LITERATURE REVIEW NURSING RESEARCH

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Inadequate Staffing in Healthcare Facilities

Jessica Colangelo

Miami Dade College

NUR3165

Summer 2021

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Literature Review

Introduction

The issue of proper staffing has plagued the nursing profession since its start; it is a matter

that affects everyone and is frequently addressed by politicians. Although healthcare institutions

realize the necessity of proper staffing and its influence on quality of service and results, many are

motivated only by financial considerations. In most jurisdictions, existing regulations are in need

of change to provide nurses a much-needed advantage when it comes to patient ratios. Nurse

burnout and high turnover rates are a result of the demands put on today's nurse-patient ratios,

which leads to nurses seeking nonclinical professions and contributing to nursing shortages. Nurse

understaffing and a high nurse-to-patient ratio are still major challenges that must be addressed in

order to enhance nursing care quality. The purpose of this review is to find out how does a lack of

nurse staffing affect nurse-to-patient ratios, patient safety, and care quality?

Background Information

Inadequate staffing is an issue that continues to plague healthcare facilities around the

country. Understaffing has far-reaching implications that can include medical mistakes, patient

falls, prescription mistakes, infections, and death. Longer periods of stay, patient discontent, and

increased readmission rates can all be consequences of insufficient nurse staffing (Lee, Cheung,

Leo, Leung, & Hung, 2017). Safe staffing has a significant impact on the safety and quality of

patient treatment, as most healthcare practitioners are aware. There is a lot of research that

identifies the consequences and results of dangerous staffing methods, but there isn't much

research that explains why it's tolerated. Lack of efficient staffing lowers the quality of services

provided, which has a direct or indirect impact on the patient's result. According to studies, a lack

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of proper personnel can have a significant impact on the quality of patient care, putting patients'

safety at risk.

Methodology

Using CINAHL database, ProQuest and Google Scholar, the study located an overall of

100 scholarly articles. However, the selection criteria for the most appropriate articles relied on

date of publication and relevance to the topic in terms of addressing the how lack of nurse staffing

affect nurse-to-patient rations, patient safety and care quality. 10 scholarly articles were chosen for

this review. The keywords used are: nurse-to-patient ratio, nurse staffing, impact of nurse staffing

to patient safety, and care quality.

Results

The findings of the ten research analyzed revealed that insufficient staffing is linked to poor

patient management and a higher death rate. The proportion of satisfaction and quality care was

high in situations when appropriate nurse staffing was provided. However, hospitals with a staffing

shortfall had a higher mortality rate, as well as a greater risk of patient safety and care.

Discussion

The association between patient satisfaction and RN staffing was investigated in a

qualitative study conducted by Nelson, Hearld, and Wein (2018). According to the study, having

more RNs on staff may assist in meeting the expectations of patients. Oostveen, Mathijssen, and

Vermeulen (2015) investigated patients’ satisfaction with enough nursing staffing. The study

discovered that appropriate personnel is required to deliver quality treatment. The Affordable

Health Care Act (AHCA) presented in 2012, for instance included a component targeted at

lowering readmission rates by punishing hospitals with high readmission rates among Medicare

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beneficiaries (Metcalf, Wang &, Habermann, 2018). The Act's purpose was to lower readmission

rates by awarding hospitals that provided high-quality care and had low readmission rates.

According to Metcalf, Wang, and Habermann (2018), lowering readmission rates requires

appropriate nurse staffing to provide appropriate discharge planning, coordinated care, and patient

education. As a result, hospitals with higher nurse staffing have a lower chance of being penalized

than identical healthcare institutions with lower staffing..

Registered nurses face a variety of stresses, including a lack of staff and resources, seeing

patient deaths, dissatisfaction with the work environment, job overload, and time spent on

administrative activities (Marie, 2017). Stress resulted in poor patient care, work dissatisfaction,

and burnout syndrome. To establish a working atmosphere conducive to high-quality patient care,

RN stresses must be addressed. The first study by Aiken in 2002 indicated that patients are at a 7%

higher risk of dying within 30 days of admission for every additional patient a nurse cared for

(Aiken, 2002). According to the study, every extra patient a nurse cared for increased the

probability of failing to rescue in an emergency circumstance. Individuals suffering from heart

failure or other life-threatening diseases were more likely to survive in hospitals and other medical

institutions with acceptable nurse staffing ratios, according to supplementary studies. Furthermore,

research show that hospitals with proper staffing ratios typically score higher on patient satisfaction

surveys (Kiekkas et al, 2019).

Setting required nurse-to-patient ratios might be one answer to insufficient nurse staffing.

This is, however, a profoundly divisive approach. For years, there has been a discussion about

whether obligatory staffing restrictions assist or harm inadequate staffing. Mandatory staffing

ratios, according to proponents, reduce nurse stress, staff turnover, patient mortality, and avoidable

blunders, to mention a few. Opponents of mandated nurse-to-patient ratio legislation contend that

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they impose significant financial expenses on hospitals and give them little control over staffing

decisions (Jenkins, 2018,). They also express concerns that, if mandated ratios are implemented,

beds may be inaccessible to patients seeking medical care due to a lack of nurses available to staff

beds in accordance with the required ratios. Despite the fact that both sides make strong arguments,

the focus must always be on the patient's best interests.

