We must continue to assess nurse staffing and patient safety

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 staffing patterns
• Interprofessional teams
• Work schedules
• Care delivery systems
• Nurse-patient ratios

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:

• Shift length
• Patient acuity
• Staff mix
• Environmental, administrative and financial factors

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.