As I read Mahlmeister's1 article Maintaining Safe and Cost-Effective Staffing Models During the Current Economic Downturn in your April/June 2009 issue, I felt a strong connection with the scenario she describes. As an assistant nurse manager in a very busy mother/baby unit, I am beginning to see the same alarming repercussions of this economic crisis. The nurses are now generally taking on heavier patient assignments than they have in the past in order to meet unit budget requirements, as well as being cross-trained to other areas to avoid the need to pay overtime or agencies for staffing shortages throughout the facility. While being involved in the budgetary process, I can see the bigger picture but many staff nurses see only the effects it has on their practice. Assigning nurses out of their comfort zone can have a detrimental effect on unit moral as well as patient safety. I agree that the greatest challenge in this state of the economy is a safe environment of care. With cesarean section rates on the rise, patients are at a greater risk for complications.2 Also, of concern is the rise in late preterm infants being admitted to the well nursery; these infants require closer observations and with the staffing changes this could lead to unfavorable outcomes.3 Implementing a best practice staffing model appears to be the only answer as the economy shows no drastic signs of improving.

Using all available resources to develop a safe staffing model is essential. Involving the staff in the process is crucial to its overall success. Even in these tough economic times when educational departments are being downsized, my facility still offers a charge nurse/frontline leadership certification. In these classes, nurses develop strong critical thinking skills as well as the art of delegating assignments and duties to ensure cost-effective patient care. As a graduate of this program, I feel it is becoming a necessity for all staff nurses to enroll as they are given greater responsibilities throughout their facility. Another vital part of this course is the communication component. Knowing how to communicate what nurses need to perform their duties is a key element in positive patient outcomes. Even in times of budget crunches, administrators are willing to compromise when overall safety is involved.

As patient care resources continue to be affected by lack of health insurance and reimbursement funds, nurses need to rise to the challenge and provide the best care possible. Keeping abreast of the changes being made in the healthcare arena, nurses must use their voice and demand when appropriate that certain programs remain in place. Most people would agree that this is a time of sacrifice but one thing never to be sacrificed is patient or staff safety. As patient advocates, nurses equipped with the right resources will continue to make a difference in the lives of patients despite the shape of the economy.

-Sherry Durden, BSN, RNC

Assistant Nurse Manager, Mother/Baby Unit, Broward Health-Chris Evert Women & Children's, Hospital Ft Lauderdale, FL 33314

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