Nursing Staff Shortage

DOI. 10.5281/zenodo.3374196 Mutisya, F.K. International Conference of Kerta Cendekia Nursing Academy. Copyright © 2019 September; 1: Accepted: August 15, 2019 http://ejournal-kertacendekia.id/index.php/ICKCNA/

© 2019 INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY

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ISSUES AND TRENDS IN NURSING ADMINISTRATION: NURSING STAFF SHORTAGE

Faith Kanini Mutisya 1*

1 Machakos General Hospital, Kenya

*Correspondence: Faith Kanini Mutisya Email: [email protected]

ABSTRACT Nursing shortage is an internationally recognized crisis and the biggest challenge in achieving the health system effectiveness. This paper sought to review literature on issues and trends in nursing administrations. Conceptual Framework for Nurse Shortage; Nursing Role Effective model, community-based model and Moos and Schaefer (1993) integrative conceptual framework and Donabedian (1980) were used to guide the study. The findings revealed that nurse staffing is associated with both nurse and patient negative outcomes. It was recommended that an improvement to nurse’s work environments and an increase in incentives may retain nurses in the profession and also attract young people into the profession.

Key words: Nursing administration, nursing staff, health system, nursing shortage.

INTRODUCTION according to patient acuity (Sullivan & Nursing shortage is an internationally Decker, 2009). A shortfall of the required recognized crisis and the biggest number of staffs indicates staff shortage. challenge in achieving the health system The main cause of nurse shortage is effectiveness (Buchan& Aikein, 2008). poor recruitment, and retention polices Hence, the worldwide attention on the (Buchan & Aikein, 2008). Whereas, the association between nurse staffing and most effective strategy to solve the problem patient outcomes (Shuldham, Parkin, is to institute efficient and effective Firouzi, Roughton, & Lau-Walker, 2009). recruitment and retention measures Furthermore, nurse staffing is also linked (McHung, 2010). This remains the sole to negative staff outcomes (Tervo- responsibility of the nurse administrator Heikkinen, Partanen, Aalto, & together with other stake holders. Vehvila”inem-Julkunen, 2008; Kane, 2009). Nurse staffing reflects the ratio of BACKGROUND AND SIGNIFICANCE nurses to patients on a hospital ward. The It is estimated that 7 million in patients number of nurses is quantified in terms of annually acquire infections while being hours of care given and skill mix; whereas, treated for other conditions and nurse patent nursing care needs are classified staffing has been implicated (Cimiotti,

