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The Relationship Between Understaffing of Nurses and Patient Safety


As it is stated on the Agency for Healthcare Research and Quality (AHRQ) website, “nurses play a vital role in improving the safety and quality of patient care” (“Patient safety and quality,” 2008, para. 1). It is also of high importance to notice that the role, which is played by nursing professionals in the contemporary healthcare system, is not strictly limited to the provision of the hospital or ambulatory treatment (“Patient safety and quality,” 2008). Nurses are also responsible for the promotion of community-based care, education of family members who consider themselves as caregivers as well as the overall facilitation of the public health sector.

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It could be hardly doubted that there are numerous problems that aggravate the quality of care. For the purposes of this assignment, the chapter by Clarke and Donaldson (2008) was retrieved from the “Patient safety and quality: An evidence-based handbook for nurses,” published by AHRQ. In the selected chapter, Clarke and Donaldson (2008) discuss the relationship between nurse staffing and patient care quality and safety. This paper aims to investigate aspects related to the problem of nurse understaffing by referencing the scholarly literature on the topic.

Understaffing as a Threat to Patient-Centered Care

According to Clarke and Donaldson (2008), “nurse staffing is a crucial health policy issue on which there is a great deal of consensus on an abstract level;” however, considerably much less agreement exists on how this problem should be solved practically (p. 111). Nevertheless, the significance of the problem could not be denied, and numerous studies on the topic were carried out. In this section, one of the most critical aspects of the problem of understaffing will be discussed, namely, its negative impact on patient-centered care.

It is possible to state that the primary objectives of patient-centered care are safety and quality of patients’ life, timely provision of care as well as efficiency and equitability of caregiving (Clarke & Donaldson, 2008). Therefore, as it is mentioned in the study by Glette, Aase, and Wiig (2017), an evidence-based correlation between understaffing of nurses and adverse events in hospitals should be considered as one of the primary risk factors in the contemporary healthcare system. This problem is also explicitly addressed by Twigg, Gelder, and Myers (2015), who 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). Accordingly, it is essential to focus on optimizing nursing workload as well as on transparency of hospital staffing policies and reporting of errors relates to understaffing (Junttila, Koivu, Fagerström, Haatainen, & Nykänen, 2016). It is evident that patient-centered care could hardly be provided in understaffed clinical conditions.

Teamwork and Interdisciplinary Communication

It could be stated with certainty that the problem under consideration could hardly be completely solved on the individual level, and thus it is of high importance to discuss such concepts as teamwork and interdisciplinary communication in the context of understaffing (Lavallée, Gray, Dumville, & Cullum, 2018). As is mentioned in the studies by Hughes et al. (2015) and Lavallée et al. (2018), teamwork is one of the essential aspects of establishing effective working conditions in hospitals, especially in understaffed clinical environments. It is evident that hospitals are not always capable of providing a sufficient number of nurses for each shift, and thus the improvement of teamwork skills among nurses can significantly facilitate patient safety, quality of care as well as efficiency of nursing units because human factors play an important role in the provision of patient-centered care (Hensel, Van Den Bruck, Klare, Heldmann, Ghebremedhin, & Jenke, 2017).

Interdisciplinary communication is another key aspect of the facilitation of understaffed clinical environments. The studies by Hensel et al. (2017), Hughes et al. (2015), and Lavallée et al. (2018) provide important insights on how an interdisciplinary approach could be used to solve the problem of understaffing. It is appropriate to state that theoretical and practical aspects of caregiving could be significantly improved by the inclusion of concepts and methods from other disciplines, primarily from management, social studies, and psychology. Managerial approaches could be effectively applied to operating nursing shifts (Tuominen, Lundgren-Laine, Kauppila, Hupli, & Salanterä, 2016). Also, the employment of ethical principles could have a large positive impact on the establishment of efficiently performing nursing teams.

Effective Communication and Collaboration Strategies

As the previous section establishes the overall importance of the problem of understaffing in its relation to the concepts of teamwork and interdisciplinary communication, it is possible to discuss the strategies, which could be employed in order to establish efficient, healthy, and safe interdisciplinary hospital teams. One of the most relatable examples of the employment of such strategies is provided in the article by Tappen (2016), in which a qualitative study of nursing home patients’ experience is studied. One of the most important conclusions that could be retrieved from this article is that it is essential to establish trusting and meaningful communication between nurses and patients, as it has a considerable positive impact on patient safety and quality of care. The study under discussion also exemplifies the importance of the interdisciplinary teamwork approach to the problem of understaffing since it negatively influences both patients and nurses.

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Quality Initiatives for the Improvement of Health Outcomes

The improvement of health outcomes is largely based on the implementation of quality initiatives. These initiatives could be established by the government on federal, regional, and local levels, by hospitals and other clinical facilities, and also they could be implemented on the basis of community effort. However, the primary aspect of any quality initiative is that it should bring positive changes to the current situation in the healthcare system by introducing policies and actions that contribute to patient safety and quality of caregiving. The examples of such initiatives could be found in the articles by Tuominen et al. (2016) and Junttila et al. (2016). Tuominen et al. (2016) propose an initiative that could be effectively implemented in the majority of clinical environments as it an Excel-based scheduling solution for the problem of understaffing. Junttila et al. (2016) provide the experience of the employment of the RAFAELA Nursing Intensity and Staffing system.


In conclusion, it is essential to state that understaffing is one of the most important and widespread issues in the contemporary healthcare system. This paper exemplifies several aspects related to this problem and investigates the factors that could positively influence the current situation. It is apparent from this research that the problem of understaffing is largely recognized in the recent scholarly literature. However, it is also evident that there is a considerable need for the development and implementation of more diverse and efficient quality initiatives that would eliminate negative consequences related to the issue of understaffing.


Clarke, S. P., & Donaldson, N. E. (2008). Nurse staffing and patient care quality and safety. In Hughes, R. G. (Ed.), Patient safety and quality: An evidence-based handbook for nurses (pp. 111-135). Rockville, MD: Agency for Healthcare Research and Quality.

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.

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.

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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.

Patient safety and quality. (2008). Web.

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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