Understaffing or a shortage of nursing personnel is a common problem for healthcare organizations across the world. According to Jacobson (2015), U.S. hospitals have to deal with chronic understaffing due to the budget restraints and high demand for frontline healthcare workers (as cited in Metcalf et al., 2018). Hudson and Shen (2015) defined understaffing in the healthcare setting as a situation in which too few professionals fulfill essential patient care tasks (as cited in Weigl et al., 2019). Such a situation puts nurses, patients, and the overall quality of medical services in jeopardy. Therefore, there are several reasons why lowering the patient-per-nurse ratio would benefit healthcare workers and patients.
First of all, an excessive number of patients per nurse directly affects the nurses’ health condition. For instance, survey data from medical-surgical units in 254 hospitals across New York and Illinois showed that over 52% of nurses experienced high burnout (Lasater et al., 2021). Consequently, over half of the nurses gave their hospitals negative safety grades, and two-thirds would not recommend those healthcare organizations (Lasater et al., 2021). In addition, Weigl et al. (2019) conducted research among 273 German nurses and revealed a significant relationship between perceived understaffing, increased blood pressure, and increased total cholesterol. Overall, a high patient-per-nurse ratio led to excessive workplace stress, negative job perception, and an increased risk of cardiovascular diseases among the nursing personnel.
Moreover, understaffing can make the situation worse by pushing nurses to leave their jobs or even quit the profession. According to a survey by Sasso et al. (2019), 35,5% out of 3,667 surveyed medical and surgical nurses in Italy expressed a desire to leave their current job due to job dissatisfaction. Moreover, 33,1% of those respondents intended to quit nursing altogether (Sasso et al., 2019). Understaffing and emotional exhaustion were the most prevalent driving factors for leaving the job (Sasso et al., 2019). In this regard, an inability to lower the staffing ratio can lead to an employee turnover, in which dissatisfied nurses leave their jobs and cause additional understaffing. As a result, their remaining experienced colleagues have to face even more stress and work in even less favorable conditions, potentially contributing to the turnover in the future.
The high patient-per-nurse ratio also poses a threat to patient safety since tired and emotionally exhausted nurses are more prone to making medical errors. A study by Metcalf et al. (2018) revealed a direct correlation between the rates of understaffing and the number of treatments missed by respiratory therapists. In particular, high workload due to inadequate staffing led to an increased probability of mistakes (Metcalf et al., 2018). In addition to direct medical errors, understaffing can harm patient safety indirectly. For instance, a tired nurse can forget to enter important data into the patient’s health record, which could lead to subsequent severe mistakes in diagnosis and treatment.
Overall, inadequate patient-per-nurse ratios proved to be harmful both for the nurses and their patients. Understaffing creates negative health implications — the nurses suffer from such conditions as professional burnout, emotional exhaustion, increased blood pressure, and high cholesterol levels. Meanwhile, the patients become exposed to a risk of medical errors. In addition, experienced nursing professionals might leave their jobs after becoming dissatisfied with working conditions, which might result in high employee turnover. Therefore, healthcare organizations should implement measures for lowering the nurses’ workload in order to avoid these negative consequences.
Lasater, K. B., Aiken, L. H., Sloane, D. M., French, R., Martin, B., Reneau, K., Maryanne, A., & McHugh, M. D. (2021). Chronic hospital nurse understaffing meets COVID–19: an observational study. BMJ Quality & Safety, 30(8), 639–647. Web.
Metcalf, A. Y., Wang, Y., & Habermann, M. (2018). Hospital unit understaffing and missed treatments: primary evidence. Management Decision, 56(10), 2273–2286. Web.
Sasso, L., Bagnasco, A., Catania, G., Zanini, M., Aleo, G., Watson, R., & RN4CAST@ IT Working Group. (2019). Push and pull factors of nurses’ intention to leave. Journal of Nursing Management, 27(5), 946–954. Web.
Weigl, M., Schmuck, F., Heiden, B., Angerer, P., & Müller, A. (2019). Associations of understaffing and cardiovascular health of hospital care providers: a multi-source study. International Journal of Nursing Studies, 99, 1–9. Web.