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Aiken, Sloane, &Wu, 2012). Among this (Steinbrook, 2002) as the baby boomers infected patient 1 in every 17 patients die prepare to retire (Beurhaus, 2000). Nursing (Klevens, Edwards, Richards, et al. 2007). workload has increased with decreased The 1990’s witnessed the worldwide length of hospital stay and increased hospital restructuring and reengineering to acuities of patients who need highly skilled achieve higher levels of labor productivity care. Conversely, the demand of nurses is and efficiency in an attempt to, enable high whereas the supply lags behind hospitals to deliver care at lower cost (Cauvorous, 2002). without decreasing quality of care (Aiken, Hospital restructuring and Clarke and Sloane, 2000). This action reengineering of the 1990s resulted in worsened the already prevailing problem of reduction of staff in middle management nursing shortage. By 2020 it is predicted positions which were replaced with that the hospital nursing vacancies will licensed assistive personnel. The reach 29% or 800,000 (American Hospital consequence of the reengineering was a Association, Commission on Workforce for decline of nurse to patient ratio which has a Hospitals and Health Systems , potential to affect patient outcomes (Heinz, 2002).Whereas, the nursing workforce is 2004). expected to increase by 6% while the Low staffing levels impact on nursing care demand is expected to grow by outcomes such as patient mortality, length 40% Health Research and Resources of stay and enormous patient complications Administration, Bureau of Health which include pneumonia, shock, upper Professions, National Centre for Health gastro intestinal bleeding and failure to Workforce (2000-2020). Projection rescue (Aiken, 2002; Needleman, 2002). indicate a mismatch between the supply and Inadequate nurse staffing has been demand of RNs and its demand in many associated with medication errors (Blegen hospitals (Buerhaus, 2008; Buerhaus et al, & Vaughn 1998), patient falls ( Krauss et al. 2009). Africa and south East Asia have the 2005), the spread of infection (Cimiotti, lowest average ratio of nurse (Buchan & Aiken, Sloane, & Wu, 2012), increased Aikein, 2008). mortality Kane, Shamliyan, Mueller, Dural, The main cause of nurse shortage is & Wilt 2007; and failure-to-rescue inadequate workforce planning, allocation (Needleman et al. 2002). Hence, patients mechanism, resource constraints, adverse outcomes are related to higher cost undersupply of new staff, poor recruitment, for both the hospital and the patient ( Myny retention and retention polices ineffective at el;2011). use of available nursing resources through Lankshear, Sheldon, & Maynard inappropriate skill mix and utilization, poor (2005) reviewed 22 multisite studies incentives, structure and inadequate career conducted in acute hospitals that adjusted support (Buchan & Aikein, 2008). for case mix and they concluded that higher Whereas, the most effective strategy to nurse staffing with richer skill mix of solve the problem is to institute efficient registered nurses was correlated with and effective recruitment and retention improved patient outcomes. Conversely, measures (McHung, 2010). Kane, Shamliyan, Mueller, Dural, & Wilt Younger nurses are leaving the career (2007) conducted a study in USA and for other higher paying professions with Canada and found a reduction of length of better working conditions. In addition, stay, failure to rescue and mortality rate there is a delay in recruitment of new nurses when patient and hospital characteristics

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 2 were adjusted with higher nurse ratio. There Staff shortage has been linked with was reduced mortality and adverse events stress as a result of excessive work load where a nurse cared for two or one patient which affects the nurse’s wellbeing. Kane, and the nurse care hours per patient per day (2009) conducted a study to establish the exceeded eleven. Greater improvement was existence and extend of work stress among seen in intensive care units and surgical 106 hospital nurses. The stressors identified units. Risk for mortality per registered were work related, work interactions, job nurse day was 16% in surgical and 9% in satisfaction and home stress. The causes of intensive care unit patients. Each additional stress were job not finishing on time due to patient assigned to a nurse was related to an staff shortage, conflict with relatives, overall risk of 17% for medical overtime, and insufficient pay. Common complications, 7% hospital acquired psychosomatic illness identified were pneumonia, 53% respiratory failure. acidity, back pain, stiffness of neck and Mortality decreased with approximately shoulders, forgetfulness, anger and worry in 2% for every additional nurse. nurse with stress. It is important to explore the issue of In addition, Wu, Chi., Chen, & Jin shortage further since it has serious (2010) found a correlation between implications to the nursing staff too. occupational stress and chronic disease Numerous research studies have implicated while Liu at el (2010) reviewed literature nurse staffing actions in patient safety which revealed a strong relationship (Kane et al., 2007). Therefore, an between stress and undesired health improvement of nurse staffing levels would outcomes among medical professionals improve nurse work environment resulting such as coronary disease, hypertension, better patient outcomes and nurse work life headache asthma, peptic ulcers lower back (Cohen, Holzemer, & Goerrnberg, 2000). pain and mental health. These results to Many research studies have shown lower work productivity, job morale, higher evidence of the relationship between poor absenteeism, job dissatisfaction and higher staffing and poor work environments, nurse turnover. Consequently, leading to higher burnout, turnover and professional attrition operational costs, lower job efficiency and (Aiken, Clarke, Sloane, Lake, & Chang, worse quality of patient care service. Sick 2008; Stone et al 2007). Therefore, nurses take sick offs hence reducing the adequate staffing results to better nurse patient care hours. retention and job satisfaction (Lake & Frizer, 2006; Ulrich, Buerhaus, Donelan, THE CONCEPT OF NURSE Norman, & Dittus, 2007). Nurses develop STAFFING stress when they are unable to cope with the Nurse staffing reflects the ratio of excessive workloads. Staff shortage nurses to patients on a hospital ward. resulting to heavy work load has been cited Higher ratios are preferable because they as the main stressors in the nursing indicate better outcomes for patients. Low profession. Recent studies revealed that 50- ratios mean fewer nurses are taking care of 60% of all lost working days is due to more patients. The number of nurses is occupational stress (cox et al.2000). The quantified in terms of hours of care given intensive care nurses reported shortage of and skill mix; whereas, patent nursing care staff as the most stressful stressor (49.6%) needs are classified according to patient Anita, Cuaderes, & Debra (2006). acuity (Sullivan and Decker, 2009). A

