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Effects of Improper Staffing on Nursing Outcomes in the Clinical Setting

Kelsey Garcia

Health Science, CSU Channel Islands

HLTH 499: Senior Capstone Project

Ashley Winans, DHSc, MSHI, MA

March 7, 2021
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Effects of Improper Staffing on Nursing Outcomes in the Clinical Setting

With the profession of nursing requiring around-the-clock interventions, proper staffing

in the hospital setting becomes a crucial factor in producing positive outcomes for the patient as

well as the nursing staff. Low staffing or high nurse-to-patient ratios, reduce job retention of

nurses, decrease the qualify of a nurse’s performance, and decrease patient satisfaction and

safety. With the ongoing nurse shortage within the United States, it becomes imperative to

implement the necessary changes to prevent the exacerbation of these factors and improve

satisfaction within the nursing profession.

Nursing Retention Rates

Due to the already existing tiresome and stressful nature that encompasses the nursing

profession, inadequate staffing only intensifies these factors producing greater job

dissatisfaction, which in turn, can create lower nursing retention rates. Authors for the Journal of

the New York State Nurses Association delve into improper staffing being the number one

stressor within the nursing field furthering job dissatisfaction and reducing job retention. These

authors demonstrate that while 64.6% of nurses surveyed stated there was a nurse-to-patient ratio

utilized on the unit, that ratio was only upheld 22.1% of the time (DeGaray, Esposito, &

Sollazzo, 2020). A staff ratio being utilized but not upheld, not only creates dissatisfaction with

the job but also of the employer. Inadequate staffing produces additional stress and fatigue due to

the increase of workload but also can create frustration as the nursing staff is not being provided

the necessary tools to be efficient, effective, and successful in their role by their employer. An

additional study provided by authors for Nursing Outlook demonstrates the severity of nurse

burnout and the level of increasing dissatisfaction with each additional patient the nurse is

assigned, increasing the nurse-to-patient ratio. Results revealed that increasing the
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nurse-to-patient by one increased burnout by 7% and job dissatisfaction by 8% further

demonstrating the negative implications of inadequate staffing amongst nurses (Bae, Park, &

Shin, 2018). The level of stress that occurs as a result of incompetent staffing, not only spurs

dissatisfaction of the job by nurses but also individual dissatisfaction regarding performance. As

nursing is typically considered a trusted profession due to its ethical obligation, nurses who are

unable to complete all the anticipated tasks due to a lack of complement staffing can result in

feelings of “moral distress” due to the thought that they did not meet the standards of effective

care that are assumed within the nursing profession (DeGaray, Esposito, & Sollazzo, 2020). The

feeling of ineffectiveness or lack of accomplishment can not only further job dissatisfaction but

also a detachment from the job decreasing the retention rate of nurses (DeGaray, Esposito, &

Sollazzo, 2020). Nurse burnout as a result of extreme stress and fatigue decreases the retention

rate of nursing, only furthering the nursing shortage creating an endless cycle of inadequate

staffing. Providing or upholding adequate nurse-to-patient ratios can reduce job dissatisfaction of

the position and employer, increase retention rates, and improve a nurse’s outlook on individual

performance.

Nursing Performance

While inadequate staffing can negatively impact a nurse’s outlook on individual

performance, studies also demonstrate that improper staffing produces an environment that

hinders nurses’ ability to be successful in their role. Despite nurses typically viewed as having

skills such as proper time-management, organization, and the ability to multi-task, an overload of

patients presents the inability to spend adequate time and focus on each patient. Increasing a

nurse’s workload beyond the proper ratio only decreases the nurse’s ability to perform effectively

and efficiently. In a review of nurse’s responses, hygiene, mobility, and skin integrity
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assessments were only some of the physical care tasks that were unable to be completed before

change-of-shift as a result of work overload from incompetent staffing (DeGaray, Esposito, &

Sollazzo, 2020). In addition to task incompletion, results demonstrate that 71.5% of nurses were

missing changes in patient conditions and status due to understaffing, hindering not only the

performance of the nurse but also the care of the patient (DeGaray, Esposito, & Sollazzo, 2020).

Inadequately providing the tools and resources that enable nurses to succeed prevent nurses from

completing their tasks effectively and inefficiently, which in turn, reduces the quality of care

provided by the nurse and creates a negative individual outlook by the nurses. As noted in a

systematic review by author Kevin Shimp for the Nursing Economics journal, providing nurses

with proper staffing not only improved job and employer satisfaction but also minimized the job

demands allowing for improved job performance and quality of the nursing staff (Shimp, 2017).

Not only does nurse performance relate to necessary tasks to complete for the care of the patient

but performance also requires collaboration with other health care professionals, such as

physicians, to provide efficient and effective care. High nurse-to-patient ratios reduce the time

available for nurses to spend collaborating with others to provide the necessary care for the

patient, which only continues to hinder nursing performance. A nurse can’t perform effectively

in their role if their provided work environment is consistently working against their success and

only hindering their ability to achieve it.

