Hustle and Bustle

So I stroll into work, expecting an average day, but alas my supervisor tells me I am going to be coordinating the care of five patients today rather than my usual three to four patients due to inadequate staffing. As a nurse, I’m sure you have all been there. Someone calls in sick, and there is not enough staffing. My hospital usually has fantastic staffing, don’t get me wrong–but it happens when there are just not enough caregivers for the patients. And in the part of the country I work, it’s a lot better than say the east or west coast, but could still use some improvement. Nurses get overloaded.

Calling in sick to nursing isn’t like calling in sick to McDonald’s. Someone gets their burger two minutes later than usual, not a big deal. Someone doesn’t get their chemo pill or cardiac medication or blood thinner on time, it’s a big deal. Someone falls and no one is there due to inadequate staffing, it’s a big deal. Someone’s unconscious and no one noticed because we don’t have time for hourly rounds, that’s a big deal. Of course everyone gets sick from time to time, everyone has things that just simply come up in life, and it’s ok–the system should account for that, but it doesn’t always do that. Staffing issues fall on both sides of management. Sometimes the system fails.

With staffing some coordinators look at patient acuity and divvy out patient’s accordingly. But others, pay little attention, and just cut the hospital wing in half. On this particular day I got the top half of the wing…one of my patient’s was unconscious when I arrived requiring emergent action, one patient required two blood transfusions, one patient was a stubborn surgical that needed to be up walking every two hours, and two patient were being discharge which involves a lot of paperwork and education, one of the two discharge patient’s required extensive Foley catheter care teaching. Days like that really suck.  That’s the thing about inadequate staffing, one day it’s doable, but the next when you have emergencies come up, it’s impossible. On days like that, I’m blessed to have the very best team of staff in the hospital (in my opinion of course).

Why should hospitals and patient’s care about adequate staffing?

Patient safety and Quality of Care

  • The odds of patient death increases by 7% for each additional patient the nurse must take on at one time (Journal of the American Medical Association, 2002).
  • RN’s have less rapport, when all they have time for is “business.” Nurses need time for therapeutic communication to gain trust and accurately assess patients.

Medical Errors

  • Meds are given late or inaccurately when there is not adequate staffing. The rush to get every patient’s medications given as close to on time as possible creates an environment that is a breading ground for errors.

RN Retention (Adds experience and saves fiscally)

  • Nurses reported greater career dissatisfaction and emotional exhaustion when they were responsible for more patients than they can safely care for (Journal of American Medical Association, 2002).

Decreased Hospital Readmission Rates

  • I’m sure you are familiar with, “If you don’t have time to do it right, when will you have time to do it over?” It’s the same concept here, if the RN has more time to spend with their patient’s they will be more likely to catch and report critical findings that could prevent readmission in the future or at the very least have more time for education upon discharge that ensures the patient truly understands the information.

I am by no means an expert in staffing and know this is a complex issue with a labyrinth of barriers, so I am grateful for our supervisors that do the best they can with what they have to work with. There are many more things I could say, but I’m afraid the human attention span isn’t very long (you might not even make it to the end of this article!) so I had better save those thoughts for another day. I’d like to say the easy solution was to just hire more nurses, but management has a budget they need to follow and their is a nationwide shortages of nurses along with many other issues. Change needs to continue and to keep evolving for the best interest of both patient’s and nurses alike, and awareness needs to continue to grow for this to happen.

Thanks for tuning in,


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