Researchers and medical professionals have known for decades that low staffing levels at hospitals can negatively impact patient outcomes and employee well-being.
Increasing patient-care needs, overworked nurses and poor leadership today are among the factors that are contributing to hospital understaffing. Some regions have legally mandated staffing standards to address the problems.
“Nurse staffing is an important target area for safety improvement. Nurse fatigue, burnout, dissatisfaction, depression and anxiety can contribute to patient and caregiver harm. Many of these outcomes are related to staffing and work environment factors and are often preventable,” Patricia McGaffigan, chief operating officer and senior vice president of programs at the National Patient Safety Foundation, said in “From Bedside to Boardroom: Nurse Leaders Drive Transformative Change.”
Across the United States, being an effective nurse manager means working to alleviate staffing shortages. Nurses who earn Doctor of Nursing Practice (DNP) degrees — including through an online DNP program — are in a position to make positive changes in nurse staffing levels through thoughtful considerations, policy changes and transformational leadership.
Reasons for Hospital Understaffing
Understaffed hospitals have been cited as the reason for a multitude of problems, including medical errors, patient falls and hospital-acquired infections. Understaffing is not as simple as not having enough nurses to fill positions. Instead, it happens as a result of multiple obstacles in the healthcare system, including:
Nurse scheduling problems
Although the terms “staffing” and “scheduling” have been used interchangeably in healthcare, they are different. Staffing focuses on positioning RNs within a healthcare organization to meet specific patient needs. Scheduling takes place when staff nurses are assigned to fill shifts.
When creating schedules, nurse leaders focus on three important factors:
- Preventing unhealthy shift patterns (ensuring nurses don’t work back-to-back shifts)
- Rotating weekend assignment responsibilities
- Accounting for employee preference
Scheduling also entails determining the number of staff nurses needed to fill a time period based on factors that include historic data and anticipated hospital volume.
Nurse scheduling is so complicated that computer scientists have been working to create easier scheduling methods. However, there are so many variables — including the nurses’ scheduling demands, the hospital’s needs and unexpected patient increases — that a single solution has not been created.
At times of short staffing and high patient loads, some nurses experience burnout, or the mental, physical and emotional exhaustion that can be triggered by high stress. Some also experience compassion fatigue, or declining empathy or compassion caused by repeated exposure to trauma and suffering. Other signs of nurse burnout include:
- Sleep pattern changes
- Weight gain
- Mood fluctuations
- Feeling underappreciated
Researchers have found that an overworked nursing staff leads to poor patient safety outcomes, including a 40 percent increase in patient mortality.
Absenteeism and Presenteeism
Absenteeism (taking unscheduled days off) and presenteeism (being at work with reduced performance) impact the daily management of staff resources and ultimately affect patient care. Some studies show that presenteeism creates more losses than absenteeism.
Studies indicate that the highest rate of unscheduled absenteeism follows seasonal and demographic trends. Nurses with heavy workloads are also more likely to take unscheduled days off. Presenteeism in nursing has been connected to minor illnesses, the physical demands of the job and overall work attitudes.
Poor nursing leadership leads to problematic nurse staffing levels for several reasons:
- Diminished staff morale
- Increased absenteeism
- Poor decision making
- Toxic work environments
Effective leadership is crucial to RN job satisfaction and contributes to a healthy and safe work environment. The best leaders are skilled at addressing problems promptly and professionally.
Addressing Nurse Staffing Issues
DNP-educated RNs who are in leadership roles understand that staffing challenges are not something that can be fixed quickly. Nursing advocacy groups and organizations around the nation have been coming up with solutions, including:
State laws and mandates
In 1999, California became the first state to enact nurse-to-patient staffing ratios as law. Since then, at least 14 states have addressed staffing mandates with official regulations, and seven states require hospitals to have official staffing plans and policies.
At the same time, however, the American Nurses Association said the numbers-driven ratios are too rigid and do not allow for individual unit needs. In November 2018, Massachusetts voters rejected a law that would have established staffing ratios. Opponents of the law said it was too expensive and could have forced smaller hospitals to close.
New scheduling systems
Healthcare organizations are continually trying to innovate ways to make scheduling easier for the nurse scheduler, more effective for patients and less problematic for staff nurses. While some hospitals still complete schedules on basic spreadsheets or with pen and paper, many are switching to scheduling software that uses predictive analytics. The new software has improved the accuracy of staffing.
Hospitals are also turning to self-scheduling, a concept that started in the 1960s but was abandoned by many organizations because of challenges with the pen-and-paper system. Today, hospitals are using internet-based self-scheduling systems that allow nurses to connect at any time to make scheduling adjustments.
Nurse leaders continually try to manage costs while ensuring quality and safe patient care. Often, they are responsible for recruiting and retaining RNs and keeping staffing levels optimal.
As leaders, DNP-educated nurses use their extensive clinical backgrounds and their broad understanding of healthcare policy to implement changes. DNP-educated RNs also have the know-how to develop positive work environments that encourage nurse satisfaction.
“If you can impact and improve the experience of the providers of care, you can impact the care patients are receiving. Improved provider experience leads to a boost for patient care. A happy and engaged workforce leads to a more engaged patient population with better health and better outcomes,” RN Danielle Miller wrote in Health Leader.
Graduates of Duquesne University’s online DNP program learn the skills to be influential leaders who can make positive and impactful changes in the healthcare system.
About Duquesne University’s Online DNP Program
Duquesne University’s online DNP program prepares RNs to work at the highest level of clinical leadership and innovate novel models for patient care services. Duquesne DNP graduates are encouraged to use evidence-based practice models to improve policy and develop initiatives that will advance care delivery.
The online DNP program is tailored for students who have professional and family responsibilities but want to earn an advanced degree. For more information, contact Duquesne University now.
From Bedside to Boardroom: Nurse Leaders Drive Transformative Change: Industry Edge
Healthy schedules, healthy nurses: American Nurse Today
Nurse Burnout – How to Spot the Signs: NurseGrid
Study: Overworked nurses may be linked to 40% increase in risk of patient death: Becker’s Hospital Review
Nurse absenteeism: An analysis of trends and perceptions of nurse unit managers: NCBI
Reasons for presenteeism in nurses working in geriatric settings: A qualitative study: Sciedu
Recognizing and Overcoming Toxic Leadership: RN Journal
Update on Nursing Staff Ratios: Lippincott Solutions
Nurse Staffing Isn’t Straightforward. Here’s Why: HealthLeaders
3 things you need to know about nurse scheduling software: Becker’s Hospital Review
Can Nurse Self-Scheduling Reduce Healthcare Costs?: Shift Wizard
Improve The Work Environment For Your Nurses With Better Scheduling And Staffing: HealthLeader