Understaffing: The Importance of Strategic HRM in Improving Patient Outcomes C. Haddock
It is not uncommon to find the phrase “quality care” incorporated into most hospital mission, visions or value statements. This idea is ingrained into their cultures and is the idea upon which the foundation of most healthcare organizations is built. Neither is it uncommon to find the problem of registered nurse (RN) understaffing permeating these organizations and jeopardizing the health and safety of thousands of patients each year. Hospitals are in fierce competition with one another and other healthcare providers to attract and retain nurses during a time when this country is facing a nursing shortage of almost epidemic proportions. In the year 2005, the United States had an estimated 126,000 unfilled nursing jobs. That number is expected to reach 400,000 by the year 2020. Although these jobs are going unfilled, people continue to require medical attention and as a result registered nurses are forced to care for an increasing number of patients at one time. Increased workloads lead to career dissatisfaction and burnout further aggravating the problems caused by understaffing and the resultant high patient to nurse (PTN) ratios (Rothberg, Abraham, Lindenauer & Rose, 2005). Safe patient to nurse ratios improve patient outcomes and ensure the provision of quality care in healthcare organizations. The value of planned human resource activities designed to help organizations recruit and retain a sufficient number of nurses to meet quality assurance goals cannot be ignored.
Nurses nationwide seem to share the common belief that hospital nurse staffing levels are usually inadequate to ensure safe and effective care for patients. Registered nurses report that they’re spending less time taking care of increasingly sick patients and as a result safety and quality care are suffering. Their belief is backed by several research studies. According to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 24% of the 1,609 sentinel events (unanticipated events resulting in injury, death, or permanent loss of function) were directly related to nurse staffing. In 2001, 75% of nurses surveyed in the US stated that increasing PTN ratios posed a threat to patient safety. In Massachusetts, 29% of nurses surveyed had first -hand knowledge of a patient death that resulted from understaffing. More than 50% of physicians felt that nurse understaffing is a significant cause of medical errors (Rothberg, Abraham, Lindenaur & Rose 2005). The link between patient outcomes and nurse staffing is becoming more and more evident with several research studies to validate this belief. One study reporting on findings from 168 US hospitals found that 23.2% of the 232,342 patients studied experienced what they defined as a major complication that was not present upon admission. Of that 23.2%, 2% died within thirty (30) days of admission. That means that 4,533 patients died, apparently from complications that developed after admission. Among the patients studied there was a clear correlation between PTN ratios upon admission, mortality and failure to rescue which is defined as mortality following complications. This study further implied that the likelihood of patient mortality increased by 7% for each additional patient added to the nurse’s average workload. The difference from four (4) to six (6) patients per RN increased the risk of mortality 14% and the difference from four (4) to eight (8) patients per nurse was accompanied by a 31% increased risk for mortality. With this study comes the implication that mortality rates could decrease substantially simply by increasing registered nurse staffing and thereby lowering PTN ratios (Aiken, Clark, Sloan, Sochalski & Rose 2002).
Patients in one hospital ICU were found to be at a...
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