Running head: ADEQUATE NURSING STAFF 1

Adequate Amounts of Nursing Staff Save Lives

Carla Fuentes

James Madison University

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Abstract

When nurses work understaffed they must increase their nurse-to-patient ratio which puts the

patient’s health at risk. Inadequate nursing staffing levels have an adverse effect on patient’s

outcomes. There are several contributing factors that have led to the nurse shortage, but an

increase in nurse dissatisfaction can be linked due to working short staffed. Nurses are required

to practice under an ethical and legal oath, but when working understaffed it jeopardizes the

integrity of the oath as well as the patient’s health. The nurse’s perspective and recommendations

on the nursing shortage will be stated.

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Adequate Amounts of Nursing Staff Save Lives

Registered nurses are the backbone of health care. Licensed practitioners depend on

nurses to follow through with the tasks they order while patients rely on nurses to take care of

them. Unfortunately, working understaffed limits the quality of care that nurses can provide for

their patients. Contributing factors that have led to the nursing shortage include low nursing

school enrollment, shortage of nursing school faculty, increased number of retired nurses, and

job dissatisfaction. Inadequate nursing staff levels have an adverse effect on a patient’s outcome,

including delayed or missed care leading to falls, infections, medication errors, hospital

readmission, and death. When nurses work understaffed they are at a higher risk for malpractice

for failing to follow the elements of liability. The nurse agrees that when working understaffed it

negatively affects both patients and nurses. Recommendations to improve the nursing shortage

include hiring nurse and providing opportunities for working extended hours. As well as for

nurses to follow the American Nurses Association (ANA) Code of Ethics.

Background

Unfortunately, the national shortage for nurses has been an ongoing challenge for several

years. There are several contributing factors to the nursing shortage. Nursing school enrollment

is low for the projected demand of registered nurses which could be caused by the shortage of

nursing school faculty (AACN, 2019). Another contributing factor is the significant number of

registered nurses that are nearing retirement age. According to AACN (2019) “50.9% of the

registered nurse workforce is age 50 or older” (p. 2). Lastly, inadequate staffing increases stress

levels for nurses leading to job dissatisfaction and driving many nurses to leave the profession.

There is a correlation between the inadequate amount of nursing staff and patient quality

care. Increased patient workload on nurses causes delayed, unfinished, or missed patient care.
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The most frequent patient care activities missed due to inadequate amounts of nursing staff

include ambulation (84%), turning (82%), patient teaching (80%), assessing effectiveness of

medications (83%), and timeliness of PRN medication administration (80%) (Blouin &

Podjasek, 2019). These missed patient care activities increase the patient’s risk of falling,

pressure ulcers, readmission rates, and poor controlled symptoms like pain and nausea. Low

amounts of nursing staff and higher rates of adverse patient outcomes are directly related. Some

of these adverse patient outcomes include pneumonia, shock, cardiac arrest, and urinary tract

infections (Martin, 2015). When a nurse adds one more patient to their assignment there is a 16%

increase in the likelihood of a patient dying (Blouin & Podjasek, 2019).

While patients suffer from inadequate staff numbers, they are not alone. Nurses also

suffer from the low employment in hospitals and other medical facilities and can create a

negative cycle, resulting in burnout job dissatisfaction, career fatigue, increased work-related

stress, and higher intent to leave. The AACN (2019) stated, “More than 75% of registered nurses

believe that the nursing shortage interferes with the quality of patient care and the amount of

time spent with patients” (p. 3). When nurses leave their jobs, the remaining nurses are left with

an increased workload and job stress causing increased burnout and turnover. Nurse fatigue can

lead to decreased work performance which can increase the risk of adverse events and

compromise patient safety.

Legal Standards

Working under these unsafe conditions puts nurses license in jeopardy. Some malpractice

cases against nurses are due to improper supervision and delegation, early patient discharge, and

nursing shortage (Croke, 2006). When a nurse has more patients than they can handle they are at

risk for failing to follow all elements of liability including duty, breach of duty, foreseeability,
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causation, and injury. A nurse can be found guilty for failing to follow duty when accepting an

unsafe nurse-patient ratio assignment. Breach of Duty is when a nurses’ care falls below the

acceptable standard of care owed to the patient (Croke, 2006). When a nurse forgets to reassess a

patient after administering an analgesic like Oxycodone due to being tied up in another’s patients

room the nurse can be filed for malpractice failing to follow breach of duty.

