Nurses and unlicensed personnel strive to provide optimum patient care. However, this becomes more difficult when their work load is increased. In a concerted effort to satisfy budget constraints, the ratio of nurses to patients is regulated.
Unfortunately, when short staffing in nursing occurs, both licensed and unlicensed personnel on duty need to have a series of coping mechanisms in place. Such strategies have resulted in improved patient outcomes and improved job satisfaction for health care professionals. These evidence-based strategies intend to improve patient care and enhance overall job satisfaction as reported by staff.
Linda Laskowski-Jones, RN, APRN, CCRN, CED, MS, and Kara Toulson, RN, CEN, BSN, (Linda Laskowski-Jones & and Kara Touslon, 2007, vol. 37 #10) have worked in collaboration to offer several strategies for short staffing such as follows:
Prioritize assignments. Nurses should start with most important assignment first. Then, they should tackle the assignment with medium priority. Assignments such as patient education might fall under this category. However, preparing the patient for a surgical procedure that is scheduled for that day demands immediate attention.
Improve on delegation skills and use unlicensed staff wisely. Effective delegation is increasingly important when there is a reduction in staff. Consider the following situation: there have been two call outs on a busy medical-surgical unit, and the primary nurse is now caring for six patients versus four. Two of her patients struggle with end stage renal disease, and they require daily weights. Weighing a patient can be done by unlicensed staff; however the interpretation of the data rests in the hands of the nurse. Nursing delegation is a key to effective time management.
Consider the following scenario: the primary nurse has an increased work load and she is caring for two dialysis patients. In this situation, she could delegate weighing those patients to unlicensed staff. The interpretation of the data, however, rests in her hands. Similarly, obtaining blood pressure measurements or blood glucose readings can be efficiently done by unlicensed staff, but the interpretation and treatment is the responsibility of licensed staff. Similarly, one nurse should not routinely have the heaviest patient load. Dispersing the severity of the patient load improves the nurses’ morale, and it improves overall patient safety.
Be a team-player. This means that the nurse is dedicated to working with her colleagues in an effort to provide supreme patient care; her needs and feelings come next. Laksowki-Jones, RN, further added that being a team-player improves the morale on the unit, and it motivates the staff to, “…continue doing what they are doing.” Similarly, being a team player makes the staff feel as if they are part of a great plan: to provide supreme patient care. And, this plan can be done even in lieu of short staffing.
Organizing the work load in an equal and efficient fashion is another method to demonstrate teamwork. And, it allows staff to accomplish their goals in lieu of short staffing. Effective delegation between licensed and unlicensed staff also reduces the fatigue of one person, it reduces overall negativity, and it enhances morale in a fashion similar to teamwork.
Involve the family in patient care activities. This can also reduce the work load, and it can increase their sense of self-efficacy and involvement. Many times care-givers are afraid of providing care, but if they are offered the opportunity to practice in a safe-environment, their comfort level is likely to increase. In this safe-environment, families or friends will have the opportunity to ask questions that they might have. Likewise, this time of sharing and intimacy can make the patient and the care-giver view themselves as a unit in the treatment process.
In a similar article, Christina Orlovsky (Orlovsky, 2005) encourages nurse managers to be an ally for their staff. They could call in other staff and offer them incentives to come in to help. Or they could inform the hospital’s nursing administration and network appropriately.
In many cases, staffing agencies can be used to recruit personnel. However, if short staffing situations are a pattern, it is the nurse managers’ duty to examine the cause and to propose solutions for repair. In the wake of short staffing, the house staffing officer should be notified. In her article, Orlovsky proposes,"… that managers should notify administration as soon as they identify the need for staff, or they could call in off-duty staff and offer them incentives to come in to work. When possible, nurse managers could assist with patient-care on their unit."
In a related article, titled “Hospital Nurse Staffing and Quality of Care,” Mark Stanton encourages nurses to maintain a positive attitude. Patients and their families can sense when a nurse is frustrated or overworked, and being positive equates to improved patient satisfaction and outcomes. Similarly, he suggests that nurses take good care of themselves and ask for what they need. Much too often, nurses feel that they have to carry the entire work load on their shoulders, and this can lead to dissatisfaction and compromised patient care. However, simply by delegating or asking for what they need, the situation can be resolved. Nurses need to take care of themselves; this means that taking breaks for meals is important and getting the proper amount of rest is crucial. Hunger and fatigue can negatively affect performance and attitude.
Short staffing is one of the perils of any profession but it can be a more severe problem in nursing. Having the right number of staff to care for the number and the severity of patients on the unit, without exceeding the proposed budget, is difficult to achieve. And, its success depends on understanding and practice.