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 3 shortfall of the required number of staffs Many researchers have used nurse- indicates staff shortage. reported perception of staffing adequacy Staffing entails providing nurses to and nurse- reported patient workloads to provide care to patients. There are two measure nurse staffing levels (Kalish, basic types of staffing measures. The first Friese, Choi, & Rochman, 2011). is dividing the number of nurses or Although, administrative data raise nursing services by the quantity of concerns for data completeness, nursing care patient needs. Common reliability, and validity (Mark, 2006). examples include patient-to-nurse ratios, However, the results of the findings have hours of nursing care delivered by been used to make recommendations that various subtypes of personnel per patient have yielded positive results. day (HPPD), and full-time equivalent (FTE) positions worked in relation to CONCEPTUAL FRAMEWORK FOR average patient census (ADC) over a NURSE SHORTAGE particular time period (Clarke & This essay will be guided by three Donaldson, 2008). To determine NHPPD models; firstly, The Nursing Role Effective hospital ward characteristics are model which was developed by Irvine et al. classified as follows; patient complexity, (1998). The model identifies the intervention levels, the presence of high contributions of nurse’s roles towards dependency beds, the emergency/ patients’ outcomes of care. The Nursing elective patient mix and patient turnover Role Effective model is based on the work (Twigg & Duffield, 2009). of Donabedian (1980) whose framework is The second measure examines the composed of structure-process and qualifications of those staff members outcome of quality care (Doran & Pringle, and expresses them as a proportion of 2011). Indeed, the structure influence the staff with more versus less training (or process and the process influences the vice-versa). Staff qualification puts into outcomes of care. Structural variables account the staff mix. These staffs include the patient (age, gender, education, include unlicensed personnel, practical type of illness and comorbidities), nurse nurses, and registered nurses (RNs). (experience, knowledge and skill level) and The specific types of educational organizational (staffing, staff mix, attained by RNs such as baccalaureate workload and work environment). The degrees versus associate degrees and process of care entails the nurse’s roles; diplomas are also considered together independent role (nursing interventions), years of experience (Clarke & medical care-related role (medically Donaldson, 2008). A high Registered directed care and expanded scope of Nurses (RNs) skill mix is required for nursing practice) and interdependent role greater staff flexibility. For example, (team communication, coordination of care Licensed Practitioner Nurses (LPNs) and case management). The outcomes and Unlicensed Assistive Personnel focus on nurse sensitive patient outcomes; (UPAs) can do procedures such as function status, self-care, and symptom general hygiene, feeding, turning and control. Safety/adverse occurrences and transferring patients while the RNs can patient satisfaction (Doran & Pringle, do frequent patient assessment, 2011). Although, the model describes the education and discharge planning role of the nurse other members involved (Sullivan and Decker, 2009).

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 4 with the care will influence the patient outcomes. Secondly, Outcomes model of community-based setting describes the three components; inputs (structure) - process and outcome. The outcomes are divided into two for both the provider and the user of the service. For instance, job satisfaction, patient satisfaction; staff work life and patient functional status are accorded at the same level. This model lays emphasis on work climate as an important outcome for the nurse since it affects how the nurse performs her duty especially with staff short fall (Cohen, Holzemer, & Goerrnberg, 2000). Thirdly, Moos and Schaefer (1993) integrative conceptual framework combines environmental and personal variables in an attempt to describe coping, health and illness status. This model will be used to bring out the relationship between poor work environments (staff shortage) and its impacts on the nurse’s health. In addition, the model puts into account personal factors and life crises and transitions as they would affect an individual’s ability to cope with workloads resulting to ill health. The staff will get sick off or leave aggravating the already desperate ratio of qualified nurses.

