such possibilities, ensuring adequate nurse staffing is imperative for the satisfaction of both the patient and the nursing staff, as well as for the patient’s safety, security, and wellness.
In spite of many researches done on the topic, still, the issue on nurse staffing and scheduling abound. Direct care nurses must have a clear understanding of staffing processes, including scheduling requirements. However, even if the nurses are well-educated about the need and importance of the issue, it is still beyond their control because hospitals are the ones responsible for hiring and scheduling tasks. As a result, the problem still persists even though nurses are clear about their roles and responsibilities.
General Background on Nursing Staffing and Corresponding Bill Affecting the Disparity
Studies revealed that hospitals with low levels of nursing staff tend to have higher rates of poor patient outcomes that include cardiac arrest, pneumonia, and urinary tract infections (Stanton, 2004, p. 2). Despite this fact, to increase nurse staffing is a daunting task. Several factors contribute to the scarcity in number such as gaps between the available nursing positions and the actual number of registered nurses willing to fill the gap (Stanton, 2004, p. 5); the increasing need of patients for more active care (Stanton, 2004, p. 3); changing demographics, career expectations, and work attitudes; and, nurses job dissatisfaction (Stanton, 2004, p. 5). The demand for nurses can exponentially increase, but the actual number of people interested in a nursing career falls behind by a big percentage.
Furthermore, the problem becomes even more complicated with the emergence of various technologies and a decline in the average length of stay of patients in hospitals. Many new medical technologies allow patients who are not seriously ill to continue and receive outpatient surgical care instead of inpatient care. Additionally, patients who would have stayed longer in hospitals before are sent home to continue recovery from home. For instance, the average hospital stay used to be about 7.5 days as compared to 4.9 days now (Weiss & Elixhauser, 2014, p. 2). As a result, because most patients do not receive the full circle of recovery in the hospital and more hospitals end up with higher number of sick people who need more care or patients with recurring illnesses.
Studies also revealed that when nurses are paid higher overtime pay, the more emergency cases the hospital receives, but when RN non-overtime staffing was higher, readmission cases was lower (Caramenico, 2011). This can be attributed to the fact that there is a shortage in nursing staff, which compromises the quality of patient outcomes. As nurses are required to work for more hours in a day, the patients are the ones who suffer.
Mensik (2014) pointed out three main models of nurse staffing in the hopes that it would help alleviate the issue. These are budget based, which refers to the allocation of nursing hours per patient day; nurse-patient ratio, which pertains to the proportion of nurses to patients when it comes to establishing the number of staffs (Mensik, 2014); and, patient acuity, that uses patient characteristics as determinant factor allocating patient staffing requirements. While the models were developed to address the nursing shortage and nurse allocation issues, the American Nurses Association (ANA) recognizes that there is no single, most effective model that will answer the problems (Kirby, 2015, p. 64). Many healthcare organizations use combination methods of the three models and tailor their staffing approach according to their needs and situation. For instance, basing staffing strategy on a purely financial approach could present problems when it comes to patient outcomes, nurse job satisfaction, and healthcare personal health, among others (Mensik, 2014).
In order to address these concerns, staffing laws are needed for the protection of nurses and improvement of patient outcomes, such as the Registered Nurse Safe Staffing Act (H.R. 2083 / S. 1132), which requires “Medicare participating hospitals, through a committee comprised of at least 55% direct care nurses or their representatives, establish and publicly report unity-by-unit staffing plans” (Safe Staffing, n.d.). According to the Act, the plans must “establish adjustable minimum number of RNs; include input from direct care RNs or their exclusive representatives; be based upon patient numbers and the variable intensity of care needed; [and consider] unit and facility level staffing, quality and patient outcome data and national comparisons as available” (Safe Staffing, n.d.), among others. One vital aspect of the Act is that registered nurses must not be required to work in areas where they have not received proper training or experience (Safe Staffing, n.d.) as this can affect patient safety and positive outcomes.
When it comes to compliance, the Act holds all hospitals accountable in instituting procedures for addressing complaints; gives the Secretary of Health and Human Services the right to enforce monetary penalties for violations; add whistle-blower protection for those who will help in exposing issues and complaints regarding staffing; and, require public reporting of staffing information (Safe Staffing, n.d.).
Illinois’ Position on the Bill
When it comes to the bill, the state of Illinois is among other states that supported the bill. There are other states that have state laws or bill about nurse staffing and this include California, Minnesota, Nevada, Ohio, and Texas, among others (Nurse Staffing, n.d.). In general, the reaction was a positive one considering that the state was one of those that implemented the bill right away. Illinois enacted the safe staffing legislation in 2007.
