The Relationship Between Understaffing of Nurses and Patient Safety in Hospitals


It could be hardly doubted that the healthcare system should be in compliance with numerous factors of a different kind to provide proper adherence to treatment and medication for every individual who is seeking help (Junttila, Koivu, Fagerström, Haatainen, & Nykänen, 2016). As it is stated by Glette, Aase, and Wiig (2017), “the incidence of patients experiencing adverse events while hospitalized has proven a major problem” (p. 1388). One of the principal issues that can significantly aggravate the quality of caregiving in contemporary clinical circumstances is the problem of understaffing, which refers to the insufficient number of nurses on shift (Hensel et al., 2017).

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It is essential to observe the principal importance of understaffing issues in contemporary nursing. It is a distinct clinical problem, which adversely influences both clinical staff and patients along with the healthcare system as a whole (Lavallée, Gray, Dumville, & Cullum, 2018). The purpose of the paper is to investigate the given issue of understaffing by referencing the scholarly literature on the topic. This essay aims to identify the methodology for searching the evidence in order to gather relevant knowledge on the problem of understaffing and to analyze and synthesize the gathered evidence to retrieve meaningful conclusions.

Identification of Methodology and Observation of Gathered Sources

Before focusing on the analysis and synthesis parts of this literature review, it is essential to discuss the methodology that was used in the process of gathering the scholarly literature on the topic. In order to comply with the initial requirements for this assignment, it was needed to find reputable sources from academic nursing journals that reflect existing and relevant knowledge on the topic. Ten sources were identified in the process of literature research. One of the primary criteria for choosing these sources was their requirement to reflect recent research, and that is why all the gathered sources were published no longer than five years from the present moment. The articles were retrieved from reputable scholarly nursing journals and they also were peer-reviewed.

Further, concerning the methodology for this literature review, it is decided to perform it in the context of the PICOT framework as it provides an efficient methodological tool for structuring the ideas in this review. The use of the PICOT framework determines the use of the following five principal aspects: observation of the population groups which are affected by the issue, the proposition of an intervention (in this particular case, interventions proposed by the authors of the selected articles will be discussed), comparison of possible outcomes of different strategies proposed by the authors, as well as desired outcomes and suggestions about the time frame which would be suitable for the solution of the problem under discussion.

Analysis of the Selected Scholarly Sources on the Topic

This section is dedicated to the analysis of the most important chosen sources in order to retrieve principal information. The first article under consideration is written by Glette et al. (2017), and it is directly concerned with the problem of understaffing in its relation to the adverse outcomes in clinical environments in terms of patient safety. This article is extensive research on the topic that dwells upon the literature research in several databases. The authors conclude that poor staffing increases the risk of mortality, and also that understaffing leads to other clinical complications such as the inability to provide a sufficient amount of attention for patients that are in need (Glette et al., 2017).

The second article, written by Hughes, Bobay, Jolly, and Suby (2015), is focused on the relation between understaffing and the phenomenon of patient churn in modern hospital circumstances. The literary item under consideration represents considerable implications for nursing management as it provides profound insights on how nursing shifts could be structured in order to decrease the negative effects of understaffing. The third article by Tuominen, Lundgren-Laine, Kauppila, Hupli, and Salanterä (2016) is also preoccupied with the problem of nursing management in the context of understaffing. The study by Tuominen et al. (2016) is of high significance for the topic of this paper since the authors present an originally developed real-time Excel-based scheduling solution for nursing staff reallocation that could significantly improve the problem under discussion.

It is also essential to mention the study by Twigg, Gelder, and Myers (2015) as it provides an important contribution to the solution of the problem of understaffing. The authors argue that “attributing the understaffing variable at the patient level enables exposure to be captured across ward changes increasing the sensitivity with which this variable can be measured” (p. 1564). Overall, the authors consider the decrease of understaffing to be the essential aspect of care delivery improvement. Additionally, the articles by Lake (2016) and Tappen (2016) were chosen in the process of literature research. The study by Tappen (2016) focuses on the experience of patients in nursing homes. The author states that in the process of investigating the patients’ perception of the quality of care in nursing homes, numerous patients characterized them as understaffed and poorly equipped to provide prompt, comprehensive care (Tappen, 2016). The research by Lake (2016) is preoccupied with the investigation of the specific population of newborns and problems related to it. The article represents a profound and sound observation of the issues in clinical circumstances that have an adverse influence on the newborns’ quality of life. On the basis of the conducted research, Lake (2016) argues that understaffed nursing care units have significantly poor outcomes for newborn babies, which is also supported by the results from Hassan (2015).

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Synthesis and Comparison of Results

Identification of Population

First of all, the population groups which are affected by the given issue to the most significant extent should be identified. Based on the scholarly literature research, two groups were identified as the most susceptible to the adverse effect of the mentioned problem: newborn babies and seniors in nursing homes (Lake, 2016; Tappen, 2016). It is evident from the research, conducted by Lake (2016), that understaffing in neonatal intensive care units (NICU) leads to increased rates of infection and lethality among newborns. Concerning the second identified group, it should be mentioned that nursing homes are often characterized by their residents as understaffed, which decreases the level of comfort (Tappen, 2016).

