The real costs of short-sighted nurse staffing schemes

FigureNow and again, seminal research is published with outcome data validating safety issues that nurses have elevated to administrators but found their calls to action fell on deaf ears. The need for safe staffing is one such issue and often the primary reason nurses decide to stay or leave positions. Units with poor nurse staffing can become revolving doors, with new nurse hires coming in and quickly going out because of both poor patient safety and untenable workload experiences. Worse yet is when administrators normalize inadequate nurse staffing into the annual budget. Then, even returning to the previous baseline staffing budget becomes an insurmountable task because nurse leaders are perceived to be asking for new positions. The administrative response just might be, "Well, you survived with fewer nurses last year—why can't you do it this year? " Hospitals may also develop alternative staffing models that use lower numbers of RNs and higher percentages of assistive personnel and then tout the model to be just as effective, yet cheaper than staffing with more RNs. To be fair, some organizations have had to implement alternative staffing models as a short-term survival strategy to take care of patients because they were unable to hire enough nurses. However, this strategy should be just that. . . short term because it comes with significant costs. To that end, Lasater et al. 1 investigated the outcomes of alternative hospital staffing models or skill mix that used fewer RNs to care for patients. Their study population encompassed nearly 6. 6 million Medicare patients in 2, 676 general acute care US hospitals in 2019. Funded through a grant provided by the National Institutes of Nursing Research, this study brings clarity to the costs of having fewer nurses. They found that for every 10-percentage point reduction in RN staffing, the odds of patient mortality increased by 7%. They also found higher odds of increased lengths of stay and readmission and decreased patient satisfaction. Together, they estimated staffing with fewer RNs can lead to nearly 11, 000 additional patient deaths, over 5, 000 avoidable readmissions, an extra 68. 5 million in Medicare costs, and hospitals losing over 3 billion in savings annually due to longer lengths of stay. This critically important research provides objective evidence in defense of safe staffing. I highly recommend reading this open-access article and downloading it as a reference, particularly when staffing stakes are high. Assuring safe staffing is a matter of protecting public health. Until next time, LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN EDITOR-IN-CHIEF, NURSING2024