I support the bill primarily because patients’ situation and nurses’ health and job satisfaction should be considered, too. Through this bill, I believe that patients can be kept safe when registered nurses are added to the unit staffing because studies revealed that 1/5 of hospital-related deaths and patient accidents are reduced significantly. This is very useful because some healthcare services have begun refusal of payment for avoidable injuries, diseases, or illnesses that a patient obtained from hospitals. It is expected that other insurers will follow soon (Safe Staffing, n.d.). Additionally, retaining experienced nurses also serves as a cost-cutting measure because there is no need to train and retrain them constantly on bedside tasks and other processes. Based on studies, hiring or training new nurses is very costly as it could be around 1.1 to 1.6 times an annual nurses’ salary (Safe Staffing, n.d.). Thus, hiring more registered nurses can prove to be more of a perfect solution for staffing problems because not only are the patients allotted more quality care, hospitals also end up saving more money because there will be less overtime pay to be taken care of.
Stakeholders
The stakeholders in this endeavor include the American Nurses Association, who ensures hospitals and nurses are educated about their rights and responsibilities; the government, for considering the plight of the patients and the nurses; the hospital administrators and managers; and the nurses themselves, who are being pushed to be part of the decision-making process.
Impact of the Bill on Stakeholders
For the stakeholders, the impact of the bill is huge as it can change and improve the situation of nurses and patients tremendously. For instance, the ANA can ensure that member-nurses are protected from possible issues that may arise in the care of a patient, especially when they are tasked to work consecutive days for long periods of hours. This means, they will have enough time to rest and take in all the changes happening around them (Fitzpatrick, Anen, & Soto, 2013, p. 227). For the government, this means the trust level of the people will increase because it shows that the government is there to protect nurses and patients. For hospital administrators and managers, it means a more efficient execution of schedules, staffing, and staffing plans. For nurses, apart from being the recipients of well-organized and competent staffing plans, they also become part of the decision-making process, which gives nurses a voice in the whole staffing issue (Fitzpatrick, Anen, & Soto, 2013, p. 228). Patients end up benefitting from all of these because this equates to better care services and patient outcomes. They are assured that care will always be available when needed and will be allotted to those who are more in need of care and attention (Fitzpatrick, Anen, & Soto, 2013, p. 225). According to a study, the success of the efforts still cannot be fully felt as more than 70% of the respondents in the research said it is still evolving (Fitzpatrick, Anen, & Soto, 2013, p. 225).
Plan of Action to Guarantee Success
Nurses play an important role in the health care system. State-mandated laws, such as safe-staffing ratios, are essential in ascertaining the safety both of the patients and the nurses, thus, having enough nursing staff is crucial in patient care and in the retention of nurses (IRI Intelligence Briefing, 2013). The issue on nurse staffing becomes a huge problem as the baby boomers of the 1970s grow older and there comes an increasing demand for health care services.
In this current time, nursing care has shown remarkable changes that not only include shadowing and synchronization of care and services for patients in a very intense healthcare environment (Dorning, 2016). Therefore, to address these disorders, strategies are needed to be put in place, in areas such as teamwork, communication, workload, and personnel deployment, among others.
Teamwork. Improvements on teamwork efforts are necessary to ensure that stakeholders all work together in providing quality care to patients. Those who provide quality care, the nurses, must always be involved in the decision-making process so that they are not only aware about their role and responsibilities. They must also develop in themselves the eagerness to help their fellow nurses and the hospital administrators and managers in improving the situation in the hospital and in providing quality care to patients (Stanton, 2004, p. 7).
Communication. Establishing a clear and open line of communication among stakeholders is necessary to improve the situation of the patient and the nurses. For the benefit of the patients, this open communication lines equates to being able to effectively transfer responsibilities from one nurse to another when a shift ends (Dorning, 2016). This means all orders and patient care tasks have been endorsed correctly to healthcare personnel whose mind and focus are on the tasks at hand and the patients assigned to him or her (Dorning, 2016). Additionally, this benefits the patient, too, because they are not left unaware about their medical situation.
Workload. Having a clear and well-planned workload for nurses’ help in ensuring the nurses’ job satisfaction is high. This is because many hospitals lose their best nurses when they are overworked. Even if they are paid overtime salary, nurses also value their personal time (Dorning, 2016). Not having enough time to do their personal plans or spend time with their family can push nurses to resign from their jobs and find something else to do. This will then result to understaffed work environment, which, in the long run, affects the patients in terms of receiving medical care (Stanton, 2004, p. 5). Apart from this, poor, inadequate nurse staffing can also lead to higher rates of unpleasant results, including instances of hospital-acquired conditions, patient mortality, and falls, among others.
Personnel deployment. Very much related to nurses’ workload, personnel deployment should be reconsidered because having a tired workforce means there is the possibility of them resigning from their jobs, thus, resulting to staffing shortage not only in nurses but the office personnel as well (Stanton, 2004, p. 2).
Integrate qualitative factors into the staffing plan. Staffing plans should not focus mainly on raw numbers. Instead, concentrate on each patient assigned to nurses and ensuring these nurses have the necessary to care for the sick. This plan should be in black and white and a preset plan (CNA HealthPro, 2009, p. 5), which organizations can implement in order to address nurse staffing and shortage issues. Staffing decisions must reflect factors such as patient diagnosis, staff competency, access to medical personnel, and satisfaction levels, among others. The staffing plan should also include factors affecting the physical layout of the hospital and rooms; technological support, such as electronic medical records and computerized order entry forms to reduce paper trail; and direct care resources, such as nurses, rehabilitation services, monitor technicians, and pharmacists (CNA HealthPro, 2009, p. 6), among others.
