Effects of Minimal Nurse Staffing and Its Effects on Patient Care and Safety

Nursing Shortages

"The United States is projected to have a nursing shortage that is expected to intensify as baby boomers age and the need for health care grows. Compounding the problem is the fact that nursing colleges and universities across the country are struggling to expand enrollment levels to meet the rising demand for nursing care…" (American Association of Colleges of Nursing).

Minimal Nurse Staffing - Negative Impacts for Patients

Agency for Healthcare Research and Quality (AHRQ) has published research on the impacts of nursing shortages in healthcare facilities. "Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes," the report explains (Stanton, 2008). This situation is exacerbated by the fact that at the time of this report there was a "…vacancy rate of 13%" in U.S. hospitals, Stanton reports.

Some of the typical negative impacts in hospitals -- "adverse patient outcomes" -- due to nursing shortages include: "urinary tract infections (UTIs)"; "pneumonia"; "shock"; "upper gastrointestinal bleeding"; "longer hospital stays"; "failure to rescue"; and "thirty day mortality" (Stanton, p. 3). Another study, conducted by the Evidence-based Practice Center (EPC), shows that lower nurse-to-patient levels were associated with "higher rates of nonfatal adverse outcomes" (Stanton, p. 3). Still another research study funded by AHRQ reflects that pressure ulcers, falls and "nosocomial infections" are more common when staffing nurses is a problem for a healthcare facility (Stanton, p. 3).

The Health Resources and Services Administration along with the Centers for Medicare & Medicaid Services, and the National Institute of Nursing Research have published facts related to nursing shortages and patient outcomes. These healthcare research groups studied the records of "5 million medical patients and 1.1 million surgical patients who had been treated at 799 hospitals during 1993," Stanton continues. They found that in hospitals with "high RN staffing," patients had "lower rates of five adverse patient outcomes," including pneumonia, upper gastrointestinal bleeding, UTIs, and shock. And higher nurse staffing also showed that there was a reduction of 2 to 25% "reduction in adverse outcomes" (Stafford, p. 4).

Why are Nurses Dissatisfied with their Jobs?

Stanton explains that a survey by AHRQ indicated that 40% of nurses interviewed were dissatisfied with their jobs and only 35.7% said that the "quality of care on their unit" was excellent (Stanton, p. 5). In fact a "large portion of nurses, 44.8%," reported that their experiences showed that there had been "deterioration in the quality of care" (in their hospitals); and moreover 83% of the nurses who participated in the survey said there had been "an increase in the number of patients assigned to them during the previous year" (Stanton, p. 5).

Nursing Shortages in the San Joaquin Valley

The California Healthcare Workforce Policy Commission (CHWPC) wrote on April 16, 2012, that both Madera and Fresno Counties are RNSA counties (Registered Nurse Shortage Area). The CHWPC updated this information as of April, 2011.

A report called "Crisis in Care: The Nursing Shortage in the San Joaquin Valley" (Barakzai, et al., 2007) -- a publication of the California State University at Fresno -- reflects that California was ranked 50th in the U.S. In terms of nurse ratio to 100,000 people. Nationally there are 825 working RNs per 100,000, but in California the ratio is 590 "employed registered nurses per 100,000 population" (Barakzai, p. 10). As for the San Joaquin Valley, it has been "…even more severely affected" by the nursing shortage. The California Institute for Nursing and Health Care (CINHC) gave the San Joaquin Valley a bad grade -- in fact Madera and Fresno Counties received a C-, and San Joaquin County was given a "D" grade (Barakzai, p. 11).