The word staffing never fails to conjure up deep feelings in every nurse and nurse leader. It can make or break a shift, a unit, a hospital, or the practice of the entire profession. Staffing has been at the core of nursing for as long as I can remember, and it's interdependent with patient care and nurse satisfaction.
Nurses' and nurse leaders' extraordinary resilience, demonstrated wave after pandemic wave, wasn't enough to prevent a workforce disruption never seen before. Vacancy and turnover rates are historically high. We'd hoped turnover would abate this year, but it hasn't. Hospitals have had to limit patient access, some closing acute care units, labor and delivery units, and even ORs. The American Nurses Association has named it a national crisis, and it's a global issue, too.
Many of us who've survived the moral injury and exhaustion of a third pandemic year have continued to practice. Others have retired, started alternate careers, began contract nursing, or transferred to practice areas with less stress and better hours. Our new nurses are finding their way and need the wisdom of experienced nurses to help them. We're in this together, and there's no clear and immediate answer.
We do know from global empirical research that RN staffing makes a positive difference in mortality odds, readmissions, length of stay, missed care, RN satisfaction, and burnout. Patients and staff benefit from effective staffing. The definition of effective varies from unit to unit, shift to shift, team to team, and patient to patient, dependent on a multitude of variables. There's no magic number, or one-size-fits-all solution, although sophisticated algorithms and predictive analytic tools could, and should, make staffing more efficient and even value-based. Empowered teams at the local level are best to determine their required staffing levels. Organizational processes should acknowledge this, and, for inpatient units, that midnight census alone isn't an adequate workload predictor for FTE (full-time equivalent) budgets.
We also know appropriate staffing is an essential standard of a healthy work environment and foundational to well-being. Decades of Press Ganey National Database of Nursing Quality Indicators(TM) (NDNQI(R)) data show that work environment impacts outcomes. And it's all connected to joy at work.
We know what we need to do now: get rid of non-value-added work, implement appropriate skill mix changes, provide resources for less experienced nurses, incorporate technology that decreases work burden and improves care, increase diversity of the workforce, integrate temporary staff effectively, focus on healthy work environment standards, develop nurse-led models, maximize advanced practice nursing, develop academic-practice partnerships...the list goes on. We yearn for new models that have been tested, and not proclaimed as "best practices" until thoroughly evaluated. The last thing we need is to risk demotivating staff and harming patients with a "fad of the month."
It can be overwhelming and has tested nurse leaders; some taking full assignments alongside staff to manage patient-care needs. Individually, we can't address all priorities at the same time-pick one in your control and work on it. At the system level, all the identified priorities must be addressed. We need to include government, educators, regulators, and our professional associations. We're on a journey to strengthen nursing's incredible value to healthcare, and staffing is fundamental.
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