Promoting a Safe Staffing Nursing Environment



Safe Staffing Nursing Environment


Nursing is among the most important professions, which unlike being a minor career; is also regarded as a vocation. People who opt to pursue nursing are said to have been called to the vocation of high magnitude, which entails the provision of health care to all those in need of health services. Nurses take care of people’s health needs ranging from physical, social, emotional, mental as well as spiritual welfare. Due to the expansive extent of their duties and the multifarious nature of the backgrounds of patients, nurses would more often than not encounter tedious and inundating experiences.

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This situation can be confounding, especially if a health care center is understaffed. The few worked up staff would always have mixed moods which will subsequently alter the anticipated outcomes. As such, the American Nurses Association (ANA) stipulated mechanisms to mitigate the eventualities that would arise as a result of the staffing of health caregivers in all health care centers in the United States. Apart from coming up with a unified code of ethics that would guide nurses' behavior to enhance optimal performance in their service delivery, ANA has been quite categorical in promoting a safe staffing nursing environment across hospitals to curb any envisaged shortages.

This has been among many concerted efforts made by the health ministry not just to promote harmonious operations in health care centers, but also to minimize the trigger of Health Care-Associated Infections (HCAI), which has been rampant in the recent past. The health care sector in the United States and other parts of the world has been grappling with Ventilator-Associated Pneumonia (VAP) whose effects are still confounding, Catheter-Associated Urinary Tract Infections (CAUTI) among other ailments, which usually emerge due to irregularities that are prevalent in health care centers.

It is confirmed that the majority of irregularities are associated with an unsafe staffing nursing environment. A safe staffed nursing environment is necessary for the health care environment as it is not only motivational to nurses in the course of their practice but also promotes efficiency in their delivery of care to patients hence improving patient outcomes.

How Does Phenomena Impacts Nursing Care

A plethora of inadequacies that prevail in hospitals is often associated with the shortage of improper staffing in the nursing environment. Organizations that are keen to provide impeccable quality of nursing care are usually obliged to address the question of safe staffing as a way to restrict the emergence of snags that are related to this phenomenon (West et al., 2014). Safe staffing includes the allotment of adequate health caregivers in any single unit of a given health care center, proper orientation and monitoring of health caregivers in their respective stations, sufficient sensitization of staff regarding their safety and the wellbeing of their clientele as well as strict adherence to the ANA code of ethics, which guide the day to day operations of nurses in their various departments among others (West et al., 2014).

Promoting a safe staffing nursing environment as an organization comes with a series of benefits; not just to the organization alone, but also to the individual nurses, patients, the governments, and the wider society. First, safe staffing will ensure efficacy in operations in any given health care organization. This is because the nurse-patient ratio would be commensurate such that every health caregiver does what is manageable. Frost and Alexandrou (2013) assert that this form of staffing augments productivity and lessens fatigue and stress among the nursing staff. Consequently, the staff will enjoy rendering their services without fear of exhaustion due to overworking circumstances at work.

Furthermore, a safe staffing nursing environment ensures optimal patient satisfaction. This reduces the frequency of patient admission in any given health care center and promotes the healthy living of both patients and nurses. It should not be forgotten that safe staffing also promotes the economic utilization of health care resources. When resources are discreetly utilized, an organization experiences less wastage and, thereby, realizes its objectives easily (Frost & Alexandrou, 2013).

Finally, the government also gains largely from the initiative of safe staffing in nursing environments. The national objective of ensuring affordable care to the majority of citizens becomes a reality only when organizations embrace safe staffing. Therefore, the above-mentioned facts make nursing care not just a very successful career, but also a fulfilling calling that would attract many more aspirants.

Literature Review

There are many discussions and deliberations about the subject of promoting a safe staffing nursing environment in any given health care organization. The subject has elicited the extent of interest among various authors who raised several merits out of the initiative. The review explains the impact of safe staffing on patient safety and quality of care provided by an organization, several medical errors arising from unsafe staffing, how safe staffing fosters the retention of experienced registered nurses as well as decreases the rates of hospital readmission.

Safe Staffing Influences Safety and Quality Care among the Patients

It is proven that safe nurse staffing in a health care organization fosters patient safety and ensures the quality of care to all those seeking health services. As such, there is a dire need for support other than mere regulations to attain safe nurse-patient ratios. According to Voepel-Lewis, Pechlavanidis, Burke, and Talsma (2012) in the “Nursing Surveillance Moderates the Relationship Between Staffing Levels and Pediatric Postoperative Serious Adverse Events,” there is a need for several variables, which affect decisions for staffing as well as the needs for registered nurses to be adequately informed and assume an active role to determine the appropriate staffing ratio, which would promote patient safety.

