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Issues of Nurse Staffing: What’s Behind The Current Crisis?

4 min read

Safe nurse staffing has been an issue since nursing was first formally recognized as a profession. The demands of the COVID-19 pandemic, and several other key factors have created a persistent crisis such that many nurses today have horror stories of desperately trying to practice safely with an overwhelming patient load.

What is Causing the Current Crisis?

1. Cost.

As hospitals face rising costs and reimbursement cuts, nurses—the largest group of health professionals— are an easy target for cost cutting measures. Hours of nursing care, typically bundled in hospital charges as room and board and not seen as a source of revenue, get trimmed as healthcare leaders look to meet budgetary expectations. Additionally, the expanded scope and sophistication of ambulatory services mean that hospitalized  patients are acutely ill and require close monitoring and complex care. A bent toward discharging patients as soon as possible leads to more frequent patient turnover. Nurse staffing numbers do not always reflect this new reality.

2. Variability.

Patients’ care needs vary greatly across practice settings. A nurse working in an intensive care setting might be frantically trying to care for two critically ill patients, while another in long-term care oversees care for several patients more comfortably. This variability, often from unit to unit within a single facility, makes it challenging to create a flexible staffing plan based on skill mix and patient acuity. Current state and national legislation related to nurse staffing often emphasizes a minimum staffing level which must be maintained, while allowing for increases based on need. ANA supports staffing committees, mandated nurse to patient ratios or standards, and mandated disclosure of staffing levels as ways to ease the staffing crisis.

3. The Nursing Shortage.

Both the U.S. population and RN population are aging. These demographic changes mean the demand for nursing services is rising just  when just when many nurses are retiring or planning to retire. This also affects academic settings where fewer nurses hold faculty positions, which limits nursing school enrollments. In addition, many nurses have left the profession due to the challenges of under-staffing, increasing workplace violence and the stress of the job. The cumulative effect of these issues is significant as nurses work continuously with limited resources while caring for individuals who are living longer with chronic disease and comorbidities.

A group of nurses have extended their arms and placed their hands together, palms touching, in a circle signifying unity and teamwork. Only the forearms and hands are clearly visible.

Nurse-Driven Solutions

Given these issues, is there any relief for us nurses? Yes! Nurses are in the best position to guide nurse-driven staffing solutions. The American Nurses Association has developed several free resources to identify the major elements that are necessary to achieve optimal staffing.

Download this free e-book, ANA's Principles for Nurse Staffing, 3rd Edition, which guides nurses in identifying and developing processes to improve nurse staffing at every practice level and setting. At just 25 pages this short guide is packed with great information that addresses interprofessional teams, workplace culture, practice evaluation and more.

View this free webinar, What’s Happening with Nurse Staffing? and hear how to use the revised principles in day-to-day nursing practice and as a guide to inform nurse-driven solutions to attain appropriate nurse staffing.

Download this free infographic, Principles for Nurse Staffing, and learn about the 5 Principles for Nurse Staffing

ANA at the Staffing Forefront

ANA also is on the forefront of actions to improve reimbursement of nursing care, foster the ongoing conversation about the nursing profession in the health care financing system, and elevate the indisputable value of nursing care.

The Nurse Staffing Think Tank launched by ANA and other leading organizations produced a series of actionable strategies that health care organizations could implement within 12 – 18 months.

The Nurse Staffing Task Force, another collaboration between ANA and other leading nursing organizations, identified another 65 proposed long term recommendations designed to spur innovation, policy and regulatory action, encourage new care models, and effectively support direct care nurses and nurse leaders in their quest for appropriate staffing. The Nurse Staffing Task Force also developed a definition of appropriate staffing:

Images sourced from Getty Images

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