Introduction
Nursing is one of the essential services required in healthcare to provide high-quality and safe services to improve patient outcomes. Nurses comprise the largest group of professionals in the healthcare field and are the closest to patients due to the time they spend providing nursing care services. However, nursing roles and responsibilities are impacted by various challenges, especially the rising staff shortage.
The increasing demand for nursing exerts pressure on practicing nurses, who must cope with high fatigue levels as they attend to more patients over a short period. Therefore, nursing staff shortage is a critical area of concern, impacting the policy needed to enhance healthcare service delivery. Short staffing at the workplace affects the performance of nurses, particularly in providing care and treating patients, due to an increased workload, high stress levels, patient-nurse ratio, and burnout.
Forces That Determine the Appropriate Staffing Levels
Hospitals require an appropriate and adequate number of nurses as one of the fundamental ingredients in cultivating a high-quality working environment. The primary objective is to have an adequate number of nurses at the bedside to observe the patients and respond to their needs, as the hospital aims to improve quality. Huston indicates that healthcare facilities may find it challenging to have adequate nurses, given that numerous variables influence their staffing (34).
The hospital administration should be supported in defining key staffing components, such as patient acuity and the proper skills mix. This involves considering that nurses attend to multiple patients per shift. Shah et al. (13) state that these are heavy obligations that call for continuous alertness from nurses. Besides having the right skills, nurses should be appropriately staffed to adequately provide services to all patients and their specific needs.
Administrators bear the responsibility of defining the appropriate nursing staffing levels. Factors such as budget allocation and prevailing labor market conditions impact the mandate. Therefore, the right level should be evaluated based on the size of the healthcare facility or the operational level, such as a department, unit, or division.
The specific time frame should also be considered based on the shift or the periodic average (daily, weekly, monthly, or yearly) (Nikoleishvili, 66). All these elements must be accounted for, considering that staffing levels across different units mirror the variations in patient populations and the severity of the disease. Significant distinctions occur when evaluating general care versus acute and chronic care units.
Administrative practices define the structure of staffing in a healthcare facility. They also affect the makeup and markers of the nursing staff and the organizational model of care used in staff distribution. Other factors in the place of work that influence the staffing level include collaboration and communication, the physical setup, support services, and information systems (Huston, 43). These factors define the overall quantity of nursing time allocated to patients and the quality of nursing care.
Impact of Staffing Shortage of Nurses
Even as organizations address the appropriate nursing staffing levels, a glaring shortage of nurses threatens patient safety and quality of care. According to Scheidt et al. (56), nursing staffing shortages represent one of the significant problems in the healthcare sector. The numbers continue to dwindle as nurses need help with increasing patient numbers and the high demand for nursing care services.
The understaffing results in an increased workload for the few nurses as the healthcare facilities struggle to counterbalance the small numbers. The nurse’s experience increased stress levels as they rushed from one patient to another (Nikoleishvili, 67). Because of the severe nursing shortage, the few nurses may have to toil for long hours and perform more duties than expected. Experienced nurses sometimes have to suffer more as they may be required to induct new nurses and simultaneously handle more critical cases, which leaves them more exhausted and possibly hurt.
Furthermore, nurses experience more challenges at the workplace, which is linked to the high patient-to-nurse ratio. They have to suffer at a personal level due to depersonalization, constrained personal growth and development, and emotional and physical exhaustion. Nikoleishvili (66) argues that newly qualified nurses are expected to report emotional exhaustion and cynicism within a year of working in an understaffed environment.
According to Huston (61), nurses who work in units, divisions, or departments with high patient-to-nurse ratios are more likely to report job dissatisfaction, high turnover intentions, and emotional exhaustion. Shah et al. (10) state that a high patient-to-nurse ratio is correlated to an increased rate of adverse nursing outcomes, including patient falls, medical errors, and patient falls that lead to increased job dissatisfaction. The high nurse-to-patient ratio also reduces the number of hours a nurse may spend on one patient, which may result in increased morbidity and mortality rates.
Another important consideration for nurses at the place of work is the level of autonomy. Nurses in a hospital or any other healthcare setting with a low level of autonomy may report high turnover intentions. Nikoleishvili (66) states that nurses may feel more relaxed and have adequate autonomy, especially when there is a proper communication system to receive feedback on their performance. This contributes to an already worse situation by lowering the safety and quality of nursing services.
In addition, nurses may face increased burnout at the workplace, which limits their capacity to provide adequate medical care services. The emotional, psychological, and physical exhaustion nurses experience from working in a constrained environment can result in burnout that is costly to their careers. Burnout is also a factor of the reduced control nurses enjoy in a highly understaffed working environment.