For instance, a nursing unit that is properly staffed and which yields a significant volume of Aortic Abdominal Aneurysms (AAA) is concomitant with better-quality patient outcomes, lesser mortality among patients, and fewer rescue failures among other health emergencies. Hospitals that are poorly staffed often experience an increased volume of AAA as compared to hospitals that have commensurate ratios of nurse-to-patient. In the latter, the mortality rates of patients decrease by nearly 60% annually (Voepel-Lewis et al., 2012).

As regards neonatal intensive care, certain health care organizations characteristically under-staff these units by at least 32%. This has been seen as a strategy of meeting minimum standards of hospital staffing. Voepel-Lewis et al. (2012) assert that it is, therefore, necessary to consider adding an extra 0.39 of a nurse population for every high-acuity infant. In reality, a substantial understaffing of neonatal nursing staff is attributed to the increased jeopardy of neonatal-related fatalities as well as a myriad of Health Care-Associated Infections (HCAI) such as Ventilator-Associated Pneumonia (VAP) and Catheter-Associated Urinary Tract Infections (CAUTI) among many other ailments.

The research conducted on close to 232,342 surgical patients in the state of Pennsylvania exposed that about 4,535 patients, equivalent to 2%, perished within the first month of their discharge from hospital (Voepel-Lewis et al., 2012). This imperative study attributed the decrease to the wide variances in the staffing ratios of nurse-to-patient, which stood at 4:1 vs. 8:1 (Voepel-Lewis et al., 2012).

A multivariate analysis involving the staffing of nurses and the outcomes of patients recounted that the moment the staffing of registered nurses is increased, there would be tremendous progress in inpatient mortality due to surgical or rather medical complications. In particular, supplementary data depicted subsequent declination in ailments such as deep vein thrombosis, pulmonary embolism as well as sepsis. It was further revealed that greater staffing was interconnected to shorter spans of stay.

Apart from that, Rogowski et al. (2013) allude in the “Nurse Staffing and NICU Infection Rates” that the staff mix ought to consider educational groundwork, career experience, and professional requirements as profound factors while addressing the subject of nurse staffing. Managers of registered nurses should evaluate respective levels of competency as well as skills of critical thinking, and then based on the information to create a safe environment for patient care. Significantly, an efficient model of staffing ought to cogitate about health care supplies and equipment together with support personnel.

According to Rogowski et al. (2013), this is essential since the availability of adequate resources at hand rallies the workflow of nurses. Finally, the ready accessibility of nursing and medical staff is coupled with the survival of those patients that are critically ill. This proposes that imminent studies on safe staffing should emphasize more on the health care team resources. The outcomes underscore the exigent necessity for a probable study of levels of staffing as well as the organization of health care in intensive care units (ICU).

Medical Errors and Safe Staffing

A large number of health caregivers are believed to cause enhanced survival rates among some patients that are reported to be seriously ailing. In the “Hospital Nursing and 30-Day Readmissions among Medicare Patients with Health Failure, Acute Myocardial Infarction, and Pneumonia,” McHugh and Ma (2013) explain that seven extra lives among 100 patients would be protected if the number of nurses would be increased from four to six per bed in each hospital ward. The reason for the improvement of survival rates with more nurses was to be that nurses usually spend more time together with patients that critically ill as compared with other professional health caregivers.

As such, it is highly probable for these nurses to detect premature symptoms of deterioration than other professionals can do. Similarly, it emerged that fewer long-lasting staff signify superior dependence on agency staff (McHugh & Ma, 2013). These may in turn proof to possess less expertise or happen to be unfamiliar with certain characteristics of the style of working in a given unit. Another study was conducted in 11 health care centers over two years exhibiting a significant correlation between registered nurses regarding medication errors, falls among geriatric patients, and skill mix among nurses (McHugh & Ma, 2013).

Following the increase in the proportion of registered nurses, there was a notable decrease in medication errors. This study discovered that for every 20% decline in the staffing of health caregivers below the anticipated minimum of staffing, the medication errors increased at least by 18%.

Nonetheless, several studies have declined to reiterate mandatory nurse-to-patient ratios. According to the report compiled by Ramson, Dudjak, August-Brady, Stolzfus, and Thomas (2013) in respect to the California Nursing Outcomes Coalition in the “Implementing an Acuity-Adaptable Care Model in a Rural Hospital Setting,” there was absolutely no significant statistically variation observed in patient safety. Moreover, there were deficient quality outcomes like diminished falls or predominance of pressure ulcers.