Provide necessary experience and training for nurses. Nurses should be given the opportunity to make decisions, thus, organizations must ensure that they hire highly trained medical personnel who can handle emergency and critical cases depending on the situation. For instance, staffing decisions must include years on the job, tenure on the unit, and level of clinical experience (CNA HealthPro, 2009, p. 7), among others.
Empower and value nurses. This means allowing nurses to fully exercise and employ their skills and knowledge, as well as use their own judgment in terms of patient assignment. As nurses are allowed to share control, authority, and professional autonomy, the more they will become motivate to continually learn and pursue career advancement for themselves that will eventually benefit the medical institution itself (CNA HealthPro, 2009, p. 10).
How to Evaluate Effectiveness of Plan of Action
It is not enough that there are strategies in place because it is also crucial to determine whether the plans for action are effective or not. Especially if the plans have already been implemented, it is necessary to know if the strategies were successful.
Surveys. For these plans of actions, it would be best to constantly have surveys among staff and nurses to determine their employee satisfaction constantly. This would mean the hospital may have to prepare reports either on a quarterly basis or semi-annual basis (NIOSH, 2013). While an annual employee satisfaction survey is also possible, the length of time for knowing whether the staff or the nurse is still happy at work is too long.
Availability of trainings. Providing opportunities for training and up skilling will ensure that nurses are always up to date with what is happening in the health industry. Trainings will also help in empowering them because a constant review of what they know or exposure to new technologies or management trainings will prepare them for better and more challenging roles and responsibilities at work (NIOSH, 2013).
Nursing staffing is an ongoing issue. However, it is being addressed not only by the government but by the health industry as well as the hospital administrators and managers, too. It will continually be a problem if not all hospitals will implement the provisions as stated in the nurse staffing law because it will only produce more unsatisfied and burn-out nurses, including patients who are unhappy and unsecured about the kind of service and care they are receiving. Therefore, it is imperative that all stakeholders work with one another for the benefit of the patients and the improvement of nurses’ working conditions.
References
Caramenico, A. (2011). Marquette professors find nurse staffing, overtime hours affect readmission rates, emergency room visits. Retrieved from http://www.fiercehealthcare.com/healthcare/marquette-professors-find-nurse-staffing-overtime-hours-affect-readmission-rates?cid=xtw_humancap
CNA HealthPro. (2009). Safe nurse staffing: looking beyond the raw numbers. Retrieved from http://www.nso.com/Documents/pdfs/Newsletters/Safe_Nurse_Staffing_-_Looking_Beyond_the_Raw_Numbers_2009-4.pdf
Dorning, J. (2016). Safe-staffing ratios: benefiting nurses and patients. Retrieved from http://dpeaflcio.org/programs-publications/issue-fact-sheets/safe-staffing-ratios-benefiting-nurses-and-patients/
Fitzpatrick, T., Anen, T., & Soto, E.M. (2013). Nurse staffing: the Illinois experience. Nursing Economics 31(5): 221-259. Retrieved from https://www.nursingeconomics.net/ce/2015/article3105221259.pdf
IRI Intelligence Briefing. (2013). Are mandatory staffing ratios coming to Illinois. Retrieved from http://www.iriconsultants.com/sites/default/files/Are-Mandatory-Staffing-Ratios-Coming-to-Illinois.pdf
Kirby, K.K. (2015). Hours per patient day: not the problem, nor the solution. Nursing Economics 9(2): 64-66. Retrieved from https://www.nursingeconomics.net/necfiles/2015/JF15/64.pdf
Mensik, J. (2014). What every nurse should know about staffing. American Nurse Today 9(2). Retrieved from https://www.americannursetoday.com/what-every-nurse-should-know-about-staffing/
Minimum required staffing. (2013). Illinois Citizens for Better Care. Retrieved from http://www.illinoiscares.org/content/minimum-required-staffing
Nurse staffing. (n.d.). American Nurses Association. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/State/Legislative-Agenda-Reports/State-StaffingPlansRatios
Safe staffing. (n.d.). American Nurses Association. Retrieved from http://www.rnaction.org/site/PageServer?pagename=nstat_take_action_safe_staffing_about
Stanton, M.W. (2004). Hospital nurse staffing and quality of care. Retrieved from https://archive.ahrq.gov/research/findings/factsheets/services/nursestaffing/nursestaff.pdf
The National Institute for Occupational Safety and Health. [NIOSH]. (2013). Training research and evaluation. Retrieved from https://www.cdc.gov/niosh/topics/training/
Weiss, A.J., & Elixhauser, A. (2014). Overview of hospital stays in the United States, 2012. Retrieved from https://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf
