Nurse Understaffing a Threat to Public Health Even Before COVID-19

An extensive survey showed that many hospitals in New York and Illinois were understaffed before the first surge of COVID-19 patients. Furthermore, over half of the nurses were already burnt out due to heavy workloads and dissatisfied with their jobs.

Evidence for nurse staffing legislation

The study “Chronic Hospital Nurse Understaffing Meets COVID-19” was recently published in BMJ Quality & Safety. In both New York and Illinois, nurse staffing legislation has been under consideration for many years. The main purpose of the study was to collect current local evidence to inform these policy decisions. The researchers wished to show how variations in nurse staffing levels affected patient care. 

The survey was conducted between December 2019 and February 2020 – by coincidence just before the COVID-19 pandemic. Thus, as pointed out by the authors, the data also provided a real-time example of the public health consequences of chronic nurse understaffing. “It is an immense credit to nurses that in such an exhausted and depleted state before the pandemic they were able to reach deep within themselves to stay at the hospital bedside very long hours and save lives during the emergency,” said Karen Lasater, lead author of the study.

Findings of the survey on nurse staffing

The survey data included information provided by registered nurses involved in direct patient care in non-federal hospitals. This information was then correlated with patient assessments of their care in the hospitals where these nurses worked. The samples included 4298 RNs working in medical-surgical units in 254 hospitals and 2182 RNs working in ICU’s in 179 hospitals.

The study found that average staffing in medical-surgical units varied from 3.4 to 9.7 patients per registered nurse. In most facilities, the ratio was far worse than the one nurse to four patients proposed in the hospital nurse staffing bills, which implies a significant understaffing level. Average ratios in ICUs were better but with a significant variance of between 1.5 to 4 patients per nurse.

Over half of the nurses surveyed scored high on the burn-out scale, and nearly a quarter indicated that they planned to leave their jobs within a year. Also significant was that half of the nurses gave their hospitals a poor rating on patient safety, and 65% reported that care was often delayed due to insufficient staff. Among the nurses surveyed, 70% said that they would not definitely recommend the hospital where they worked to family or friends. 

Furthermore, unfavorable ratings of the quality of care and safety in hospitals, both the nurses and patients, were strongly associated with poorer staffing ratios.

Nurse staffing levels documented

“This study provides an important public service by documenting in real-time and in states debating current nurse staffing legislation actual hospital nurse staffing levels — information not now easily accessible to the public – and consequences of such great variation in an essential component of hospital care — nursing,” said Maryann Alexander one of the coauthors and Chief Officer at the National Council of State Boards of Nursing.

The study was conducted by the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, and the National Council of State Boards of Nursing.

Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.

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