The Nursing Shortage: Who Is at Risk? It’s a known fact in the health care industry that the United States is facing a potential shortage of Registered Nurses. The Bureau of Labor Statistics has estimated that there will be over a million job openings for nurses by 2022. Another study found that a nursing shortage will be in effect through 2030, with a particular impact on the southern and western parts of the country.1 The demand for nurses – including advanced practice nurses – can be traced to greater access to health care as a result of the 2010 Affordable Care Act, as well as an aging population—which includes many nurses heading into retirement.
There are many reasons to be concerned about this development. Not enough nurses for too many patients results in heavy workloads, which have been shown to have a negative impact on patient safety, as well as on nurses’ satisfaction with their ability to do their jobs effectively. There have been many studies on the effect of understaffed nursing units and departments. This is an overview of some of their findings.
More Patient Infections
Some studies have found a link between fewer nurses and greater rates of pneumonia. One study in a neonatal ICU found that rates of E cloacae infections increased significantly when the unit was understaffed. Another found higher rates of hospital-acquired infections in a pediatric cardiac ICU with lower numbers of nursing hours per patient day.2
Greater Failure to Rescue
There is some evidence that lower nurse staffing levels can impact failure to rescue, defined as death within 30 days among patients who suffered complications. One study found that one additional patient per nurse resulted in a 7 percent increase in the probability of failure to rescue, as well as the chances of death within 30 days of admission.1
Professional Stress and Burnout
Nurses with higher patient numbers and acuity levels can suffer from high stress levels, which can lead to job dissatisfaction and burnout, defined as “emotional exhaustion, depersonalization, and reduced personal accomplishment.”3 In one study, 40 percent of hospital staff nurses reported strong indications of job-related burnout, and more than one in five were planning on leaving their jobs within a year. The high turnover related to stress and burnout can lead to even lower nursing staffing levels and higher costs for health care organizations as they search for and train replacements.
Vigilant nurses are often the step between the patient receiving the wrong medication or an incorrect dose prescribed by a physician or a pharmacist. An Institute of Medicine report found that “mandatory overtime and double shifts contribute to nursing-related medication administration errors.”4
Mitigating the Impact on Patients and Nurses
While it will take time for enough nurses to join the ranks to prevent a nursing shortage, there are ways to lessen the risks to patients and ease the burden on nurses.
The Institute of Medicine has called for 80 percent of nurses to hold a Bachelor of Science in Nursing by 2020, in part to successfully handle the challenges of a changing health care industry, but also because more education benefits patients. One study found that every 10 percent increase in the proportion of BSN-prepared nurses could be linked to a decrease in the risk of death among patients by 4 percent.1
Limit Patient to Nurse Ratios
In some cases, nurses are fighting for contracts or guidelines that limit assignments by number of patients and acuity levels. In 2004, California implemented legislation that outlined minimum nurse-to-patient staffing ratios, followed by other states enacting staffing regulations.5 However, some experts have warned about unintended effects of such legislation, including increased costs with no attendant improvement in the quality of care and the potential for unfunded mandates.6
Take a Systemic Approach to Staffing
Another way to approach the problem is to consider designing staffing strategies. Nurse managers and administrators should consider variables such as individual nurses’ level of experience, competencies, critical thinking skills, and other strengths to design an effective staffing mix and schedule. Availability and easy access to equipment and support staff are also important considerations that can streamline workflow and save nurses valuable time.7
What Can You Do?
Nurses can help the nursing field manage the shortage in a number of ways. Join committees and professional associations to weigh in on policies regarding staffing ratios. Have strategies to take care of yourself and manage your stress when you have a large workload. Work on staffing plans that maximize each nurse’s strengths.
Earning a nursing degree can help you gain the skills and critical thinking abilities to help mitigate potential risks of a nursing shortage. The online Master of Science in Nursing program at the University of Saint Mary emphasize these areas as well as more advanced studies of nursing practice. Request more information call us at 877-307-4915 to discover how you can help your profession and thrive in your career.
1Nursing Shortage Fact Sheet, American Association of Colleges of Nursing, http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-shortage
2 “Nursing Workload and Patient Safety—A Human Factors Engineering Perspective,” from Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Available at http://www.ncbi.nlm.nih.gov/books/NBK2657/
3“Nurse Burnout and Patient Satisfaction,” in Med Care, February 2004. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2904602/
4Preventing Medication Errors, 2007. Available at www.nap.edu/catalog/11623/preventing-medication-errors-quality-chasm-series#toc
5“Impact of Nurse-to-Patient Ratios: Implications of the California Nurse Staffing Mandate for Other States,” Department of Professional Employees, AFL-CIO, 2011, available at http://dpeaflcio.org/programs-publications/issue-fact-sheets/impact-of-nurse-to-patient-ratios-implications-of-the-california-nurse-staffing-mandate-for-other-states/
6 “Nurse-Patient Ratio Law in MA Raises Cost, Quality Concerns,” Health Leaders Media, June 23, 2015,available at http://www.healthleadersmedia.com/nurse-leaders/nurse-patient-ratio-law-ma-raises-cost-quality-concerns#
7Safe Staffing Literature Review, American Nurses Association, August 2014, available at http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/NurseStaffing/2014-Nurse-Staffing-Updated-Literature-Review.pdf