Proposed Intervention

One of the better interventions that could be implemented to solve the given problem (or at least to decrease the adverse impact) is described in the study by Tuominen et al. (2016). The researchers propose an Excel-based scheduling model for “the flexible allocation and reallocation of nurses” (Tuominen et al., 2016, p. 22). It is evident from the research that the proposed solution significantly supports the obtaining of a well-balanced schedule with fewer employment costs (Tuominen et al., 2016). Also, it is argued that this model saves managers’ time when they reallocate nursing staff (Tuominen et al., 2016).

Comparison with Other Strategies

Further, it is possible to compare the proposed solution with other strategies that might be implemented. As it was mentioned in the previous paper, the policy of raising the salaries and providing paths for career growth could be a significantly positive alternative; however, it would imply additional costs. Also, the study by Hughes et al. (2015) investigated the correlation between the nurse workload and patient churn. It is proposed by the researchers that clinical managers have to make churn-based adjustments, which would help in saving the budget for nurse staffing (Hughes et al., 2015). This strategy is somewhat similar in outcomes to the one which was proposed in the previous section.

Desired Outcomes and Possible Time Frame

Finally, the outcomes of the proposed solution and the possible time frame of its implementation should be discussed. It is evident from the research that one of the most plausible results will be the increased level of patient safety (Glette et al., 2017). It should also be mentioned that the quality of care will also be improved with the decreased amount of understaffed shifts (Twigg et al., 2015). Concerning the time frame, one can assume that the intervention under discussion should be implemented for a month to test the proposed outcomes and to make further adjustments.


In conclusion, it should be noted that the necessity of an efficient solution to the problem of understaffing is undeniable. This paper has conducted literature research in order to retrieve information about the problem of understaffing and its presentation in contemporary scholarly nursing literature. It is possible to state with certainty that gathered sources are highly efficient in terms of theoretical and practical use for decreasing the adverse outcomes caused by understaffing. The significance of this literature research is determined by the choice of articles that provide different perspectives on the same problem, highlighting existing issues in various clinical environments.


Glette, M. K., Aase, K., & Wiig, S. (2017). The relationship between understaffing of nurses and patient safety in hospitals—A literature review with thematic analysis. Open Journal of Nursing, 7(12), 1387-1429.

Hassan, M. B. (2015). Assessment of pediatric nurses’ burnout in Al-Najaf Al-Ashraf city. International Journal of Scientific and Research Publications, 5(10), 732-735.

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Hensel, K. O., Van Den Bruck, R., Klare, I., Heldmann, M., Ghebremedhin, B., & Jenke, A. C. (2017). Nursing staff fluctuation and pathogenic burden in the NICU-effective outbreak management and the underestimated relevance of non-resistant strains. Scientific reports, 7, 45014.

Hughes, R. G., Bobay, K. L., Jolly, N. A., & Suby, C. (2015). Comparison of nurse staffing based on changes in unit-level workload associated with patient churn. Journal of Nursing Management, 23(3), 390-400.

Junttila, J. K., Koivu, A., Fagerström, L., Haatainen, K., & Nykänen, P. (2016). Hospital mortality and optimality of nursing workload: A study on the predictive validity of the RAFAELA Nursing Intensity and Staffing system. International journal of nursing studies, 60, 46-53.

Lake, E. (2016). Improving the lives of fragile newborns: What does nursing have to offer? Web.

Lavallée, J. F., Gray, T. A., Dumville, J., & Cullum, N. (2018). Barriers and facilitators to preventing pressure ulcers in nursing home residents: A qualitative analysis informed by the Theoretical Domains Framework. International Journal of Nursing Studies, 82, 79-89.

Tappen, R. M. (2016). They know me here: Patients’ perspectives on their nursing home experience. OJIN: The Online Journal of Issues in Nursing, 21(1). Web.

Tuominen, O. A., Lundgren-Laine, H., Kauppila, W., Hupli, M., & Salanterä, S. (2016). A real-time Excel-based scheduling solution for nursing staff reallocation. Nursing Management, 23(6), 22-29.

Twigg, D. E., Gelder, L., & Myers, H. (2015). The impact of understaffed shifts on nurse‐sensitive outcomes. Journal of Advanced Nursing, 71(7), 1564-1572.

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StudyCorgi. (2021, July 10). The Relationship Between Understaffing of Nurses and Patient Safety in Hospitals. Retrieved from

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StudyCorgi. 2021. "The Relationship Between Understaffing of Nurses and Patient Safety in Hospitals." July 10, 2021.


StudyCorgi. (2021) 'The Relationship Between Understaffing of Nurses and Patient Safety in Hospitals'. 10 July.

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