The International Nurse Leaders sampled from nine nations around the globe convened to deliberate on the usual trends that affect the capacity of nurses in their delivery of effective and safe patient care (Ramson et al., 2013). Among the issues discussed were cuts to health care, levels of safe staffing, a 24/7 working environment contained within the range of health care together with the economic worth of registered nurses to wider society (Ramson et al., 2013). It also emerged that nursing surveillance comes in as an important facet in the observation of projects of quality improvement as well as for the appraisal of efficient nursing care. A momentous correlation was testified between staffing and the span of stay of registered nurses.

This proposed that early diagnosis and treatment of impending antagonistic proceedings would lead to earlier discharges. In another scenario, several health care centers in Europe where nurses have entrusted the care of few patients and possess an advanced proportion of undergraduate degree-trained nurses had considerably an insignificant number of surgical patients perish while undergoing medication. According to Ramson et al. (2013), the findings of this study underscore the imminent hazards to ailing patients especially when the staffing of registered nurses is reduced and advocates an augmented prominence that the bachelor’s education for nurses has a high capability of reducing hospital-related fatalities.

In the same breath, staffing plans are often annually developed and are founded on the previous data, the turnout of patients, regulatory standards, acuity, internal and external benchmarks, the skill mix and experience of nursing as well as the organization’s budget (Tellez & Seago, 2013). Unsurpassed staffing practices in nursing entail a central staffing organ that focuses on a panoramic perspective of a hospital. It should also be able to budge Registered nurses’ staffing in actual time to lodge variations in volume and acuity (Tellez & Seago, 2013).

The apposite exercise to the management of the impromptu deficits in staffing is to adopt a proactive approach and create a strategic plan ahead of the looming crisis. There is a dire need for nurse leaders to make critical examinations of the survey and sustenance of registered nurse ratios when the tally is high then decrease the same staffing the time the census decreases.

Influence of Safe Staffing on the Retention of Experienced Registered Nurses

In his study, Aiken in the “Nurse Staffing and Quality,” established that the relationship between lower nurse-patient ratios and a greater degree of purported dissatisfaction as well as burnout among registered nurses was statistically significant (Arling & Mueller, 2014). Ostensibly, Aiken has spent numerous eons attempting to determine whether the larger number of nurse staff can lead to improved quality of nursing home care.

Similarly, Bostick together with his colleagues arrived at a virtually positive conclusion, regarding the quality relationships and nurse staffing after reviewing several of their articles. On the other hand, Spills Bury also screened similar qualitative researches conducted from 1987 to 2008 and found them to be much more critical of methodologies as well as findings from them (Arling & Mueller, 2014). Significantly, health care administrators should collaborate to develop a sustainably viable formula for safe nurse staffing. Improved governmental impact by nurse-to-patient ratios that are mandated does not serve as the relevant approach to the issue of staffing (Arling & Mueller, 2014).

Options to the mandatory nurse-to-patient ratios encompass committees of staffing that have a strong acuity system, resilient nursing presence, as well as public nurse/patient revelation. Voluminous aspects have to be put into consideration while making decisions regarding staffing. These decisions will include the sternness of an infection, family needs or situations, requirements of observation and intervention, and team dynamics among others.

Impact of Safe Staffing on the Rates of Hospital Readmission

Quantitative research regarding optional cardiac patients documented a relationship between enlarged levels of nurse staffing and a decline in cardiac readmissions. In the “Using Minimum Nurse Staffing Regulations to Measure the Relationship between Nursing and Hospital Quality of Care,” Spetz, Harless, Herrera, and Mark (2013) reiterate that surplus reimbursements of improved staffing comprised inferior mortality rate in the in-patient hospital. For instance, the mortality rate for elderly people mechanically ventilated patients who obtain treatment in ICU is extraordinary.

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The research revealed a relationship between the staffing of nurses, their education, and their quality of health-care work environments together with the mortality ensuing usual procedures of surgery. A differentiating characteristic of ICU is a grander investment in nursing care. The main objective of the research was to determine the extent to which disparity in ICU nursing staffing characteristics, working environments, education, and professional experience is related to the death of patients (, 2013).

Therefore, the research outlines apt strategies that would suffice to improve survival rates among patients. Correspondingly, health care facilities, which support a positive working environment versus convenient patient workloads, have collectively had significant patient outcomes. If nursing organizations possess a patient-nurse ratio of 4.95 and below, more time would be available for patient sensitization as well as the preparation of the patient to transition home. Consequently, the lower nurse-to-patient ratios resulted in the reduction of the readmissions of heart failure patients by 7%, readmissions of acute myocardial infections by 6%, and readmissions of the ventilator-associated pneumonia patients by 10% (Spetz et al., 2013).

Similarly, the studies have also portrayed that the increases in levels of registered nurses in the units of general hospitals have resulted in the decline of 5.7% of patients’ admission days (Spetz et al., 2013). This trend toward expanded registered nurses’ staffing levels has exhibited a decrease in preventable events like in-patient falls and hospital-acquired pressure ulcers.

