There’s no denying the correlation between nurse staffing levels and patient outcomes. As the Baby Boomer generation continues to retire, the need for additional medical attention increases (hospitals, aging facilities, etc). But because the nurse population mirrors the overall population, this means we also face a bubble of nurses entering retirement, reducing the number of experienced health care staff available to serve patients and creating new stresses on health care teams and health care facilities. A recent article in the Wall Street Journal stated that the United States is in the midst of a nurse retirement epidemic. These and other trends are creating exposures nurses are facing today and into the foreseeable future.
Risk experts at Nurses Service Organization (NSO) identified key risks for nurses as a result of staffing shortages:
1. Higher patient loads.
The Affordable Care Act has impacted the volume of individuals with health insurance, including individuals with complicated issues who once used to only seek treatment when necessary through the ER. This larger and more complex patient load places additional pressures on nurses. When care suffers, positive outcomes are negatively impacted, which only strikes down hospital reimbursement rates, making it all the more difficult for hospitals to be able to afford additional highly qualified nurses. It’s a vicious cycle.
2. Extended hours.
As shifts stretch (often last minute), fatigue becomes more of a factor, mental acuity may suffer, and the opportunity for an incident increases. When combined with increased patient ratios, nurses have more opportunities to, inadvertently, make mistakes and injure those they serve or themselves. These added hours also can create job dissatisfaction, which stresses health care teams and staffs.
3. Increased responsibilities.
Nurses are at the center of patient care, acting as an advocate between patients and physicians, and patients and family and friends. More and more, nurses are becoming accountable for the coordination of care and providing informed discharge notes for patients, which extend the potential to impact outcomes and the nurse’s exposure beyond the facility walls.
4. Greater likelihood of “floating.”
The nursing shortage creates gaps in coverage and the need for additional nurses to ‘float.’ Unfortunately, when nurses are assigned to an area they are unfamiliar with, or when a team of nurses has a professional from another department entering their zone, it can create confusion and issues. In fact, the most recent NSO claims report shows agency nurses (who often are sent to help facilities fill gaps in coverage) were involved in nearly 25% of the closed claims in the study. We can expect these workplace dynamics will continue to evolve as facilities move nurses as needed to address shortages on the fly.
5. New nurses entering the workforce.
The next eight years will see a steady stream of new nurses entering the workforce to replace those retiring. Much like nurses who float, these new nurses will need experience, on-the-floor training, and mentoring to acquire the skills needed to master their environment.
As the country continues to see an increase in the number of people ages 65 and up as well as more patients entering the health care marketplace, the nursing shortage will continue to be a concern. This rising concern has the potential to place all nurses into higher risk working conditions they need to protect themselves, and their careers, against.