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Conceptual Framework for Nurse Shortage; Nursing Role Effective model, community-based model and Moos and Schaefer (1993) integrative conceptual framework.

Structure Process Outcome

comorbidities Nursing outcomes e.g. patient interventions, falls, nosocomial infections, patient interdependent experience satisfaction roles

Nurse; staff staff mix, workload, work environment. illness

A Conceptual framework of the three for hospitals (Lucero, Lake, & Aiken, models brings out a clear understanding of 2009). the impacts of staff shortage in the health Needleman (2002) revealed a strong organization. For it looks at the multiple and consistent association between nurse effects brought about the organizational staffing variables and five patient outcomes structure, process of care and both staff and including urinary tract infections, patient outcomes. pneumonia, length of stay , upper gastro intestinal bleeding and IMPACT OF NURSE STAFF shock in medical patients, in surgical SHORTAGE patients’ failure to rescue was the only Nursing staff shortage impacts directly variable with a strong consistent on both the staff and the patients. Staff relationship. shortage will result to heavy workload for Glance at el (2012) performed a cross- the nurse to manage. The consequence will sectional study of 70,142 patients admitted be inadequate care to the patients, the nurse to 77 Level I and Level II centers using will get burnout resulting to ill health and Healthcare Cost and Utilization Project others may leave the profession. In Nationwide Inpatient Sample. Logistic adequate staffing has been linked to missed regression models were used to examine the necessary nursing care whilst adequate relationship between nurse staffing staffing would be an effective strategy to measures and mortality, healthcare improve patient outcomes (Xiao-wen, associated infections and failure-to-rescue. 2012). Patients who do not receive the Patient risk factors controlled were injury necessary nursing care may have increased severity, mechanism of injury, co length of stays, resulting in financial losses morbidities, age and gender; whereas,

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 6 hospital structural characteristics such as Linear regression was used to estimate the geographic region technology level, effect of nurse and hospital characteristics teaching status, teaching status, hospital on health care– associated infections. The size and trauma center status - Level I results revealed a significant correlation versus Level II. The results revealed that a between patient-to-nurse ratio and urinary 1% increase in the ratio of licensed tract infection (0.86; P = .02) and surgical practical nurse (LPN) to total nursing time site infection (0.93; P = .04) (Cimiotti, was associated with a 4% increase in Aiken, Sloane, &Wu, 2012). mortality and a 6% increase in sepsis .Three A prospective, observational, single- excess deaths were prevalent in hospitals centre cohort study was conducted in the with the highest quartile of LPN and 5 more medical intensive care unit (ICU) of the episodes of sepsis per 1000 patients University of Geneva Hospitals. The study compared to hospitals in the lower quartile was conducted between January 1999 and of LPN staffing. Thus, they concluded that December 2002 and it included all patients an independent association between higher who were at risk for ICU- acquired hospital LPN staffing levels with slightly infection admitted during that period. They higher mortality rates and sepsis in trauma were followed from admission to discharge. patients admitted to Level I or Level II By multivariate Cox regression analysis, trauma centers. This study implicates need they found that a high nurse-to-patient ratio of RN rather than LPN for severely ill was associated with a decreased risk for patients. In addition, Sovie (2001) VAP (hazard ratio 0.42, 95% confidence suggested that an increase of registered interval 0.18 to 0.99) (Hugonnet, Uckay, & nurse. Hours per patient per day was related Pittet, 2007). Thus, an association of Lower to lower fall rates and higher patient nurse-to-patient ratio with increased risk satisfaction and lower urinary tract for late-onset VAP. This may be attributed infections rates. to increased workloads and time constrains Bond, et al (1999) found out that other resulting in noncompliance of standard healthcare providers, such as medical infection control precautions. Ultimately residents, registered pharmacists and increasing the length of hospital stay and medical technologists influenced mortality cost too. Besides, the negative impact of rates. Thus, an increase of certified health staff shortage on the patients, research professionals including registered nurses evidence revealed effects on the nurse too. decreased mortality rates. In addition to Tervo- Heikkinen, Partanen, Aalto & skill mix, the number of years of nursing Vehvila”inem-Julkunen (2008) Conducted experience in a particular area was directly a survey on 664 registered nurses from 34 associated with mortality rates acute care inpatient hospital wards in order (Tourangeau, 2002). to assess the interrelationship between Other researchers have studied to show nurses work environment and nursing the association between staffing levels and outcomes. It was revealed that staffing patient complications. For instance, A adequacy, respect and relationships were survey was done with data obtained from the most important factors of work the Pennsylvania Health Care Cost environment that had influence on job Containment Council report on hospital related stress, job satisfaction, patient infections and the American Hospital satisfaction and adverse events to patients Association Annual Survey to examined and nurses. 77% registered nurses reported urinary tract and surgical site infection. adverse events. 96% reported patient’s