Ethical Dilemma

An ethical dilemma that any nurse may struggle with is nonmaleficence which requires

nurses to avoid harming their patients. The nurse believes that when nurse staffing levels are

inadequate, the ability to practice ethically is questionable. This is not only morally demanded of

nurses, but also legally demanded by the profession. Working inadequately staffed affects the

way in which nonmaleficence can be carried out. As staffing becomes more and more limited,

the principle of nonmaleficence becomes harder to follow.

Nurse’s Perspective

Although the nurse has been working as a registered nurse for approximately 2 years, she

has personally dealt with working understaffed on multiple occasions. The unit the nurse works

on has dealt with inadequate nurse staffing since she started as a new graduate nurse. From the

nurse’s experience, she agrees that it is hard and unsafe to take care of ill patients. Working

understaffed takes away nurse’s resources of having extra help while taking care of patients

especially during emergency situations. For example, there have been times where all nurses are

needed during an emergency and by being short-staffed, there were not enough nurses leftover to

safely monitor remaining patients. The nurse has personally dealt with nurse fatigue, especially

after being short staffed.

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Recommendations

The nurse recommends for unit managers and charge nurses to communicate with staff

nurses ahead of time when shifts will be understaffed. Knowing ahead of time provides the

opportunity for someone to pick up shifts. It also prepares the nurses to work harder and stronger

as a team. Overtime and critical shift bonuses should be offered and accepted by the manager for

nurses who accept working extra hours. Working extended hours increased positive patient

outcomes including patient identification errors, pressure ulcers, communication errors and

patient complaints (Kunaviktikul, et al., 2015). The best way to improve inadequate nursing staff

is to hire more registered nurses. To attract nurse candidates, the manager can set up nurse fairs

and open available spots on the hospital’s job opportunity page. Another way to increase nursing

staff is to contract travel nurses, but the manager should make it a priority to hire permanent

nurses within the hospital’s organization.

The nurse can testify that it is physically and emotionally hard to work a 12-hour shift

understaffed. She recommends nurses to remember and follow the ANA Code of Ethics during

all shifts. One of the most important provisions in the ANA Code of Ethics that all nurses should

follow is provision 5.1 Duties to Self and Others. This provision states, “Nurses must take care

of themselves before taking care of others” (ANA, 2015, slide 12). The nurse believes that to

take care of themselves before others can create a healthy environment of general wellbeing and

lead to better care for patients. Another major provision that the nurse believes is important is 5.2

Promotion of Personal Health, Safety, and Well-being (ANA, 2015, slide 13). When nurses have

days off from work they should focus on eating a nutritious meal, exercising, developing healthy

sleep patterns, and enjoying time with their friends and family. It is essential for nurse’s well-

being to have a balance in personal and professional life.

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In conclusion, when nurses are inadequately staffed it affects their ability to deliver safe,

quality care for their patients. Adverse outcomes for patients due to inadequate staff include falls,

infections, medication errors, hospital readmission, and death. Unfortunately, there has been a

national shortage of nurses due to low nursing school enrollments, shortage of nursing school

faculty, increased number of retired nurses, and job dissatisfaction. Nurses are at risk for

malpractice due to failing to follow legal and ethical demands. The nurse recommends that to

prevent understaffing, hospitals should hire more nurses while offering overtime and critical pay

for those who want to work extended hours during the week. Following the ANA Code of Ethics

will help nurses get through difficult shifts when understaffed, but overall adequate amounts of

nursing staff save lives.

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References

American Association of Colleges of Nursing (AACN). (2019). Fact Sheet: Nursing Shortage.

Retrieved from https://www.aacnnursing.org/Portals/42/News/Factsheets/Nursing-

Shortage-Factsheet.pdf

American Nurses Association (ANA). (2015). Guide to the Code of Ethics for Nurses

[PowerPoint slides].

Blouin, A., & Podjasek, K. (2019). The Continuing Saga of Nurse Staffing: Historical and

Emerging Challenges. Journal of Nursing Administration, 49(4), 221–227.

https://doi.org/10.1097/NNA.0000000000000741

Croke, E. (2006). Nursing malpractice: determining liability elements for negligent

acts. Journal of Legal Nurse Consulting, 17(3), 3–24. Retrieved from

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Kunaviktikul, W., Wichaikhum, O., Nantsupawat, A., Nantsupawat, R., Chontawan, R.,

Klunklin, A. Sirakamon, S. (2015). Nurses’ extended work hours: Patient, nurse and

organizational outcomes. International Nursing Review, 62(3), 386–393.

https://doi.org/10.1111/inr.12195

Martin, C. (2015). The Effects of Nurse Staffing on Quality of Care. MedSurg

Nursing, 24(2), 4–6. Retrieved from https://search.ebscohost.com/login.aspx?

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