Introduction
The healthcare system of the United States of America experiences multiple problems. These issues need to be addressed by policies that consider various factors that are either external to health care or refer to its structure and current state. Nowadays, one of the most burdening problems of health care is staff shortages, which emerged as a result of measures for preventing expenses, retiring members of the hospitals’ staff, and more significant patient complexities, numbers, and demand (Haddad et al., 2022). The insufficient amount of medical workers, especially nurses, creates stress on the healthcare employees’ working circumstances and affects patient care and the general performance of the organizations (Haddad et al., 2022). Hence, a policy that would improve the situation is proposed and has already been implemented in some clinics. Namely, improved nurse staffing would enhance the quality of care by eliminating the challenges arising from the lack of workers. The policy of adequate nurse staffing is chosen for discussion because of its value for the most relevant issues of health care at the moment; it provides multiple advantages that outweigh its costs.
The Problem of the Nursing Shortage and Unsafe Staffing
The inadequate amount of nurses in a clinic in view of the rising population of elderly and complex health problems results in a significant issue that disrupts the daily operation process of the workers. Namely, inappropriate staffing supposes that nurses should partake in a greater number of tasks to maintain the quality care of the patients, taking more responsibilities and sometimes increasing their workload. As such, some caregivers graduate and begin working only to discover that the career is not what they expected. Others may work for some time before being burnt out and leaving the field. These conditions induce significant stress among the clinicians and lead to burnout and professional exhaustion, which results in retiring from the job. According to Shah et al. (2021), burnout and stress (related phenomena) are the most frequent reasons for leaving a job. Hence, the stressful environment of the hospitals with inadequate staffing causes turnover of the nurses, which also increases the inappropriateness of the number of caregivers in a unit.
The other important outcome of the nursing staff shortage is the increased frequency of medical errors. In fact, nurses are the most numerous hospital employees and are in charge of the core part of care delivery. Therefore, it is critical to control the influence of their work setting on the quality of care and patient experience. An increasing body of research suggests that insufficient nurse staffing in hospitals is linked to adverse occurrences such as patient falls, healthcare-related infections, prescription mistakes, and in-hospital fatalities (Haegdorens et al., 2019). Even the possibility of the errors that might put the lives of the patients in danger is overwhelming for modern healthcare and does not justify any financial economy. As a result, professional nursing groups in the United States and across the world frequently campaign for safer staffing circumstances.
Specifics of the Policy of Improved Nurse Staffing
Enhanced nursing staffing could be implemented via the use of several approaches. First, nurse-to-patient ratios are used to allocate available nursing personnel among hospital wards and are defined as the percentage of nurses available per client (Haegdorens et al., 2019). These ratios should be developed by bedside nurses, who know the specifics of care and the needs of the patients. A more advanced method is the nursing hours per patient day technique, which is computed by dividing the available nursing hours by the number of admitted patients during a 24-hour period (Haegdorens et al., 2019). The policy that uses the second approach is discussed among the authorized clinicians as a candidate for mandatory practice for defining the number of staff in healthcare organizations. As such, the state of California has already instructed its hospitals to calculate nurse staffing requirements in accordance with this technique (Haegdorens et al., 2019). Hence, the improved nurse staffing policy via appropriate nurse-to-patient ratio deserves investigation.
Health-related Costs
However, there is a point that should be considered when suggesting such a policy, namely, healthcare-related costs. The complicated problem of nursing staffing is sometimes exacerbated by cost concerns and can become political. Nurse staffing regulations can have a direct impact on hospital expenditures and treatment quality. Employment and wage expenses account for around more than half of the hospital budget, with nurse wage costs accounting for some of the highest spending. According to Bartmess et al. (2021), “the average cost of hiring, insuring, and recruiting a nurse in the United States was $98,000 per year” in 2011, and it should have significantly risen in recent years (p. 7). Hence, the administrators of health care facilities might consider increasing staffing to be a financially devastating project. However, research demonstrates that higher proportions of nurses lead to lower incidences of adverse patient events, readmissions, and patient lengths of stay in hospitals–the events that contribute to the largest expenditures of the hospitals (Bartmess et al., 2021). Therefore, the costs of recruiting an adequate number of nurses per shift are less than spending additional resources on providing care for ill-treated patients.
The Role of the Nurse
The other factor that needs to be regarded when implementing the policy is the role of the nurse in the hospital. As such, researchers discovered that changes in nurse preparation might have an impact on patient outcomes. Increasing the proportion of registered nurses in hospitals, rather than certified nursing assistants and unauthorized support workers, for example, has been linked to lower increased morbidity and mortality (Bartmess et al., 2021). Nursing skills and years of experience can also have an impact on health outcomes, with higher levels of nursing skills related to a decreased risk of hospital-acquired illnesses and death (Bartmess et al., 2021). Finally, nurses’ autonomy refers to their ability to act on their knowledge to deliver quality care coordination and influence hospital processes to establish guiding principles for patient care, improving care outcomes (Bartmess et al., 2021). Therefore, not only the ratio of nurses per patient but also the competence, experience, and autonomy affect the productivity of the hospitals.