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 7 adverse events during the three monthlies work home conflicts, absenteeism, and of retrospective period. The economic burnout and turnover intension to leave. changes affecting the whole healthcare Job dissatisfaction is a major staffing in the 1990s (recessionary period consequence of staff shortage. Turnover of and health care staffing reduction) nurses is expensive because, it’s costly to pressures for hospital recon structuring and recruit, orientate and train new nurses. the decrease of working age population Therefore, creating cultures of retention in have an impact on the health care system organizations, bolstering the nurse and work environment of registered nurses. education infrastructure, establishing Poor organizational climate and high financial incentives for investing in workloads are associated with increased nursing, rewarding hospitals with magnet levels of needle stick injuries. hospital characteristics and implementing. Burgess, Irvine, & Wallymahmed effective nursing systems according to staff (2010) cited that some nurses become number and mix (Tomey, 2009). severely distressed resulting to high sickness, absence, poor staff retention and ROLE OF NURSE ADMINISTRATOR ill health due to work overload. IN NURSE STAFFING Furthermore, Adriaenssens, De Gucht, Van One of the priority responsibilities of der Doef, & Maes (2011) found that work nurse leaders is staffing by determining the environment and job characteristics of most appropriate number and mix of nurse nurses were important predictors of stress – staffing to ensure patient safety whereas health outcomes. Emergency nurses also maintaining a cost-effective and reported more pressure, physical demands, efficient nursing workforce (Kane et al., lower decision authority, less adequate 2007). work procedures and less reward than a Nursing shortage is critical; therefore, general hospital nursing population. Work the health care system needs to quickly opportunity for skill discretion and better expand the available services beyond the social support by colleagues. Work time normal to meet the increased demand for demand appears to be an important care (AHRQ, 2004). The health system’s determinant of psychosomatic complaints surge capacity needs to be addressed. The and fatigue in emergency nurses. Personal surge capacity elements are strained characteristics, decision authority, skill personnel, equipment and supplies, discretion, adequate work procedure, structure, policies and procedures supervisors are strong determinants of job (Barbisch & Koening, 2006). The elements satisfaction, work engagements and lower are interrelated for with better equipment’s intentions in emergency nurses. and supplies less staff will be needed. At the Occupational stress can lead to a variety of same time proper policies and procedures in health-related problems that consequently place will enhance better scheduling and impact on the organization. Stress related allocation of the available staff. In addition, physical illness such as migraine headache, policies and procedures can facilitate in hypertension, coronary heart disease recruitment and retention measures. syndrome and psychological problems Managers need to establish conditions including anxiety, depression, and insomnia to support recruitment and retention of and feeling inadequacy. These symptoms adequate staff. Due to the insufficient are related to decreased work performance, staffing practices and its potential impact, hospitals need to shift their view and way

