We must continue to assess nurse staffing and patient safety

By | 2019-11-06T15:55:20-05:00 June 18th, 2019|4 Comments

Among her many well-known quotes, Florence Nightingale gave us a simple but meaningful one that has resonated over the centuries: “For the sick it is important to have the best.”

Then, as now, providing the best patient care calls for having the best nurses with the best training and the best staffing — also known as nurse staffing and patient safety.

These three — along with advanced and continuing education, appropriate orientation and training, and good skills — have been at the heart of our growth as a profession.

But we’ve never been able to stop studying, working on, and yes, even struggling with nurse staffing.

What you know about nurse staffing and patient safety

You know your role is to care for patients, help them get well and keep them safe.

But you also know — everything from infections to medication errors to falls to needle sticks to poor communication and incomplete handoffs — are part of a long list of patient safety concerns.

All too often, inadequate nurse staffing is the thread running through that list.

“Our staffing numbers have for too long been a continued problem we haven’t been able to fix. I have too many patients to care for and not enough time or hands to give them all they need.”

Sound familiar? Some might think a comment like this is a mere complaint, while others hear it as a cry for help. I believe it’s the latter because you go to work every day for all the right reasons — none of which is to complain.

Last month, we celebrated National Nurses Week to recognize you for your many contributions to patients, the profession and healthcare.

To make these contributions and give patients the best of your nursing education, training and talents, you need the right:

Nurse-patient ratios are most closely linked to quality outcomes and patient safety issues.

Staffing and safety research you should read

According to a nurse staffing and patient safety report by the Agency for Healthcare Research and Quality, “some seminal studies have demonstrated the link between nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity and even mortality.”

Other studies have shown improvements in quality indicators and patient outcomes after instituting staffing ratios.

Various staffing patterns, algorithms and calculations have been put forth for two decades after California passed the first nurse-patient ratio legislation.

Along with the use of nurse-patient ratios, whether legislated or not, factors that have influenced care outcomes include:

The use of nurse-patient ratios has grown, and more than a dozen states now have authored bills and enacted legislation requiring them.

As recently as a few months ago, New York introduced a new bill (A3374) known as the “Safe Staffing for Hospital Care Act,” calling for minimum staffing levels for healthcare workers in different facilities, submission of staffing plans and restriction of most mandatory overtime.

Nurse staffing and patient safety is not just a numbers game

6:1, 4:1, 1:1.

Can patient safety be ensured by numbers alone? As we continue to study our biggest safety concerns in patient care, we’re also considering staff safety.

Protection from accidents and injuries in the workplace is important to staff and the patients they serve. Providing you with a place to work that is environmentally safe and includes the right amount of staff is crucial to your ability to assess and evaluate patients and plan and implement care.

Staffing is being studied all the time, and nurse-patient ratios are only a part of that work. Many healthcare experts champion ratios. Others haven’t fully embraced them.

Hospital restructuring, remodeling of care delivery systems, changing RN roles and patient populations are just some of the variables that healthcare leaders have been looking at since the early work by nationally known researcher Linda Aiken on nurse staffing and patient outcomes.

Further information and research are needed. We can be very proud of all that’s been done, but there’s still more to do.

These are the issues you need to understand and be concerned about and researchers need your careful consideration, opinions and voices. Here are some ways you can do just that.

  • Think about what you want to know, and know what you want to say.
  • Get answers to your questions.
  • Study the connections between staffing and safety.
  • Find good articles on studies and research outcomes, and share them with your colleagues.
  • Get involved.

Whether you’re a nursing leader or staff, you have to determine what is best for each patient. Staffing matters. Education and skill matter. Care, caring, competence and compassion matter.

Take these courses about nurse staffing and patient safety:

National Patient Safety Goals – Nursing
(1 contact hr)
This course will cover the 2019 National Patient Safety Goals for nursing staff in the hospital setting.