Conclusion of the Literature Review

Following the enactment of the California Assembly Bill 394, the conclusion of the research, which investigates whether the patient’s quality had made any improvement or not became a reality. The implementation of the bill into practice paved way for the Agency for Healthcare Research and Quality’s (AHRQ) to prepare a report that the Patient Safety Indicators portrayed a momentous decrease in pressure ulcers, patient falls, and restraint use (Arling & Mueller, 2014). Nonetheless, there was conflicting data offered courtesy of a panel of Californian health facilities. This panel failed to establish significant supportive data to the findings of AHRQ.

Between 2000 and 2006, several studies have generated reports indicating the availability of statistically significant decreases in post-operative respiratory failure together with the Hospital-Acquired Pressure Ulcers. A Nursing Productivity Committee (NPC) was used by the Magnet® hospital for the management of staffing to implement the concept of health care hours allotted to every patient per day (Tellez & Seago 2013). This HPPD is a steadfast metric standard that is utilized in the creation and management of systematic staffing patterns. HPPD observes the flow of patients, the flow of nurses, the availability of patients’ beds via meetings of bed census in reviewing the realistic and anticipated patient census as well as nurse staffing in 24 hours (Tellez & Seago 2013).

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The panel comprised one nurse manager, an associate staffing director, an analyst of nursing informatics as well as the organizational nursing supervisor. The model of adaptable acuity is a model of care, which is aligned with the resources of nursing. This distinctive model billets patients on the same unit right from the day of admission to discharge. Consequently, the model eliminates communication errors via frequent hand-offs. Notably, the acuity-adaptable model stimulates the flexible assignment of patients and minimalizes empty beds.

Furthermore, the model upgraded the engagement of nurses in the process of planning as well as cultivating nurse and patient gratification. However, there has never been significant declination in the falls and the Health Care-Associated Infections (HCAI). The fulfillments of nurses as well as their rates of retention were experiential after the momentary passage of the California law on staffing. There was considerable satisfaction among all the registered nurses who worked in acute care from 2004 to 2008 (Tellez & Seago 2013).

More significantly, as the nursing personnel become of age and retire; a shortage of experienced nurses will ensue. This implies that there will be inadequate staff to take care of the increased demand for health care as stipulated in the Affordable Care Act. Such facts mount pressure on the existing system of health care to cater to more patients with a lesser nurse population (Ramson et al., 2013). Conversely, nurses that have a longer tenure in employment are more prepared and experienced to deliver optimal care to patients that are critically ill. Reassuring nurses to retain their profession by delegating ratios develops job satisfaction and staff morale. It has also been proven to have the capacity of saving the lives of patients by lowering patient mortality.

Immediately after the implementation of California’s AB394, subsequent studies have re-counted that, registered nurses became more satisfied with their work environment than before (Ramson et al., 2013). Due to sufficient staffing, registered nurses have set aside ample time for patient education. At the same time, models of staffing together with staff planning engender a dire need to replicate the convolution of patient acuity. Therefore, this should encompass patient turnover in terms of admissions, discharges, and patient transfers as well as be flexible to permit the nurse managers in meeting staffing requirements within the resources that are allocated resources. With the use of a weight factor, which is added to work hours per patient day (WHPPD), nurse managers may usefully plan for accurate and sustainable staffing.

Potential Research Question

Mandatory nurse-patient ratios would eliminate flexibility and neutralize a negative influence on the system of health care delivery. According to the formal statement pronounced by the American Organization of Nurse Executives (AONE), a question still lingers as to whether the mandated Registered Nurse’s staffing ratios would be geared towards augmenting stress on the already overburdened system of the health care system. In the process of inspecting the RN’s workload, the AONE backs a wide range of standards.

Pragmatically, imbalanced staffing ratios cause a big detriment to nurses since the respective organization may be required to lay off subsidiary nursing staff to meet mandatory standard ratios. This would engender an inflated amount of work for registered nurses. Committees that are in charge of staffing were also found to be an appropriate remedy in addressing plans for staffing based on the preparation of registered nurses, the unit census education, and the unit activities. There is no supportive evidence indicating that the usage of obligatory ratios develops patient results. Enacting the legislation, which is supportive of the authorized ratios with no regard to optimal vigilance, is hypothetically dangerous.

Fundamental factors like nursing education, amount of experience, know-how, and skills should be put into consideration during the examination of patient outcomes. For instance, during the 394 California’s Assembly Bill, only 50% of the mandated nurses were required to be registered. Obligatory ratios of staffing do not consider patient acuity, a span of stay for individual nurses, requisite treatments, dynamics of teams, preferences of physicians, prevalent technology, and obtainability of subordinate staff among other essential factors.

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