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Effects of Nurse Staffing Levels on Patient Safety


Understaffing is widely considered a primary nursing issue globally, with many nursing leaders and scholars claiming it to be detrimental to patient outcomes. However, in this context, it is not considered that there are many other professional factors at play that lead to poor results in inpatient care. Low levels of nursing are not strongly associated with the actual quality of care since the latter depends on nurses’ competence, nurse-patient communication, and the available resources to a much greater degree.

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While low staffing levels are continuously mentioned in the clinical and administrative aspects of nursing, it is vital to consider that nursing consists of a complex system and predetermined set of tasks, most of which are fulfilled no matter the staffing level. An alternate viewpoint on the issue suggests examining the perspective of efficiency and competency. It is argued that staffing causes nurses to be unable to fulfill their duties efficiently and significantly shortens the time spent with patients. However, if methods of multitasking and communication amongst the nursing team and with patients are improved, then patient outcomes could be improved within the realities of the healthcare system.

1st Con-Point

A decrease in the quantity and quality of communication strongly affects the quality of care. Within the staffing structure of modern hospitals, Portoghese, Galletta, Battistelli, and Leite (2015) argue that nurses are unable to build effective communication that will appropriately divide the workload and optimize key processes, which would significantly improve healthcare delivery. Nursing education is a contributing factor, as the quality of nursing benefits with an increased focus on communication strategies in education processes rather than issues such as understaffing. Effective communication elements should be naturally built into nursing protocols for the optimal result. Therefore, with properly structured communication and training processes, nurses would be able to meet the diverse needs of patients even in low-staff environments.

2nd Con-Point

Undoubtedly, the nurse-to-patient ratio (NPR) can be low at certain times. However, it is not a primary factor for the drop in service quality, but rather the unavailability of resources. According to the theories of Kahouei, Farrokhi, Abadi, and Karimi (2016), nursing consists not only of human resources but also informational, infrastructural, and technological resources as well among others. For example, services such as patient education can be delivered through digital technology and appropriate databases of information that do not require a nursing presence. Furthermore, infrastructure for the effective provision of care and patient communication is often lacking. Therefore, it can be argued that for as long as other supporting resources are lacking, there will be limited effects.

3rd Con-Point

The communication between nurses and patients, which has a profound impact on outcomes both while patients are hospitalized and after discharge, does not directly depend on NPR. When dismantling communication efficacy, Stalpers, de Brouwer, Kaljouw, and Schuurmans (2015) suggest that it consists of various aspects such as culture, language, and personal demeanor. Management of patient needs and overall communication can be enhanced through digital tools and improved communication training, which limits redundancies and allows to quickly establish a clear dialogue with the patient. In turn, this leads to an improved quality of life and service for patients by nurses, relatively unaffected by staffing levels. This should be considered in implementing administrative interventions and conducting nursing education.


It is evident that the complexity of nursing care and its effect on patient outcomes depends on numerous factors. While staffing levels unarguably could be improved, they are not the primary cause of such issues as adverse patient outcomes and poor service quality. Improved education, communication efficacy, and additional resources could have profound impacts that would allow even a skeleton staff to efficiently fulfill all duties and establish a rapport with the patients.


Kahouei, M., Farrokhi, M., Abadi, Z. N., & Karimi, A. (2016). Concerns and hopes about outsourcing decisions regarding health information management services at two teaching hospitals in Semnan, Iran. Health Information Management Journal, 45(1), 36-44. Web.

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Portoghese, I., Galletta, M., Battistelli, A., & Leiter, M. P. (2015). A multilevel investigation on nursing turnover intention: The cross‐level role of leader–member exchange. Journal of Nursing Management, 23(6), 754-764. Web.

Stalpers, D., de Brouwer, B. J., Kaljouw, M. J., & Schuurmans, M. J. (2015). Associations between characteristics of the nurse work environment and five nurse-sensitive patient outcomes in hospitals: A systematic review of literature. International Journal of Nursing Studies, 52(4), 817-835. Web.

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