Creating a Culture of Safety and Reducing Medical Errors in the OR
(1.5 contact hrs)
The OR is a complex environment. Highly trained individuals interact in a specialized setting with sophisticated and technically complicated devices, instruments, and equipment. There also are substantial differences among team members related to education, experience, skill level, influence, and formal and informal power. This module will inform nurses and surgical technologists of the evidence-based steps to take to create a culture of safety in the OR.

Inpatient Fall Prevention: The Balance Between Mobility and Safety
(1 contact hr)
Since 2008, the Centers for Medicare and Medicaid Services have modified the reimbursement structure of payment, denying or limiting hospital reimbursement that results from adverse events which may occur to a patient while in the hospital. Falls and the traumatic injuries caused by falls in the hospital setting are key components to this program. Research shows that early mobility is essential to patient recovery in the hospital. It is essential that hospital staff understand the importance of maintaining patient mobility while patients are in the hospital and implement fall prevention strategies to keep patients safe when ambulating. By providing a safe hospital environment for patients, completing thorough clinical assessments, improving both patient and staff education and promoting open communication among team members, the clinical staff can minimize the risk of patient falls and improve patient safety.

About the Author:

Eileen Williamson, MSN, RN
Eileen Williamson, MSN, RN, continues to write and act as a consultant for Nurse.com. Before joining the company in 1998, Eileen was employed by North Shore-Long Island Jewish Health System in New York (now Northwell Health System) where she held a number of leadership positions in nursing and hospital administration, including chief nurse at two of their System hospitals. She holds a BSN and an MSN in nursing administration and is a graduate fellow of the Johnson & Johnson University of Pennsylvania Wharton School Nurse Executives program. A former board member and past president of the New Jersey League for Nursing, a constituent league of the National League for Nursing, Eileen currently is a member of the Adelphi University, College of Nursing and Public Health Advisory Board.


  1. Avatar
    tricia hussar June 30, 2019 at 1:48 am - Reply

    I had such a bad experience while being a new Registered Nurse, that I wrote a book about it!

    On Amazon, “Nurse to Patient Ratios: Causes, Effects and Strategies to address Patient ratios Kindle Edition
    by Tricia J. Hussar BSN RN.”

  2. Avatar
    Susan Ates June 30, 2019 at 7:25 am - Reply

    For past 3 yrs have held, and guit 3 wonderful positions in acute care rehab.Due to staffing issues and patient to nurse ratios.Unsafe care due to ratios.Facilities seem to care for income in their pockets vs patient health and welfare.32 yrs as RN, and I felt overwhelming stress.Loved last job.Change needed to ratios.

  3. Avatar
    Jessica McGowan June 30, 2019 at 12:10 pm - Reply

    This article does focus on a topic that is critical to patient care. However, I am going to report on a subject no one wants to address. Many of us have been in the position of having enough staff but quite frankly, one staff person is ‘a slacker’. This is the most uncomfortable subject for the charge nurse. Confrontation is difficult. Even when done professionally, if the staff person does not improve do you then report them on the next level? Then you become a ‘snitch’. However, the charge nurse who does nothing earns the contempt of the other staff members who are picking up the work left by the slacker. Have you ever heard someone say “some people are worse than nothing”. Reason for this is that on paper, it looks good but in actual working the person does NOT work. I have heard charge nurses say “don’t send him, I’ll work short”, actual quote. If you have the correct number than complete work is expected on you. However, not doable if you have a slacker. We need articles on this. It’s out there, it happens, everyday.

  4. Avatar
    Gil Yost June 30, 2019 at 7:06 pm - Reply

    Hello I enjoyed your article

    My name is Gil and I am a graduating graduate student from Northpark University. For my capstone I wrote essentially have the same issue. I looked at some history and some complications of nursing systems. I discovered essentially that given Nursing’s position in the healthcare arena ratios will not actually be the issue. I would love to discuss some details. Feel free to contact me.

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