Nearly three-quarters of nurses who participated in an American Nurses Association (ANA) online poll that drew almost 15,000 responses reported insufficient staffing at their workplace. Forty-two percent of respondents also cited inadequate staffing as the reason they were considering leaving their position—suggesting nurse shortages will worsen.
The results of the anonymous poll that's been live on the Safe Staffing Saves Lives Campaign Web site since March 2008 were released last week, illustrating the need for sufficient nurse staffing and nurses' views on its significance to the delivery of quality patient care.
The majority (84%) of respondents indicated they were employed at hospitals and most (76%) worked full-time. Nearly 75% were staff nurses. Furthermore, nurse experience levels varied, with 55% reporting less than 15 years experience and 45% more than 15 years.
While the number of respondents who reported staff shortages is high, it isn't necessarily alarming, but concerning that it still is an issue.
"Staffing has been an ongoing issue for decades," says Isis Montalvo, MS, MBA, RN, director of the ANA's National Center for Nursing Quality. She adds that the ANA recognized concerns related to sufficient staffing in the early 1990s. "During that time, a lot of hospitals were reengineering and cutting back positions, and nurses knew that cutting back positions would affect patient outcomes. The ANA [has since] funded quite a bit of research and multiple studies to identify the linkages between staffing and patient outcomes." The work continues with ANA's National Database of Nursing Quality Indicators®.
What may be surprising is nurses' candor about the effects such staffing are having on patient care.
For example, more than half of the nurses (52%) who took the poll reported the quality of care on their unit declined in the past year, and half said they would not feel confident having someone close to them receive care in their facility.
"By [the respondents] identifying ‘No, I wouldn't come to this facility,' that says something because they're in that working environment," Montalvo says. "And while we want to all take pride in what we do, nurses are first and foremost patient advocates. So they are being very candid about their work environment and why they may not want family to come there."
Time—or nurses' lack of—appears to be one factor influencing care quality.
Sixty-six percent of nurses reported that they "always" perform non-nursing activities, such as delivering meals, transporting patients, and drawing labs, while still carrying out their usual nursing duties. A meager 2% reported "never" performing non-nursing tasks. In addition, nearly one-quarter said they were "rarely" able to take a full meal break.
Looking to the future, much needs to be done to keep nurses from flocking from the profession. "When it comes to retaining nurses and taking a look at the work environment, there are many aspects that are very important for nurses," Montalvo says. "Is there shared decision making? Are they being included in the decisions that make an impact in their work environment, as for their patients? Do they have autonomy in their respective roles?"
Montalvo also stresses the need for collegial relationships, strong nurse leadership, and nurse managers with the ability to support staff in their work and advocate on their behalf.