This literature review examines the effects of nursing shortages on patient outcomes in healthcare settings. The paper analyzes research from the American Association of Colleges of Nursing (AACN) and other authoritative sources, highlighting the relationship between nursing education levels, adequate staffing ratios, and patient mortality rates. Key findings demonstrate that baccalaureate-prepared nurses and sufficient nurse-to-patient ratios correlate with lower adverse outcomes. The review also categorizes nursing workforce composition into three professional types and identifies barriers to nursing education enrollment as a contributing factor to workforce shortages.
There is a severe shortage of nursing in today's healthcare workforce, which significantly impacts patient outcomes in terms of healthcare quality and overall health. According to the Nursing World website, "Nursing is integral to patient care and is delivered in many and varied settings. The sheer number of nurses and their central role in caregiving are compelling reasons for measuring their contribution to patients' experiences and the outcomes that are attained" (2010, p. 1). This literature review examines the effects of nursing shortage on patient outcomes by analyzing current research in this area of inquiry.
The American Association of Colleges of Nursing (AACN) has documented the relationship between nursing education levels and patient safety. According to research published in Health Services Research in August 2008, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes. Nurses prepared at the baccalaureate level were linked with lower mortality and failure-to-rescue rates. The authors concluded that "moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients" (AACN, 2013, p. 1).
Consumer perception further reinforces the importance of adequate nursing resources. According to a November 2004 national survey sponsored by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health, 40% of Americans reported that the quality of healthcare has worsened in the last five years. Consumers identified the most important issues affecting medical error rates as follows: workload, stress, or fatigue among health professionals (74%); too little time spent with patients (70%); and too few nurses (69%) (AACN, 2013, p. 1). These findings underscore the direct link between nursing shortage and perceived quality of care.
Understanding the structure of the nursing workforce is essential to understanding how shortages affect healthcare delivery. According to Buerhaus et al. (2007), "The delivery of care for hospitalized patients is complex and requires coordinated efforts by many health professionals. Physicians, advanced-practice nurses, registered nurses (RNs), and other allied health professionals each provide individualized health care services. Hospital administrators—namely, chief executive officers (CEOs) and chief nursing officers (CNOs)—develop strategic plans; build, manage, and continually improve facilities and systems of care; and oversee resource allocations. Patterns of problem recognition, communication, teamwork, and problem solving within and among these groups contribute to a hospital's capacity to operate efficiently and manage difficult and changing stressors" (p. 1).
The nursing profession comprises three distinct types of workers. According to Keenan and Kennedy (2003), registered nurses are the single largest group of health care professionals in the United States, and current and projected nursing shortages reflect the fact that fewer people are entering the profession. The three types of nursing professionals are as follows: (1) registered nurses that provide patient care directly and are licensed by the state, holding either two-year associate or four-year baccalaureate degrees; (2) licensed practical nurses that provide care for patients under the supervision of registered nurses or physicians; and (3) nursing aides (Keenan and Kennedy, 2003, p. 1).
"Staffing levels inversely related to mortality rates"
Nurses are the primary providers of care-giving in all healthcare environments and are critical to providing quality care. It is essential that educational institutions provide more opportunities for students interested in the nursing profession to enable them to gain nursing education and enter the professional workforce. Long waiting lists for nursing school enrollment discourage prospective students, causing many to pursue alternative careers to advance their futures. Addressing the nursing shortage therefore requires not only retention of current nurses but also expansion of educational capacity to increase the pipeline of new nursing professionals entering the healthcare system.
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