Nursing Shortage Risk Management Plan for Healthcare

Introduction

Nursing staff scarcity is a widespread issue across several segments of the healthcare sector. It is often a challenge to find an adequate number of qualified nursing professionals to meet staffing requirements. Nursing professionals represent a crucial part of healthcare teams and facilities, and a dearth of qualified nurses may leave a healthcare facility vulnerable. Furthermore, because of staff shortages, existing workers are typically expected to work more than normal. A key concern with regard to this shortage and the resulting workload on the existing workforce is that the continuance of safety practices within healthcare organizations may ultimately be compromised, leading to perpetual organizational vulnerability.

Overworked nursing staff members, or those required to care for a greater number of patients than is appropriate, must typically make sacrifices. They cannot focus sufficiently on individual patients, as is necessary for ensuring satisfactory nursing care. Thus, patient safety is impacted, as are the healthcare organization and its stakeholders from a broader perspective.

Quality and risk management are essential elements of healthcare facilities. Personnel turnover and satisfaction are major issues for all organizational risk mitigation strategies. Several research studies have been conducted on this subject, enhancing the possibility that mitigation strategies will prove more effective and allowing implementation strategies to be built on sound evidence-based research. Improving workforce satisfaction levels ensures low personnel turnover rates; turnover leaves organizations susceptible to further instability. A large number of best practices have been devised that have proven their ability to enhance job satisfaction. For instance, employee training levels have been found to correlate with overall job satisfaction (Schmidt, 2007). Thus, a study of factors linked to personnel satisfaction may serve as the ideal basis for developing a hospital risk management strategy.

Major Issue: Care Rationing and Nursing Scarcity

A key problem linked to patient care rationing is the associated negative publicity. In numerous circles, the notion of "healthcare rationing" is frequently a politically and emotionally charged topic. People often fail to understand the frequency of implicit rationing patterns. Irrespective of people's views regarding care rationing, however, it is quite a common process. In a Texas study, nearly all participants reported some level of rationing in at least one nursing activity, while a majority rationed several activities. Moreover, rationing preference trends support the accomplishment of tasks aimed at meeting the immediate physiological requirements of patients over other tasks (Jones, 2015). Nursing staff must personally decide which areas merit their time at different points throughout their workday, as well as how to prioritize the specific issues they face.

Despite implicit rationing being a widespread practice, numerous situations exist in which it may be exaggerated because of inadequate resources, thereby making the organization susceptible. Research into this area suggests that nursing staff constantly ration their care and time, and this seriously threatens patient care quality and, subsequently, patient safety. Areas such as hygiene, patient mobilization, patient assistance, feeding, communication, discharge planning, patient education, care documentation, and surveillance are frequently omitted or inadequately handled (Papastavrou, 2013). Often, appropriate patient care levels represent a somewhat subjective measure, but with resource shortages, implicit care rationing is more likely to be interpreted as a practice more in keeping with patient neglect and inferior health outcomes, resulting in organizational and stakeholder vulnerability to major errors.

Care rationing by nurses — a term used to refer to withholding or failing to perform specific care activities owing to scarcity of resources — is both a moral and an economic challenge. The challenge is economic because patient care delivery occurs within numerous socioeconomic constraints and multiple nursing components must be budgeted. Rationing has a moral dimension as well, since it entails judgments potentially at odds with professional and personal standards (Papastavrou, 2013). According to the "missed care" theory, the choice of completing, delaying, or omitting care elements is governed by inner factors — including nurses' attitudes, beliefs, and values regarding their responsibilities and roles — that shape their behaviors.

Three Potential Impacts of Risks and How They Affect Stakeholders

Shortage of nursing staff is linked to poor patient survival rates among critically ill patients. Duffin's (2014) research revealed that as many as 7 additional patients per hundred could be saved if nurses increased in number from 4 to 6 per patient. Researchers found that survival rates increased with a larger nursing staff because nurses could devote more time to critically ill patients compared to other healthcare providers and were more likely to identify early signs of patient deterioration. A second contributing factor is that fewer permanent nurses implies increased dependence on agency nurses who may not be familiar with all aspects of organizational operations and may not be adequately qualified or experienced.

Beyond its effects on care delivery quality and patient safety, nursing staff scarcity reduces healthcare facilities' patient treatment capacity. A study conducted for the American Hospital Association (AHA) found that participants reported nursing staff shortages led to overcrowding of emergency departments (38%), emergency patient diversion (25%), decreased staffed beds in hospitals (23%), service and program cessation (17%), and elective surgery cancellations (10%). Approximately 60% of study participants reported that the nursing workforce believes providing superior-quality patient care today is difficult owing to workforce scarcities.

In healthcare settings with a high nurse-to-patient ratio, patients face numerous adverse outcomes: they contract infections, suffer injuries, die, or are discharged too early without sufficient information about how to manage their condition. This often results in patients returning to the healthcare facility in a worse state than when they left. Having fewer patients per nurse ensures better patient care. Patients are also more likely to understand how to manage conditions such as diabetes, use assistive devices correctly, and recognize symptoms warranting medical attention — knowledge that helps them avoid further deterioration. When nurses are overburdened, they are more likely to be neglectful in intercepting and preventing errors, increasing patient injuries and mortality rates. Conversely, when nurses have adequate time to advocate with insurers, physicians, and other stakeholders regarding patient care plans, patients' health outcomes are more likely to improve.

Conclusion

The nursing shortage represents one of the most pressing challenges facing the modern healthcare system. Its effects — ranging from implicit care rationing and reduced patient survival rates to diminished organizational capacity and compromised safety — have far-reaching consequences for patients, nurses, and healthcare stakeholders alike. Evidence-based interventions, including improving nurse satisfaction and retention, cultivating strong nursing leadership, utilizing staffing agencies strategically, and enhancing job attractiveness, offer viable pathways to mitigating these risks. Equally important is the development of robust measurement frameworks grounded in nursing-sensitive outcomes and appropriate risk adjustment to accurately evaluate the relationship between staffing levels and patient care quality. A commitment to these strategies, supported by sound research, positions healthcare organizations to build more resilient and effective nursing workforces.

References

Clarke, S. P., & Donaldson, N. E. (2008). Nurse staffing and patient care quality and safety. In R. G. Hughes (Ed.), Patient safety and quality: An evidence-based handbook for nurses. Agency for Healthcare Research and Quality.

Duffin, C. (2014). Increase in nurse numbers linked to better patient survival rates in ICU. Nursing Standard, 28(33), 10.

Hunt, S. T. (2009). Nursing turnover: Costs, causes, & solutions. SuccessFactors, Inc.

Joint Commission on Accreditation of Healthcare Organizations. (2002). Health care at the crossroads: Strategies for addressing the evolving nursing crisis.

Jones, T. (2015). A descriptive analysis of implicit rationing of nursing care: Frequency and patterns in Texas. Nursing Economics, 144–154.

Papastavrou, E. (2013). The ethical complexities of nursing care rationing. Health Science Journal, 346–348.

Schmidt, S. (2007). The relationship between satisfaction with workplace training and overall job satisfaction. Human Resource Development Quarterly, 481–498.

Tellez, M., & Seago, J. (2013). California nurse staffing law and RN workforce changes. Nursing Economics, 31(1), 18–28.