Nurses play a vital role in patient safety. There is a well-established link between nurse staffing and healthcare outcomes in patients such as recovery rates and mortality levels. Maintaining adequate nurse staffing to patient ratio is essential in ensuring the delivery of high-quality patient care. Safe nursing means that patients have access to an appropriate number of healthcare providers at all times. The nurses enrolled should meet a required level of education, skills, and experience to maintain competency in the working environment. Unsafe nurse staffing can lead to unsustainable workloads opening up room for poorer patient experience of care. Missed care refers to nursing care that ends up being delayed, incomplete or neglected due to understaffing or nurse incompetency.
Kathleen and Audrey Lyndon recorded and analyzed the responses from nurse members of the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN). The main aim of the study was to identify the underlying consequences of inadequate nurse staffing and their perception of the staffing guidelines (Simpson & Lyndon, 2016). Three main themes were recorded as potential consequences of inadequate staffing. The first one was patient care not done on time; care that was partially done and care that could not be completed at all. The second one was the potential for adverse outcomes in patient health outcomes because nurses were unable to provide quality healthcare (Simpson & Lyndon, 2016). The third was negative implications to the professionalism and careers of the nurses involved in missed care issues. This study shows how deep the effects of missed care can go. Nurses are expected to plan, deliver, and assess patient care to manage their symptoms and responses to care. Therefore, missed care not only leads to medical errors but also acts as a form of medical underuse and neglect.
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Kalisch model for missed nursing care uses nursing principles to expound on the factors that contribute to unsafe nursing care and missed nursing. Nurse work overloads can be caused by increased demand for nurses, low supply of nurses form schools, increased overtime and changes for time spend in hospitals. Nurses working in understaffed environments are forced to make clinical priorities bay assessing which healthcare requirements can be delayed or omitted (Simpson & Lyndon, 2016). Priority choices can be made based on the perception of the nurse group norms, the nurses perception on which of their patients can survive under delayed or reduced care and the their personal values, attitudes and beliefs. Prioritization on specific patient care leads to delayed care for other patients creating subsequent problems due to resource inadequacy and understaffing.
Failure to act on the patients conditions in a timely manner leads to failure-to-rescue cases, which are defined as the inability to prevent death after a patient develops complications. Nurses are expected to always complete ongoing assessments and monitor patients as needed. By doing so, they can recognize any negative patient conditions that can lead to potential deteriorations and adverse outcomes. Understaffing limits nurses effectiveness in carrying out their duties (Simpson & Lyndon, 2016). Increased workloads can lead to job dissatisfaction and burnout when nurses are required to work overtime. Without sufficient resources to meet patient health demands, nurses encounter emotional exhaustion leading to missed care. Nursing shortages and inequitable distribution of nurses has also caused some organizations to substitute staffing roles and incorporates skill mixes into their workforce. Hospitals end up with unqualified individuals attending to patients leading to deteriorated patient care. Similar approaches have been proven to lead to poor patient health outcomes and incur unnecessary costs.
Results from studies carried on the survey of AWHONN indicated that most nurses working in understaffed environments were suffering from stress (Simpson & Lyndon, 2016). Nurses who are not in their right state of mind are prone to making errors in the workplace. Studies have indicated that without pressure, nurses with more clinical expertise performed much better compared to negative results when the same nurses were subjected to time pressure. Interruptions disorient nurses from their normal schedules creating room for risk events such as medication errors (Simpson & Lyndon, 2016). Missed care sets in motion other related omissions, leading to more complications. Hospitals with better staffing protocols experience lower rates of cases associated with missed care. Organizations suffering from the highlighted issues such as work overload should work on prevention measures. Addressing staffing levels, work environment, and team response is the first task towards achieving better patient healthcare (Simpson & Lyndon, 2016). Primarily, missed care is caused by time pressure and inadequate staff to complete demands. Empowering nurses who quit their jobs due to overworking and students in healthcare courses can help in bringing much needed reinforcements.
Unsafe staffing has caused strikes in some hospitals in Ohio, Toledo, and New York among other places. Nurses have taken a stand to demand safe staffing because the inadequate staffing has a major impact on their patients. The government has even made effort to create legislation that will ensure hospitals enjoy safe staffing. Confessions from nurses indicate that, unsafe nursing leads to depression, stress and injuries, and some even end up quitting the nursing career entirely. On its part, California passed a law to address the staffing of nurses within hospitals. It ensures that the nurse-to-patient ratio is observed at all times. The impact has been felt for close to 15 years now, as California is the only state with better nurse staffing, and positive patient outcomes.
Unsafe nurse staffing and missed care has serious implications on various aspects of healthcare. Nurses working in maternity wards are unable to provide adequate care to mothers and newborns. This is just one of the many aspects of healthcare that are paralyzed by understaffing. Therefore, the government should prioritize more resources towards solving staffing issues. Morale levels are directly linked to the productivity of every professional. Nurses working under stressing conditions do more harm than good to the expected healthcare outcomes of most patients. Most negative complications go unnoticed until they become too complex to avert. Organizations need to identify vulnerable points leading to failure-to-rescue situations to facilitate proactive responses to evade unnecessary errors. Lastly, hospitals should take nurse-staffing surveys to identify underlying errors affecting their overall performance. Nurses are advised to report their respective institutions that have not addressed any cases of understaffing.
Reference
Simpson, K. R., & Lyndon, A. (2016). Consequences of Inadequate Staffing include Missed Care, Potential Failure to Rescue, and Job Stress and Dissatisfaction. Journal of Obstetric, Gynecologic, & Neonatal Nursing , 481-490. http://dx.doi.org/10.1016/j.jogn.2016.02.011
