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Overcoming Staffing Obstacles in Nursing

Health Care Delivery Models and Barriers to Staffing

Effective organization staffing is a challenge faced by the majority of health care organizations. Both nurses and unlicensed personnel make efforts to provide health care at the highest possible level. However, due to heavy workload, an adequate nurse-to-patient ratio is hard to maintain. For that reason, a series of coping mechanisms should be applied to improve patient outcomes and increase the job satisfaction of the staff.

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Case One

According to Ms. Lilah Jones, the nursing director in a New York hospital, their health care organization mainly utilizes a system of team nursing. This system enables the delegating of assignments to the responsible care workers, ensuring that there is an ample mix of team members available to perform safe, quality health care (Fernandez, Johnson, Tran & Miranda, 2012). The leading factors in staffing every unit of the organization are patient numbers and conditions, the educational level of staff members, and their experience.

The team nursing model helps to achieve higher staff satisfaction and increase their input and autonomy, as well as gain a higher nurse-patient interaction (Bender & Feldman, 2015). According to Ms. Jones, the RN (registered nurse) coordinates the work of the subsidiary staff to furnish individualized care within a small group of patients. The nurse is responsible for patient assessment and coordination of the team, in terms of patient activities, and ensures clear communication.

However, certain obstacles may arise when staffing the organization. Quite often, patients are treated by different caregivers, which results in possible problems with maintaining the consistency of care and leads to customer dissatisfaction (Mullen, 2015). The team leaders may face difficulty in communicating clear goals and, in general, may not possess the leadership skills they need, which leads to crucial medical mistakes or overlooking the primary health needs of the patients.

Case Two

According to another nursing director, Mr. Karl Robbins (from a Miami health care organization), the hospital where he works practices the functional model of health care delivery. As well as team nursing, the functional model follows a task-oriented pattern. This means that staff members perform tasks assigned to them by the charge nurse (Fernandez et al., 2012). The RN is responsible for care planning and administering the activities, while the other staff members carry these plans out for the specific group of patients.

The current system implies that less-skilled or inexperienced staff members perform specialized activities, and the RN supervises. Unfortunately, certain obstacles arise from the nursing personnel mix paradigm, because while several employees carry out limited-care tasks, the priority needs of the patient may remain neglected (Bender & Feldman, 2015). In addition, caregivers may lack motivation, as they have to accomplish the same tasks on a daily basis. The unpredictable availability of staff, and economic limitations, negatively affect nursing turnover and result in burnout (Mullen, 2015).

Meeting Staffing Goals

Successful planning of human resource staffing requires considering a variety of aspects. It is crucial to choose the appropriate well-trained and qualified professionals who will be able to provide safe and timely care to patients, within the constraints of the financial condition of the organization. The staffing plan defines assignments, responsibilities, and authorities who delegate tasks and make decisions regarding the nursing staff (Cimiotti, Aiken, Sloane & Wu, 2012). Additionally, planning should strive to decrease nursing turnover, staff burnout, patient mortality, and length of stay (LOS) of patients, while increasing patient and nursing satisfaction.

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General Points

The application of team nursing system variations would ensure patient-centered care in a safe environment, through optimum nursing outcomes from timely healthcare activities. In addition, it would facilitate successful communication within the working teams to achieve joint work goals. Variations on this care delivery model within units and even shifts would permit flexibility in nursing assignments, and respond to acute care settings.

Case Management

Many researchers consider the team nursing system to be effective, though it is advisable to apply case management to manage the total care of patients through discharge. Case management is a dynamic approach that can be applied to the situation at hand when caring for the chronically ill, as well (Cimiotti et al., 2012).

Staff Mix

Personnel policies should be reflected in the staffing plan, and take the employees’ experience and level of education into consideration (Bender & Feldman, 2015). Moreover, the staff mix should be compiled in accordance with current job descriptions, and ensure adequate rotation policies that would minimize or compensate for absenteeism at work.

Other Variables of Planning

Worth noting is that, besides the staff variable, environmental issues (such as equipment availability, organizational plan, linguistic diversity, and support services) are crucial for planning the staffing matrix. The nursing intensity should be defined by the amount and complexity of care required, the proportion of RNs to subsidiary staff members, and the measure of general productivity.

Short Staffing Management

When health care organizations face short staffing, they should utilize strategies that will help to regulate the nurse-to-patient ratio. For instance, by prioritizing assignments according to their importance, nurses will be able to tackle urgent issues first (Parker, Eisen & Bell, 2012). Next, the nurse may delegate easier tasks that require less autonomy or responsibility to unlicensed staff members, and then interpret the gathered data by him- or herself (Wallis, 2012). As a result, this maneuver would help to improve communication within the team and enhance the reliability of the workgroup members.

The implementation of the following guidelines will ensure patient-centered care in a safe environment, through the positive nursing outcomes from timely healthcare activities. The plan contributes to cooperative communication within the working teams to achieve the settled work goals. It facilitates flexibility in nursing assignments and enables responding to the acute environment.


Bender, M., & Feldman, M.S. (2015). A practice theory approach to understanding the interdependency of nursing practice and the environment implications for nurse-led care delivery models. Advances in Nursing Science, 38(2), 96-109.

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Cimiotti, J. P., Aiken, L.H., Sloane, D.M., & Wu, E.S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6): 486-490.

Fernandez, R., Johnson, M., Tran, D. T. & Miranda, C. (2012). Models of care in nursing: A systematic review. International Journal of Evidence-Based Healthcare, 10(4): 324-337.

Mullen, K. (2015). Barriers to work-life balance for hospital nurses. Workplace Health and Safety, 63(3), 96-99.

Parker, F.M., Eisen, S., & Bell, J. (2012). Comparing centralized vs. decentralized nursing unit design as a determinant of stress and job satisfaction. Journal of Nursing Education and Practice, 2(4), 66-76.

Wallis, L. (2012). Barriers to implementing evidence-based practice remain high for U.S. nurses. American Journal of Nursing, 112(12), 15.

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