RN Staffing in Hospitals…Are We Asking the Right Question?

By Roberta Heale, Associate Editor

I’ve been working with a number of students in a nursing masters program who have chosen to study teamwork. One study includes a survey question about the percentage of time that a nurse feels that his/her unit is appropriately staffed. I’ve been thinking about this issue and I think that simply asking for the nurses’ perception of staffing is skimming a much more complex issue.

We read stories from around the world about the outrageous workloads of nurses. Stress, burnout, and intention to leave are the buzzwords and the reality for many. Although there are descriptions of the type of work that nurses do, the cause of the nursing work life stresses are rarely addressed. I started working as an RN in the late 1980’s on a medical floor. An RN who had been working there for 30 years told me that when she started it was rare to have a patient with an IV and, if there was one, the doctor had to insert it. By the time I started on that unit, every patient had at least one IV, and there were also many tube feedings, chest tubes, catheters, telemetry monitoring and more. Yet, during those 30 years between her start date and mine, the number of nurses on the unit each day and night shift hadn’t increased. I’m sure that since then with the push for faster hospital discharges and, subsequent increased patient acuity, the workload on that unit has increased even more … without additional RNs. So, even if today’s nurses are asked if they are appropriately staffed on their unit, they’ll likely be answering from today’s perspective…do we have the full number of RNs we are allotted, rather than do we really have the number of RNs we need to safely care for these patients? Instead of answering and addressing the real issue, nurses become stressed, frustrated, overworked and many leave hospital care, or nursing altogether, creating even greater problems in the profession.

We can’t reduce the acuity of patients and that it isn’t ethical to withhold technology to assist patients and their healthcare needs. So, one solution seems to be that the number of  RN staff on a unit should be increased to match the current health care environment. In 2004, California enacted mandatory nurse-patient staffing ratios which has increased RN staffing in hospital settings. The result has been improved patient outcomes and increased nursing satisfaction (Aiken et al., 2010).

Nurses and nursing care is constantly scrutinized and studied. Policies and money often follow the findings. We need to ensure that when we’re asked to complete surveys or take part in studies, that we are asked questions that truly reflect our current practice and we should insist on being part of the interpretation of the findings. Otherwise, I can’t help but feel that things will only get worse.

Aiken, L.H., Sloane, D.M., Cimiotti, J.P., Clarke, S.P., Flynn, L., Seago, J.A., Spetz, J., & Smith, H.L. (2010). Implications of the California nurse staffing mandate for other states. Health Research and Educational Trust, 45(4), 904-921. doi: 10.1111/j.1475- 6773.2010.01114.x

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