By Karen Haller, PhD, RN
VP of Nursing and Patient Care Services,
Johns Hopkins Hospital
For 2006, the International Council of Nurses has taken “Safe Staffing Saves Lives” as its theme and is focusing the world’s attention on this concept. There are few definitions or policy statements that merge the concept of safe with staffing. Most of the rhetoric on staffing, and nurse-to-patient ratios in particular, has been about workload.
What is safe staffing? One of the best definitions comes from the American Federation of Teachers: “Safe staffing means that an appropriate number of staff, with a suitable mix of skill levels, is available at all times to ensure that patient care needs are met and that hazard-free working conditions are maintained.” I think we can all agree with this.
But what is the minimum level of staffing that will result in safe care and better outcomes? The exact numbers are ill-defined, however we do know that hospitals characterized by high levels of RN staffing experience fewer cases of urinary tract infections, less upper gastrointestinal bleeding, fewer cases of hospital-acquired pneumonia, and a lower rate of shock or cardiac arrest. There is a growing body of evidence that links hospital staffing to patient outcomes, and suggests that one way to improve quality is to increase staffing.
Can we afford more nurses? Recent research has shown that there is an unequivocal business case for hospitals to improve nurse staffing. Cost is offset by avoiding hospital days, morbidity, and mortality.
Is it all about the numbers or the nurse-to-patient ratios? Clearly not! Staffing goes beyond the numbers to include characteristics of the patient, the qualities of the nurses, and variables in the work environment. Patient characteristics include medical complexity and social support. Nurse qualities include education level, experience, and expertise. Environmental variables include nursing leadership, the autonomy and control exercised by nursing, and the status of nursing in the organization.
We know that the quantity of nurses is related to fewer adverse patient outcomes; but the quality of nursing practice also has an effect that is independent of the numbers.