Safe staffing

Healthcare workers saw the staffing crisis coming.

The COVID-19 pandemic accelerated the staffing shortage, but it did not create it. Frontpage news of overwhelmed hospitals exposed the public to a crisis that’s been building in American hospitals for years. Hospitals were understaffed, in many cases dangerously so, long before the current public health emergency. And now, frontline caregivers are burned out, exhausted from the moral injury of being forced to provide inadequate care; and they are leaving hospital employment in record numbers.

Driven by profit, hospitals and health systems have systematically undervalued and under-invested in the healthcare workforce. While executives enjoy multimillion-dollar compensation packages, healthcare workers have been forced to do more with less. From mandatory overtime to unsafe patient loads, many healthcare workers were stretched beyond their limit long before the pandemic.

Most alarming of all, in 2018, long before the pandemic, assaults on healthcare workers accounted for 73 percent of all nonfatal workplace violence.[1] The situation has only worsened during the pandemic with U.S. healthcare workers experienced a staggering 249 percent increase in injury and illness rates in 2020, based on employer-reported data, as they encountered serious safety and health hazards while serving those in need and labored countless hours battling the pandemic. In fact, healthcare and social assistance workers combined accounted for more injuries and illnesses than any other industry in the nation.[2] Quite simply, America’s hospitals have failed their most basic responsibility: providing a safe place for patients to receive care from healthcare professionals.

As a leading healthcare union, the AFT is committed to advancing long-term strategies to build, strengthen and diversify the healthcare workforce. At the same time, we must continue to create safe and sustainable work environments for health professionals.

When nurses and health professionals are assigned to more patients than they can care for safely, patient safety suffers, resulting in healthcare workers burning out and diminished health outcomes for patients. With unsafe staffing levels, patients are more likely to acquire infections, to be readmitted, and to die.

Research shows that adding just one more patient to a nurse’s workload increases the risk of 30-day in-hospital mortality by 7 percent.[3] In pediatric units, adding just one more patient to a nurse’s workload increases a child’s risk of being readmitted to the hospital within 30 days by 48 percent.[4] Safe patient loads have even been shown to reduce Emergency Department wait times by more than 20 minutes.[5]

Environments where nurses report less burnout also produce better patient outcomes. Better work environments for nurses reduce the likelihood of burnout and intention to leave the profession by nearly one-third. In these work environments, rates of adverse events and death are 8 percent lower and patient satisfaction is 16 percent higher.[6]

We support a team-based multipronged approach to safe staffing.

Patient care depends on a team of professionals. Medical assistants, techs, nurses, physicians, advanced practice providers and others all play an essential role in providing high-quality care. An effective staffing plan will draw on the expertise of all members of a care team and will include three essential pieces: 

  • Safe patient limits to set the floor, not the ceiling, for safety;
  • Staffing committees with robust worker input to create staffing plans that meet the unique needs of individual facilities; and
  • Public reporting of staffing levels to hold hospitals accountable and to keep patients informed.

The AFT supports the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act introduced by Rep. Jan Schakowsky (D-Ill.) and Sen. Sherrod Brown (D-Ohio) that would establish a national floor for safe patient limits and require individual staffing plans to be created in committees with bedside caregivers[LBC1] .