Patient Satisfaction and Safety

As clearly demonstrated through a variety of research articles and studies, inadequate

staffing greatly impedes the satisfaction and performance of the nursing staff. These adverse

outcomes of incompetent staffing not only impede on the nurses but unfortunately directly

impact the satisfaction and safety of the patients being treated. With the working environment
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creating inabilities for nurses to complete necessary tasks, adverse outcomes are seen on the

condition and status of the patient. Author, Melita Persolja, for the Journal of Nursing

Management discusses the relation of nurse staffing to patient satisfaction, needs, and safety. The

work of this author demonstrates that more than 50% of the patients researched did not receive

assistance from nurses for hygiene, mobility, elimination, feeding, as well as decrease of

monitorization of infusion lines and vital signs, which was observed in connection to improper

staffing (Persolja, 2018). This decrease in nurse-to-patient interaction due to excessive work and

patient load can create negative outcomes for the patient regarding their healthcare as lack of

monitorization increases safety risks. Margo Halm, author for the American Journal of Critical

Care utilizes her work to demonstrate the influence appropriate staffing has on patient status and

outcomes. According to this research, patient health implications such as falls, hospital-acquired

pressure injuries (HAPI’s), catheter-associated urinary tract infections, surgical site infections,

sepsis, and heart failure are all seen to increase when adequate staffing is not utilized in the

clinical setting (Halm, 2019). As patients come to the hospital to improve their complicated

health status, it is of the utmost importance to provide nurses with the environment to improve

the healthcare and lives of these patients rather than put their health status at additional risks. No

patient should be forced to undergo additional health complications as a result of a clinical

environment that lacks the provision of resources and tools that enable nurses to succeed and

improve a patient’s health. Not only does high nurse-to-patient ratios hinder the safety and health

of patients but also, reduces the satisfaction and confidence of patients regarding the care they

receive from the nurses. When reviewing patient satisfaction, results showed that patients did not

feel their nurse’s assumption of their needs accurately aligned with what their actual needs were,

reducing the ease of the patients. (Persolja, 2018). Increase nurse workload decreases the amount
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of time that can be allotted to each individual patient that the nurse is assigned to. With a

decrease in nurse-to-patient interaction, this can be seen creating unease and dissatisfaction

amongst patients as well as their families who may serve as an aid to the patient’s health care

needs upon discharge. Therefore, providing nurses with an environment for success through

adequate staffing can improve patient outcomes by reducing falls, mortalities, length of patient

stays, cardiac arrest events, and complications at discharge. Promoting nursing performance not

only improves the care through greater job satisfaction but is also seen greatly improving the

outcomes of these patient’s health status and safety during and after their hospital stay.

Conclusion

Proper staffing within the nursing profession is a critical component for nurses to

continually provide effective health care for patients while maintaining job satisfaction. The

significance of maintaining nurse-to-patient ratio aids in ensuring staffing accurately accounts for

the needs and required time that may be necessary by the varying patient demographic.

Providing nurses with the proper resources and tools for success cannot only reduce adverse

outcomes within the nursing profession but can begin to bridge the gap that is seen through the

nursing shortage in the United States. Withholding and implementing a proper nurse-to-patient

ratio can be seen to improve nursing retention, nursing performance, and patient safety and

satisfaction.
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References

Bae, S., Park, J., & Shin, S. (2018). Nursing staff and nurse outcomes: a systematic review and

meta-analysis. Nursing Outlook, 66(3), 273-282.

https://doi.org/10.1016/j.outlook.2017.12.002

DeGaray, C., Esposito, C.L., & Sollazzo, L.C. (2020). Nurses unions can help reduce burnout,

depression, and compassion fatigue, part 2: NYSNA 2020 staffing and job stress survey

results. Journal of the New York States Nurses Association, (47)2, 32-44. Retrieved

March 4, 2021, from

https://issuu.com/nystatenursesassociation/docs/nysna_journal_v47n2?fr=sYjg2MTE5OT

MyMjc

Halm, M. (2019). The influence of appropriate staffing and healthy work environments on

patient and nurse outcomes. American Journal of Critical Care 28(2), 152-156.

doi:https://doi.org/10.4037/ajcc2019938

Persolja, M. (2018). The effect of nurse staffing patterns on patient satisfaction and needs: a

cross-sectional study. Journal of Nursing Management, 26(1), 858-865. DOI:

10.1111/jonm.12616

Shimp, K.M. (2017). Systematic review of turnover/retention and staff perception of staffing and

resource adequacy related to staffing. Nursing Economics, 35(5), 239-259. Retrieved

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