The Impact of Improved Nurse Staffing Policy
The policy of improved nurse staffing could affect several aspects of quality care by solving the issues of workers shortage. Lower ratios (fewer patients per nurse) help patients, resulting in decreased fall incidence, hospital-acquired infections, pressure injuries, and duration of stay (Bartmess et al., 2021). Moreover, comprehensive observation, medical records, treatment plans, mental health support, emotional security, patient communication, and health education are all part of the nursing process that can be performed with adequate staffing since there are more available persons for these tasks (Bartmess et al., 2021). Bedside nurses, rather than management, selecting appropriate nurse-patient ratios will result in increased work satisfaction, greater productivity, and a lower desire to quit their chosen careers. Adequate staffing levels reduce mistakes, enhance patient satisfaction, and raise nurse retention rates (Haddad et al., 2022). Thus, the improved staffing policy might provide more opportunities for quality care and increase the health of the population.
The Effectiveness of Improved Nurse Staffing Policy
The effectiveness of the policy can be assessed by examining the cases of implementation of adequate nurse-to-patient ratios and other techniques. For example, the longitudinal observational study by Haegdorens et al. (2019) explored the association between nurse staffing levels and adverse mortality in medical and surgical wards in Belgian hospitals. It revealed the link between increased nurse staffing and decreased patient mortality. However, it was also discovered that many patient outcomes, including in-hospital mortality, appear to be influenced by nurse-to-patient ratios and caregiver education, according to evidence (Haegdorens et al., 2019). The other research also confirms that, although mandated ratio policy choice influences how patient outcomes improve with fewer patients per nurse, it does not address the requirement to assess nurses’ preparedness or encourage active nurse autonomy over staffing rules and procedures (Bartmess et al., 2021). Thus, the policy is effective in reducing mortality rates, and yet it does not present a comprehensive solution to the problem.
The Pros and Cons of the Policy
Hence, the advantages and disadvantages of implementing the policy of improved nurse staffing through mandated ratios should be discussed. First, it is obvious that the policy can change the workload, which affects the mental state of the nurses and increases their productivity. Second, the policy provides excellent results in reducing in-hospital mortality and improving the general quality of care. However, one might point out a drawback of this solution, namely, increasing costs of operating the hospitals. Yet, it was established that the fixed ratio’s effects on care result in the reduction of expenditures related to the mistakes and missed procedures done by the nurses. Hence, the lesser financial spending is also an advantage of the proposed initiative. Yet, if the ratio technique is not used with qualified and experienced personnel allocation, it might perform worse.
Recommendations
Several recommendations could be made based on the findings described above. As such, it is suggested that the nursing staff of the various facilities promote the policy to their managers. Moreover, the public health nurses and activists who have authority over the medical society can present the effectiveness of the policy to discuss its implementation variants. Next, the importance of the policy should be explained to the hospital stakeholders so that they can evaluate the economic and quality changes that it might bring. Finally, these arguments must be presented to legislators so that to discuss the probability of mandatory measures against inadequate staffing. Thus, the service provided by the health care facilities would help more people and result in fewer incidents of death and illness complexities.
Conclusion
Inadequate nurse staffing leads to a range of problems that affect the quality of care and, in some cases, increase morbidity in hospitals. These issues pressure the workers who might feel burnout and leave their jobs, causing even lesser numbers of nurses available for care in the facilities. To solve this problem, the policy of lower ratios of nurse-per-patient so that there would be enough caregivers to guarantee that each patient receives safe and proper treatment. This policy has multiple advantages that outweigh its disadvantages and could be promoted among healthcare-related people.
References
Bartmess, M., Myers, C. R., & Thomas, S. P. (2021). Nurse staffing legislation: Empirical evidence and policy analysis. Nursing Forum, 56(3), 660–675. Web.
Haddad, L. M., Annamaraju, P., & Toney-Butler, T. J. (2022). Nursing shortage. StatPearls.
Haegdorens, F., van Bogaert, P., de Meester, K., & Monsieurs, K. G. (2019). The impact of nurse staffing levels and nurse’s education on patient mortality in medical and surgical wards: An observational multicentre study. BMC Health Services Research, 19(1). Web.
Shah, M. K., Gandrakota, N., Cimiotti, J. P., Ghose, N., Moore, M., & Ali, M. K. (2021). Prevalence of and factors associated with nurse burnout in the US. JAMA Network Open, 4(2), e2036469. Web.