Magazine article American Nurse Today

Hospital Nurse Staffing for Dummies

Magazine article American Nurse Today

Hospital Nurse Staffing for Dummies

Article excerpt

IT'S TIME to stop searching for nursing's cost-benefit ratio and believe the data. For more than two decades, health services researchers across the United States and around the globe have found that more RN hours and a higher skill mix are positively associated with reduced mortality, shorter hospital stays, and reduced rates of pressure ulcers, falls, hospital-acquired infections, pneumonia, medication errors, and failure to rescue.

The threat of shrinking reimbursement is fueling today's cost-reduction frenzy. Once again, as hospitals look to reduce labor costs, the laser beam focuses on nursing, which has the largest concentration of workers. What doesn't make sense, though, is that smart hospital leaders are equally concerned about quality. After all, their survival depends on quality, as new payment incentives reward hospitals for positive outcomes and penalize them for adverse events and poor outcomes. Good quality is as healthy for a hospital's bottom line as it is for patients. The key is to employ sufficient nurses to affect desired outcomes--not only by preventing adverse events but also by providing safe, timely, effective, efficient, equitable, and patient-centered care.

Why do many hospital leaders become amnesiac about the data their chief nursing officers (CNOs) no doubt have provided, which show higher RN hours yield better outcomes? While it's true that more RN hours could mean higher labor costs, evidence also links more desirable RN staffing to higher RN satisfaction, lower RN turnover and overtime, and cost avoidance for adverse events--all of which reduce expenses.

A fundamental element of a positive practice environment is an adequate number of nurses with clearly defined role expectations and accountability. When too few RNs are available, too heavy a workload can have dire consequences, including missed safety checks, poor communication, and reduced patient monitoring. Continued heavy workloads can diminish staff motivation and morale, leading to higher stress and burnout--triggering a cycle of dissatisfaction and turnover. And with a high cognitive workload comes a greater risk of decision-making errors. When too few nurses are around to help each another, the safety net within a hospital unit erodes. …

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