Inadequate staffing is often a problem in the nursing field and has emerged as both a personal and professional concern for practitioners in this sector. According to Harrington, Schnelle, McGregor and Simmons (2016), poor staffing is among the top reasons nurses leave their jobs and patients fail to get adequate and quality care. Staffing challenges often pose many problems for patients and nurses alike because they have been associated with dissatisfaction among patients, inequitable assignments, poor patient safety standards, and an increased complexity of care (Harrington et al., 2016).
A study by Liang, Chen, Lee and Huang (2012) has further shown that staffing challenges are associated with high patient mortality rates. Additionally, Stanton (2014) says that some adverse patient outcomes that are associated with this problem include “urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality” (p. 3).
These above findings come from research studies, which have documented an association between low staffing levels and adverse patient outcomes. Similar studies documented by Stanton (2014) and supported by the Evidence-based Practice Centre (EPC) showed that low levels of nurse-patient ratios were associated with lower patient safety standards and nonfatal adverse outcomes. Frith, Anderson, Tseng, and Fong (2012) observe that these problems are partly linked to drug administration errors made by nurses that stem from increased fatigue levels experienced by some nurses. Nonetheless, the problem of low staffing is widespread because even unionized nurses often bring it up as an issue for negotiation when drafting contracts for their members.
Methodology for Searching the Evidence
In this study, we used secondary data to investigate the research issue. To do so, we sought reliable articles from two reputable databases – The National Center for Biotechnology Information and Google Scholar. These platforms helped the researcher to get peer-reviewed articles that formed the basis for the analysis. The inclusion criterion for the research articles only allowed for peer-reviewed journals published within the last five years (from 2012 to 2017). The exclusion criterion was articles that did not fall within the aforementioned publication dates and were not peer-reviewed. The keywords used to search for the articles were “nursing,” “staffing” and “challenges.”
According to several studies, there is a strong association between low staffing levels and one or more adverse patient outcomes (Simpson, Lyndon, Wilson & Ruhl, 2012; He, Staggs, Bergquist-Beringer & Dunton, 2016). These adverse patient outcomes include (but are not limited to) pneumonia, urinary tract infections, poor prenatal outcomes and upper gastrointestinal bleeding (Simpson et al., 2012). In a study done by Stanton (2014) to investigate how often adverse patient outcomes occur in the health care setting, it was established that increased rates of urinary tract infections (UTIs) occur because of low staffing levels. The same findings showed that increased rates of pneumonia also occur because of low staffing levels (He et al., 2016).
These findings were derived from evidence, which showed that there was a general increase of pneumonia cases from 1.2% to 2.6% among surgical patients who received care in low-staffed health care facilities and an increased rate of UTIs from 1.9% to 6.3% because of the same reasons (Palmer, Lee, Dutta-Linn, Wroe & Hartmann, 2013). The Health Resources and Services Administration and the Centre for Medicare and Medicaid Services funded studies that revealed these findings (Stanton, 2014).
The National Institute of Nursing research and the AHRQ also supported the same findings after commissioning different research studies to investigate the effects of staffing shortages in the nursing sector (Stanton, 2014). Their findings were developed after investigating the same research issue across a sample population of 5 million patients who had received treatment in more than 700 hospitals (Stanton, 2014). The studies also included more than 1 million patients who had undergone some type of surgery (Stanton, 2014).
Other studies conducted by Daud-Gallotti et al. (2012) showed that health care facilities that were adequately staffed had lower incidences of adverse health outcomes. The opposite was also established because low staffing levels were associated with high incidences of adverse patient outcomes (Daud-Gallotti et al., 2012). The same findings showed that hospitals that were well staffed had a 3%-12% reduction in adverse patient outcomes, while high staffing at all nursing levels were associated with up to a 25% reduction in adverse patient outcomes (Daud-Gallotti et al., 2012).
Studies have also drawn a strong correlation between nursing staffing issues and job dissatisfaction levels (Stanton, 2014). For example, in one study funded by the National Science Foundation and AHRQ to investigate the relationship between staffing issues and hospital patient acuity (the severity of illness associated with in-patient groups) in the health care setting, it was established that staffing challenges were associated with up to a 21% increase in hospital patient acuity (Stanton, 2014). The same outcome (increase in patient acuity) was associated with a 14.2% decrease in the number of licensed nursing staff (Stanton, 2014). This decline was attributed to an increase in job dissatisfaction levels.
Foster and Lee (2015) have also highlighted the impact of nursing staffing challenges on the health care sector and on patient outcomes in a research study, which showed that the problem was associated with serious quality problems. Similar studies have pointed out that staffing challenges in the nursing sector are related to hospital-associated infections (Shang, Stone & Larson, 2015).
However, researchers who have conducted these studies say that some researchers contest such outcomes by demonstrating that staffing challenges create mixed outcomes if evaluated in the context of causing hospital-associated infections. The mixed reviews could stem from a variety of reasons. However, differences in measuring staffing numbers, relative to patient needs, emerge as the most common one highlighted by many researchers (Liang et al., 2012).
Researchers have also explained the issues associated with the barriers to proper staffing as some reasons that keep fanning the problem of low staffing in the nursing sector (Shang et al., 2015). Economic concerns associated with employing more nurses are top reasons for low staffing levels because observers say that financial challenges limit the resources available to health care facilities to provide quality care for patients (Twigg, Myers, Duffield, Giles & Evans, 2015). Bing-Jonsson, Hofoss, Kirkevold, Bjørk and Foss (2016) add that hospitals often grapple with the challenge of keeping costs at a minimum and providing quality care. Studies also point to the weak enforcement of nursing staffing guidelines (imposed by governments) as another cause of the staffing challenges in the sector (Bing-Jonsson et al., 2016).
Analysis and Synthesis of Evidence
Based on the evidence gathered above, staffing issues seem to cut across most areas of patient and health care quality assurance processes with patient outcomes emerging as the most reliable indicators of the problem. This finding stems from evidence that has shown that staffing challenges are associated with one or more adverse patient outcomes. Studies that have affirmed a relationship between hospital-associated infections and staffing shortages also support the same analysis (Stanton, 2014).
These findings reveal that patients and nurses are both victims of staffing challenges because patients suffer from poor quality health care, high mortality rates, and adverse health outcomes, while nurses suffer from job dissatisfaction (Twigg et al., 2015). These outcomes are correlated. Indeed, as highlighted by researchers such as Foster and Lee (2015), the evidence gathered in this paper mostly shows that the adverse health outcomes associated with the problem emerge from a more pressing issue of job dissatisfaction, which mostly plagues health care facilities that do not have the proper nurse-patient ratio.
Although the findings of this study show that staffing problems cause several adverse patient outcomes, such as increased cases of UTIs and pneumonia, these outcomes should be viewed as indicators of the effects of staffing challenges in the nursing field and not necessarily a representation of the full scope of staffing issues on patient outcomes. Concisely, staffing challenges are broad and they could spread across political, social and economic issues affecting the nursing field. Thus, when analyzing the impact of staffing issues on nurses and patients, it is imperative to contextualize it within the complex environment it exists in because a simplistic view of the same would not capture the true scope of the problem.
The findings of this study show that staffing is a major problem in the nursing sector because it has adverse implications for patients and the nursing sector. Evidences from this study show that the problem partly thrives on the economic and political issues affecting the nursing sector. One way of addressing it is setting a higher minimum nursing staffing standard to make sure each health care facility has enough workers. Other solutions could come from addressing the economic issues causing the problem because using a legislative solution alone to address the issue could not be enough. Thus, it is important to approach nursing staffing problems from an informed and holistic point of view.
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