California was the first state to pass legislation imposing strict nurse-to-patient ratios in

hospitals. The legislation aims to improve patient-centered care, and though a consensus has yet to

be established, evidence from multiple studies show that the law has accomplished its goals in

several areas. Many additional states have voiced a desire for mandated minimum ratios since then,

but just a handful have enacted legislation. Inadequate staffing, according to research, can result in

increased expenses and lower quality of treatment (Kiekkas et.al, 2019). As a result, legislation

should be passed in every state to safeguard not only patients but also nursing personnel. In current

times of qualified nursing shortages, there are solutions to nurse staffing issues. They include

making the most of current personnel, balancing permanent and contingent personnel, and better

projecting future employment needs (Wolf, Perhats, Delao, Clark, & Moon, 2017).

Inadequate nurse staffing may lead to longer lengths of stay, patient discontent, increased

readmissions, and more adverse events, all of which can lower quality and hurt the bottom line. As

stated by Lee et.al (2017), the success of evaluations and activities aimed at optimizing patient

outcomes and decreasing adverse occurrences determines the quality of nursing care. The extent to

which nurses estimate the risk of falls in hospital patients upon admission, adopt evidence-based

fall-prevention protocols, and manage such prevention measures, for example, has an impact on

nursing care quality. According to Wendsche, Hacker, and Wegge (2017) low nurse-to-patient

ratio means that safety issues such as drug administration accuracy receive less attention. With a

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low nurse-to-patient ratio, safe treatment and monitoring tailored to the patient's needs to guarantee

early detection of patient deterioration are impeded. When healthcare facilities have insufficient

nurses on staff, patients' health may be threatened (Rochefort et.al, 2020). Furthermore,

overworked nurses are more likely to overlook key facts or fail to interact with patients effectively.

Furthermore, overworked nurses are more likely to overlook key facts or fail to interact with

patients effectively. Patients may be unsatisfied with nursing treatment because of understaffing.

Conclusion

The findings imply that providing enough nurse staffing and working hours will help

improve care quality and safety while also reducing the amount of care that is left undone in

hospitals. According to the findings, insufficient staffing is linked to an increased occurrence of

back pain and other work-related issues that contribute to patient problems. Whether one supports

or opposes obligatory nurse-to-patient ratios, everyone concerned recognizes the need for reform.

Finding strategies to protect patients and employees as healthcare changes and adapts should be a

key priority. Patient outcomes will improve as nurse staffing improves. As the focus moves to

value-based care, nurse staffing will be important in delivering high-quality, cost-effective care. As

a result, the number of persons employed in health-care facilities has a significant impact on

patient safety. Nurse staffing, therefore, should not be cut or lowered for financial reasons, as this

might jeopardize patient safety.

References

Aiken, L. H. (2002). Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job

Dissatisfaction. JAMA, 288(16), 1987. https://doi.org/10.1001/jama.288.16.1987

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Jenkins, D., (2018). Inadequate Staffing: Patient Safety in Today's Healthcare Market Place: A

Four-Part Series. Retrieved from www.allnurses.com

Kiekkas, P., Tsekoura, V., Aretha, D., Samios, A., Konstantinou, E., Igoumenidis, M., ... & Fligou,

F. (2019). Nurse understaffing is associated with adverse events in postanaesthesia care

unit patients. Journal of clinical nursing, 28(11-12), 2245-2252.

Lee, A., Cheung, Y., Leo, J., Leung, C., & Hung, W. (2017, May). Are High Nurse

Workload/Staffing Ratios Associated with Decreased Survival in Critically Ill Patients? A

Cohort Study. Annals of Intensive Care, 7(1). https://doi.org/10.1186/s13613017-02692

Marie Chantal Uwimana, J. K. (2017). Exploring Stressors Experienced by Registered Nurses at a

Selected Urban Teaching Hospital in Rwanda. Africa Journal of Nursing & Midwifery, 41-

55.

Metcalf, A. Y., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed

treatments: primary evidence. Management Decision.

Nelson, D., Hearld, L. R., & Wein, D. (2018). The Impact of Emergency Department RN Staffing

on ED Patient Experience. Journal of Emergency Nursing, 394-401.

Oostveen, V., Mathijssen, C., & Vermeulen, E. (2015). Nurse staffing issues are just the tip of the

iceberg: a qualitative study about nurses' perceptions of nurse staffing. . International

Journal of Nursing study, 15-18.

Rochefort, C. M., Beauchamp, M. E., Audet, L. A., Abrahamowicz, M., & Bourgault, P. (2020).

Associations of 4 nurse staffing practices with hospital mortality. Medical care, 58(10),

912.

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Wendsche, J., Hacker, W., & Wegge, J. (2017). Understaffing and registered nurses’ turnover: The

moderating role of regular rest breaks. German Journal of Human Resource

Management, 31(3), 238-259.

Wolf, L., Perhats, C., Delao, A., Clark, P., & Moon, M. (2017, Mar,1). On the Threshold of Safety:

A Qualitative Exploration of Nurses Perceptions of Factors Involved in Safe Staffing

Levels in Emergency Departments. Journal of Emergency Nursing, 43(2), 150- 157.

https://doi.org/10.1016/j.jen206.09.003