No single healthcare issue has prevailed quite as long as sufficient nurse staffing. Nurse staffing is a complex, debated, diminished and highly researched variable in the formula that results in safe, high-quality patient care. The complexities of nurse staffing revolve around our ability to quantify a sufficient number and mix based on the needs of each unique shift, care unit and facility; identifying, collecting, measuring and evaluating those outcomes most sensitive to the care provided by the professional nurse; and willingly adjusting staffing number and mix to result in the best outcomes.
Although there have been a few junctures when a true shortage of RNs existed; there is always an excuse for keeping this most vital resource for patient safety and quality outcomes in limited quantities. Hospitals cry that the cost is too high and that nursing is the single largest line item in the budget. Why not? Patients are admitted to a hospital for one primary service: nursing care. Surgery, diagnostics and most treatments can be managed on an outpatient basis; but ongoing, comprehensive, highly skilled nursing care is the service for which patients come to the hospital. Of course the line item will exceed others. Using fewer RNs and substituting unlicensed or lesser-skilled nursing staff to provide care to more patients is not the answer. The downsizing, redesigning and restructuring fiascos of the 1990s demonstrated that all too clearly.
For the past 20 years, there has been escalating and increasingly sophisticated health services research that uses structure, process and outcomes indicators most closely linked to nursing services to measure the relationship between nurse staffing levels and patient outcomes. Findings show the tipping point in patient care assignments that result in increased readmissions, mortality and poorer outcomes, yet still the findings are ignored and hospitals choose to lay off nursing staff. If a hospital sees that increased readmission rates will result in a reduction in reimbursement rates, then why lay off nurses as a cost-sparing measure?
The imperative to force accountability for safe, high-quality care among those facilities receiving compensation for nursing care is a priority. Members of AFT Nurses and Health Professionals are persistently addressing that kind of accountability and advocating for safe and appropriate staffing levels through collective bargaining, community education, and state and federal legislative initiatives.