Nurse Understaffing in the United States

Problem Statement

One of the current problems in health care in the United States is understaffing in nursing. It does not only make nurses feel under pressure and overloaded with work but is also dangerous for patients. Understaffing is caused by the shortage of registered nurses. Nurse shortage, in its turn, is a result of the growing demand for nurse professionals while enrollment in nurse baccalaureate programs is reducing because nursing as a career is losing its appeal.

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The setting of the Problem

The problem of nurse understaffing can develop in different settings. However, acute care settings suffer most of all. Thus, neonatal intensive care units and acute care hospitals are more understaffed than other healthcare facilities.

Problem Description

The problem of nurse understaffing should be a primary concern of present-day healthcare. Nurse understaffing is a subject for many recent studies. Thus, Twigg, Gelder, and Myers (2015) provide evidence that understaffed shifts have diverse nurse-sensitive outcomes. For example, surgical wound infection, urinary tract infection, pressure injury, pneumonia, upper gastrointestinal bleed, and sepsis are among the patient conditions most sensitive to understaffing. The problem is crucial for neonatal intensive care units (NICU) where the need for professional nurses is the greatest, but few nurses agree to work there because of tense conditions and high responsibility (Rogowski et al., 2013).

Thus, understaffing of NICU is 31%, while that of high-acuity infants is 68% (Rogowski et al., 2015). The authors stressed the necessity of matching staffing to the needs of patients, which is not always adequate. Gagliardi et al. (2015) support the findings of previous studies and investigate the nurse-to-patient ratio in NICU, which is lower than it should be.

Finally, improper nurse staffing and scheduling cause longer-term nursing staff allocation problems. Maenhout and Vanhoucke (2013) investigate nursing staff allocation methodology and conclude that there should be an agreement between staffing and scheduling policies because increased demand for high-quality care causes the necessity of effective staff management.

Impact of the Problem of the Quality of Care and Patient Outcomes

There is a direct relationship between nurse understaffing and the quality of care as well as patient outcomes. Thus, nurse understaffing is proved to have an impact on the increased risk of healthcare-associated infection (Shang, Stone, & Larson, 2015). Another negative outcome of inefficient nurse staffing is an increase in-hospital mortality (Junttila, Koivu, Fagerström, Haatainen, & Nykänen, 2016). Thus, understaffing increased the mortality rate 13 times if compared to the optimal workload.

Significance of the Problem

The problem of nurse understaffing is crucial for contemporary healthcare. The lack of nurse professionals creates an additional workload on the staff leading to stress and burnout, which, in their turn, lead to undesirable patient outcomes. For example, nurse understaffing increases the risk of infections in patients (Kiekkas, 2013).

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Solution

The possible solutions to the problem of nurse understaffing are as follows. First of all, it is necessary to improve work conditions by providing an adequate workload and schedule. Effective staffing and scheduling methods should be applied to meet both the needs of patients and preserve job satisfaction among nurses. Also, it is important to develop retention programs for graduate nurses and provide them with the necessary support during the first months of their professional activity. Finally, there is a need for the popularization of nursing as a career among school graduates.

References

Gagliardi, L., Corchia, C., Bellù, R., Coscia, A., Zangrandi, A., & Zanini, R. (2015). What we talk about when we talk about NICUs: infants’ acuity and nurse staffing*. The Journal of Maternal-Fetal & Neonatal Medicine, 29(18), 2934-2939. Web.

Junttila, J., 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. Web.

Kiekkas, P. (2013). Nurse understaffing and infection risk: current evidence, future research and health policy. (2013). Nursing in Critical Care, 18(2), 61-62. Web.

Maenhout, B., & Vanhoucke, M. (2013). An integrated nurse staffing and scheduling analysis for longer-term nursing staff allocation problems. Omega, 41(2), 485-499. Web.

Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2013). Nurse staffing and NICU infection rates. JAMA Pediatrics, 167(5), 444-450. Web.

Rogowski, J. A., Staiger, D., Patrick, T., Horbar, J., Kenny, M., & Lake, E. T. (2015). Nurse staffing in neonatal intensive care units in the United States. Research in Nursing & Health, 38(5), 333-341. Web.

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Shang, J., Stone, P., & Larson, E. (2015). Studies on nurse staffing and health care–associated infection: Methodologic challenges and potential solutions. American Journal of Infection Control, 43(6), 581-588. Web.

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

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