As an active-duty military nurse, I'm familiar with the Military Nursing Outcomes Database (MilNOD) project described in "Staffing Matters-Every Shift" (December 2012). The authors did a great job of highlighting the always pervasive issue of nurse staffing.

We all want what's best for our patients, but many times it seems like issues such as staffing are beyond our control. I have experienced this as a charge nurse numerous times. Coming in at the beginning of shift, everything seems under control; then, all of a sudden, staff call in sick or need to go home, and the phone begins ringing, announcing the arrival of more patients. Having precautions in place such as an on-call nurse can help, but only to a certain extent as patient census and acuity continue to rise.

Adequate and appropriate nurse staffing is essential to ensuring that our patients receive quality care. I completely agree with the authors that the leadership must take into account the number as well as the experience level and mix of nurses working during a given shift. Decreasing adverse events and improving quality of patient care must be a priority for us all.

Veronica Spencer, RN

Yokota Air Base, Japan