Right after it aired on April 30, 2023, a link to #NursingAdvocate Sarah DiGregorio's segment about nurses on CBS Sunday Morning was quickly sent to me by a friend.1
Ms. DiGregorio's stunning message to the general public summed up the value that nurses bring to communities and the real life-or-death consequences to patients when there are not enough of them. She recounted decades of research that associate high levels of nurse staffing with improved patient outcomes and lower patient mortality. She also pointedly noted that research has failed to correlate any patient mortality reduction or community value with rapidly rising, multimillion-dollar hospital CEO salaries. She then asked two provocative and transformational questions: "What is the purpose of a hospital? Should its budget reflect its purpose?" These questions reveal the extent that corporate healthcare distorted the budget focus and ultimately catalyzed the nurse staffing crisis.
Labor costs predominate in hospital budgets. They are easy targets for cuts to offset other expenses. Over the past several years, the nursing workforce has taken direct and shortsighted hits through intentional budget reductions and failures to add nurses when rising patient volume and acuity dictated it was necessary-even when hospital profits were strong. Priorities shifted from hospital purpose to hospital profit; the paradigm transitioned from health care to health business. That shift defied the moral compass that drives nurses to be nurses and their ethics in providing patient care. The result is moral distress, leading to moral injury.
Corporate leaders justify budget cuts with rationale like, "we project a lower patient census next year," or the ever-popular, "national benchmarks indicate your unit can function with fewer nurses." Of course, census projections and staffing benchmarks are often wrong; nurses are left to work even harder and patient care suffers. Then, if nurses survive working short-staffed because they know patients need them, administrators use that as evidence that no additional nurses are necessary for the next budget year. This is a dangerous budgeting game that nurses typically lose.
Heavy nursing workloads, inadequate support, documentation burden, dysfunctional work environments, and workplace violence are root causes of nursing burnout and turnover; each has a direct link to hospital priorities and budget decisions.2-4 It is time to stop placing vulnerable patients and nurses at risk. Health systems must change their priorities to align their budget with the purpose of enabling safe, high-quality care for patients, delivered by a fully supported and robust nursing workforce. Patients and nurses deserve nothing less.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2023
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