1. Ashe, Leah RN

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I'm writing in response to "Taking Nurse Staffing Research to the Unit Level" by Rebecca A. Paulsen, PhD(c), MS, RN, CPN (July 2018). The author notes that when staffing levels aren't met, patient mortality increases. She also indicates that the baccalaureate-prepared nurse has a wider knowledge base than a nurse with a 2-year degree, which leads to lower patient mortality. Paulsen stresses quality of care to achieve patient outcomes, which, in turn, can lead to higher reimbursement. Nurse-to-patient ratios are substantially important when trying to keep infection rates, potential drug reactions, and medication errors at a minimum.


This article reminds us that no matter how much experience we have, if ever in doubt, just ask! As a novice nurse, it's influenced me to take note of what factors lead to a successful, efficient healthcare professional. My purpose for writing this letter is to share the importance of adequate staffing based on nurse-to-patient ratios, as well as provide experiential insight into decreased infection rates, medication errors, and transfusion reactions based on my oncology unit.


Hospital reimbursement is based on performance. If units don't adequately staff enough professionals to provide the care that patients need based on their acuity level, reimbursement may significantly be affected. On the oncology unit in which I practice, we typically staff in line with our patient acuity level. Typically, around 3 p.m., we're able to staff down if we've released our discharged patients and our acuity levels aren't as high; however, there are days when we're unable to do so. When units have higher turnover rates, including admissions, discharges, and transfers, additional nursing time isn't recognized in shift variability when considering staffing needs and nurse-to-patient ratios. We staff based on patient acuity, and we work as a team if we're understaffed. Our management team comes to the floor to provide additional resources as needed.


Communication between the patient's nurse and the charge nurse is imperative to ensure that the unit has the resources needed to provide excellent patient care. By being able to provide adequate staffing, our oncology unit currently has no central line-associated bloodstream infections or catheter-associated urinary tract infections, and we've experienced only five falls and one transfusion reaction in 2018. Clearly, education, teamwork, and preparation are key to the success of any healthcare organization. I fully believe that if all units were run the way ours is, there would be dramatically lower infection rates on those units. When I obtain my BSN, I'll be able to further use the knowledge acquired to help assess patient acuity levels and provide adequate staffing, as well as any additional resources my unit may need.


-Leah Ashe, RN