Dall’Ora et al. (12) state that constrained working conditions can limit nurses’ control in defining their required resources to complete or perform their duties. Without proper staffing, nurses will perceive that the working environment is unfair, which can cause burnout due to a feeling of unfairness. Remuneration is an important consideration in an understaffed environment, given that a lack of proper reward structures may reduce nurses’ morale to perform. The pressure from the community can further increase burnout as they seek safe and high-quality medical services in an understaffed environment.
Eventually, the listed challenges culminate in a high nursing turnover ratio. According to Huston (72), the nursing profession has one of the highest turnover ratios in the country. In research by Scheidt et al. (55), nearly 95 per cent of nurses who receive new certifications from the hospital quit the profession within three years. 17.5 per cent quit within one year, 33.5 per cent leave after two years, while 43 per cent give up after three years, leaving a mere 5 per cent who stay longer (Scheidt et al., 7).
The problem further pressures many healthcare organizations as they need help with a high nursing turnover rate, which impedes their capacity to provide safe, high-quality medical care services. Nurses who choose to stay must suffer longer before vacant positions are filled, considering hiring new nurses is highly costly and time-consuming. Some nurses may be pushed to work longer shifts, even up to twelve hours, which leads to a high nursing turnover rate that is also strongly correlated with high-stress levels.
Spillover Effects on Patients
Staffing shortage affects the nurses and patients, the primary customers of their work. Patients are affected by being allocated fewer hours of nursing care, leading to low quality and safety. Nurses may not have adequate time to monitor the patients, which may cause them to apply personal interventions in the healing process. Elderly patients are likely to report increased incidents of falls that can be painful and costly to treat.
Nikoleishvili (67) indicates that some patients may choose to remain in beds as they spend more time waiting for nurses, making them immobile for longer. Some patients needing to be moved at specific times of the day may develop bed sores due to a longer waiting time. Another problem may arise when patients need two nurses to lift them out of bed. In a facility with a shortage of nurses, the patients may need to be attended to adequately, which may result in worsening conditions or injuries.
Additionally, high-quality and safe nursing care requires attention to detail. In a working environment characterized by a shortage of nurses, there is a high likelihood that services will be rendered at top speed. In the process, nurses may need to be more attentive and miss critical aspects, leading to an increased risk of medical errors.
Huston states that nurses may find that they are exhausted but have to work longer shifts, adding to the danger of committing medical errors that may devastate patients (53). The problem is highly correlated with a high prospect of failure to provide nursing care or providing delayed or incomplete care, such as skipping a planned prescription dose. The events will result in reduced prospects for a facility to attract and retain patients who are the primary clients (Shah et al., 5). Patients who feel that they may have to wait longer to be attended to will report lower satisfaction with the services offered. This will hurt the revenues and may affect the proper compensation of nurses despite working in a challenging environment.
Conclusion
The high demand for nursing services may not be satisfied by the current low number of professional nurses and dwindling supply of nursing graduates. Hospitals and other healthcare facilities need help to define the appropriate staffing levels due to the influence of several factors, including the budget. Nurses willing to work in an understaffed environment must endure an increased workload, a high patient-to-nurse ratio, a low level of autonomy, burnout, and a high turnover ratio. The reduced number of nurses impacts patients directly as they may suffer prolonged hospital stays, medical errors, falls, and low satisfaction with the nursing care services offered. The eventual impact of these challenges is reduced quality and low safety of medical services.
Works Cited
Dall’Ora, Chiara, et al. “Burnout in Nursing: A Theoretical Review.” Human Resources for Health, vol. 18, no. 1, 2020, pp. 1–17, Web.
Huston, Carol Jorgensen. Professional Issues in Nursing: Challenges and Opportunities. 5th ed., Wolters Kluwer, 2020.
Nikoleishvili, Elza. “Factors Affecting Nurses’ Shortage – Literature Review.” American Journal of Biomedical Science & Research, vol. 13, no. 1, 2021, pp. 66–67, Web.
Scheidt, Lori, et al. “Show Me the Nursing Shortage: Location Matters in Missouri Nursing Shortage.” Journal of Nursing Regulation, vol. 12, no. 1, 2021, pp. 52–59, Web.
Shah, Megha K., et al. “Prevalence of and Factors Associated with Nurse Burnout in the US.” JAMA Network Open, vol. 4, no. 2, 2021, pp. 1–11, Web.