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Financial Implications of Nurse Understaffing


In recent years, the relationship between nurse understaffing and adverse events such as medical errors, poor patient outcomes, and burnout has attracted considerable interest among nurse practitioners and other medical stakeholders. Research is consistent that nurse understaffing has affected many countries globally due to factors such as cost-containment, commercialization of medical institutions, deterioration of job security, insufficient pay, and extended working hours (Basinska & Wilczek-Ruzyczka, 2013; Kiekkas et al., 2008). On her part, Sanford (2010) acknowledges that the problem of nurse understaffing is exacerbated by health institutions that fail to hire new nurses to significantly reduce nursing labor costs. While this may be the case, the concerned institutions fail to quantify the adverse financial implications related to nursing understaffing.

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Bae (2012) acknowledges that understaffing leads to a heavy workload for nurses, which in turn triggers an increase in medical errors, patient mortality, falls with injuries, as well as nosocomial infections. In a leading editorial, Kiekkas (2013) notes that the problem of nurse understaffing is to be blamed for an increase in infection risk among nurses working in intensive care unit (ICU) settings. Such nurses, according to the author, are exposed to infections such as methicillin-resistant Staphylococcus aureus, pneumonia, septicemia, and other central line-associated bloodstream infections. Nurse understaffing has been found to lead to burnout among nursing professionals, which in turn causes nurse dissatisfaction and turnover intentions (Shoorideh, Asktorab, Yaghmaei, & Majd, 2015). Indeed, these authors argue that burnout outcomes related to nursing understaffing “are dangerous not only for the person who experiences it but also for others, such as care recipients, colleagues, and family members” (p. 66). Research has also proved that perpetuating the trend of nurse understaffing in order to reduce nursing labor costs has a negative connotation in terms of significantly increasing the number of patient adverse events as well as longer lengths of hospital stay (Sanford, 2010).

Drawing from this analysis, it is evident that numerous research studies have attempted to address the various adverse events occasioned by nurse understaffing. These events include poor patient care outcomes, patient mortality, nurse dissatisfaction, turnover, burnout, and increased infection risk. However, there is a gap in the literature regarding the adverse financial implications of nurse understaffing on nurses, patients, as well as health institutions. It is this gap in knowledge that the proposed study seeks to fill.

Purpose of Study

The purpose of this quantitative study is to investigate the adverse financial implications related to nursing understaffing. The importance of quantifying the effects of nurse understaffing in monetary terms is based on the need to understand the scope or context of the problem and how it financially affects nurses, patients, and healthcare institutions. The effects of nurse understaffing will be identified and quantified using dollar units for ease of quantitative analysis and interpretation of study findings. It is believed that the findings of this study will be instrumental in assisting managers of healthcare institutions to develop and implement strategies that will significantly reduce the adverse financial implications associated with the issue of nurse understaffing. Such strategies could be essential in assisting healthcare institutions to free resources for use in the hiring of more nursing professionals. Furthermore, the strategies could be used to enhance patient care outcomes and ensure that nurses are fairly remunerated and rewarded with the view to curtailing turnover. Lastly, the findings will serve as a scholarly reference for nurses and other practitioners within the context of understanding the adverse financial implications related to nursing understaffing.


Bae, S.H. (2012). Nursing overtime: Why, how much, and under what conditions? Nursing Economic$, 30(2), 60-72.

Basinska, B.A., & Wilczek-Ruzyczka, E. (2013). The role of rewards and demands in burnout among surgical nurses. International Journal of Occupational Medicine and Environmental Health, 26(4), 593-604.

Kiekkas, P., Sakellaropoulos, G.C., Brokalaki, H., Manolis, E., Samios, A., Skartsani, C…Baltopoulos, G.I. (2008). Association between nursing workload and mortality of intensive care unit patients. Journal of Nursing Scholarship, 40(4), 385-390.

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Kiekkas, P. (2013). Nurse understaffing and injection risk: Current evidence, future research and health policy. Nursing in Critical Care, 18(2), 61-62.

Sanford, K.D. (2010). Nurse staffing: Finding the right number and mix. Healthcare Financial Management, 64(9), 38-39.

Shoorideh, F.A., Asktorab, T., Yaghmaei, F., & Majd, H.A. (2015). Relationship between ICU nurses’ moral distress with burnout and anticipated turnover. Nursing Ethics, 22(1), 64-76.

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