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As a nurse leader, I view our direct care nurses as one of the most valuable resources in healthcare. Staffing the right number of nurses with the right knowledge and skill base to meet the needs of patients is essential to achieving optimal nursing outcomes. But defining the "right" number of nurses is challenging in today's economy with the intense focus on reducing costs.
Those of us in the profession know well the danger of unsafe staffing levels. But trying to explain those risks to our colleagues in finance or administration isn't easy if the "evidence" comes solely from anecdotes or what you've come to believe based on your real-world experiences. Like the science of clinical practice, staffing decisions should be based on the evidence.
That's why I want to be sure you're all aware of key evidence-based research on this front entitled, "Nurse Staffing and Inpatient Hospital Mortality," published in TheNew England Journal of Medicine.1 The authors concluded that inpatient mortality increased when RN staffing was below target levels. Their findings reinforce the value of matching nurse staffing with patients' needs. (See "Nurse-patient Ratios: Low RN Staffing Linked to Higher Mortality," Clinical Rounds, page 26.)
Though you might say, "I could have told you that," you now have more solid evidence to support your opinion. The results of this objective study contribute significantly to the scientific basis of nursing quality, seamlessly connecting research, clinical practice, and leadership to guide staffing decisions in support of patient safety.
Staffing decisions shouldn't be made in a vacuum. Sources that can help us plan staffing models or determine appropriate nurse-to-patient ratios include standards defined by professional nursing organizations and regulatory agencies, and benchmarks from the American Nurses Association's National Database of Nursing Quality Indicators. I applaud the investigators for their work, encourage nurses to consider the implications in their own practice settings, and advocate for continued research in this critical area.
Until next time-
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM
Editor-in-Chief, Nursing2011 Vice President, Emergency, Trauma, and Aeromedical Services Christiana Care Health System, Wilmington, Del.
1. Needleman J, Buerhaus P, Pankratz VS, Leibson CL, Stevens SR, Harris M. Nurse staffing and inpatient mortality. N Engl J Med. 2011;364(11);1037-1045. [Context Link]
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