1. Section Editor(s): Davis, Charlotte BSN, RN, CCRN

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Safe staffing ratios continue to be a major concern for nurses. Recent healthcare reform and changes in reimbursement for medical services have resulted in reduced profits and large reductions in nursing budgets. Many healthcare facilities are experiencing operational deficits and have responded by changing staffing ratios in an effort to conserve money and remain open to meet their community's healthcare needs. These changes include reducing nursing personnel, offering early retirements, initiating layoffs, and permanently closing recently vacated nursing positions.

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In recent studies, the American Nurses Association reports that 50% of all nurses state they have insufficient time with their patients. Forty-three percent report increased overtime; 54%, excessive workloads; 96%, starting a shift fatigued; and 33%, inadequately staffed units for patient acuity levels. With reduced nursing budgets and a growing nursing shortage, management team members have been placed in the awkward position of asking their nurses to work longer hours while providing labor-intensive care to an aging population. As we're asked to do more with less, many of us experience frustration and burnout, potentially leading us to seek another position or an entirely new profession. This situation can negatively impact the quality of care delivered, patient safety, and the nursing budget.


According to the Institute for Safe Medication Practices, nurses who work longer hours are at increased risk for medication errors and failure to notice changes in their patients' clinical condition. If you're concerned about the safety of your assignment, consult with your manager or immediate supervisor. Incorporating management team members into the discussion facilitates both temporary and long-term solutions that will allow you to continue providing comprehensive care to meet your patients' healthcare needs.


Be acutely conscious of team members who have labor-intensive patient assignments and offer them assistance. Many healthcare facilities encourage nurses to have the same assigned patients when they work multiple days in a row for continuity of care. However, it may be advisable to change assignments to decrease the nurse's stress level if the patient assignment is labor intensive or has other stressful components, such as family conflict, cognitive dysfunction, suicidal ideation, or known flight risk.


Many states have recently legislated safe staffing ratios. Common components of safe staffing legislation include:


* holding hospitals accountable for the development and implementation of valid, reliable, unit-by-unit nurse staffing plans


* creating a staffing matrix in coordination with clinical nurses that's tailored to each unit's unique circumstances or needs


* prohibiting nurses from being forced to work on units where they aren't adequately trained or experienced


* staffing based on patient census and the acuity or intensity of care needed


* incorporating the level of education, training, and experience of the nurses providing care


* incorporating both unit- and facility-level staffing needs


* comparing unit-level staffing, quality, and patient outcomes data with similar institutions nationally


* including other factors impacting care delivery, such as unit location (isolated or centrally located) and the availability of additional monitoring tools or technology.



We must continue to seek innovative solutions with our management teams that will allow us to minimize the risk of operational deficits for our facility, provide top-quality care to our patients, and give our team members the assistance they need.