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 8 of managing nursing resources (McHung, primary nursing care, better relationships 2010). For example, institution new ways to between nurses and physicians, nurse’s provide adequate staff during peaks in daily preference for interdisciplinary care and occupancy (Lituak et al 2005). Enhancing patient involvement in care (Aiken, 2002) recruitment and experience of nurses is may be considered in attempt to retain paramount to attaining required staffing nurses in the profession. Years of nurse levels (Heinz, 2004). Involving men in the experience in a specific unit is related with higher position like those of nursing deans lower 30-day mortality rate (Torangeau, would change the image of nursing 2002). Therefore, encouraging resulting to more male nurses enrolling in specialization of nurses in certain areas the nursing profession hence, solving the would enhance their expertise and nurse shortage issues, (Roth and Coleman, competence. This would act has an intrinsic 2008). motivator for them to remain in the Recruitment should include both RN profession. and others such LPNs and UAP. However, Thus, incentives are required to the number of RNs should be larger since enhance retention of nurses within the they are accountable for evidence-based profession (Heinz, 2004). Belgian, Vaughn care. Whereas, LPNs and UAP can assist in and Goode (2001) found that good mentors’ non-nursing duties. The Registered nurse is colleagues were the main reason nurses based on knowledge. Their education remained with the employer. Thus, program and work experience provide them enhancing mentorship training and with knowledge and guides them indecision establishment of worker friendly making to give appropriate care to patients. environment is inevitable (Heinz, 2004). Adequate staff provides them an Motivation of the staff towards job opportunity to utilize their knowledge achievement is the duty of the nurse efficiently and effectively. Unlicensed manager. It is important for the nurse leader Assistive Personnel are trained individuals to have strong purposeful leadership and to assist registered nurse in providing management skills to be effective in the patient care (ANA, 1999). daily operations, (Donnell, Livingstone, & The nurse administrator should ensure Bartam, 2012). ongoing recruitment of nursing workforce Nurses should be offered opportunity by advocating for the profession and for participation in, decision making and encouraging the new generation to join the input into the work environment as in profession. The local, state and government magnet hospitals. In order for nurses to offices should depict a positive image of balance family, work and social demands nursing profession to enhance recruitment self-scheduling (flexible scheduling) may of nurses. Other methods include, hiring be adopted. Offering educational nurses overseas, providing flexible opportunities in continuing educational schedules, more regular work hours, programs and sponsorship for advanced encourage greater working hours from part- nursing education. In addition, promotions time employees and provide government of health work environment, support loan payback incentives for students promotion ladders and offering more salary seeking degree in nursing (Heinz, 2004). for more experienced nurse (Heinz, 2004). Attributes as those demonstrated by For hospitals to efficiently maximize nurse magnet hospitals which include increased staffing investing in nursing education and autonomy regarding clinical bedside care,

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 9 workforce infrastructure, and an inclusion capacity. Competitive faculty salaries may of incentives would do (McHugh, 2010). encourage more nurses into the education Kalish, Friese, Choi and Rochman career (Aiken, Cheung, & Olds, 2009). An (2011) conducted a cross-sectional increment of faculty members will result in correlational study of 92 medical-surgical, more trained nurses to curb the severe rehabilitation, and intermediate in 11 acute shortage. care hospitals. The findings were a View research on staffing and corerlation (r=−.276, p=.008) between outcomes identify safe staffing levels, Hours of Care Per Patient Per Day (HPPD) unrelation to patient acuity level and and the nurse-reported patient workload on variability with staff experience and last shift. A correlation (r=−.384, p=.000) expertise put into consideration between perceptions of the adequacy of organizations resources policies and staffing and nurse-reported patient procedures and support available to patient workload on last shift. care unit and issues related to patient care Multivariable analyses revealed a unit and issues related to work significant association between inadequate environment. Evaluation of staff systems numbers of assistive personnel and both should include nurses work life, outcomes perceived staffing adequacy and nurse- and patient outcomes. Quality of work life reported patient loads. Unit- level Case mix was found to be related to quality of care. Index (CMI) had a significant relationship Therefore, work related staff illness and with both HPPD and nurse-reported patient injurie states, over time rates , flexible loads. Thus, an additional number of human resource polices and benefits assistive personnel will relive the nurse off package, compliance and applicable federal extra nursing care hours and workloads. state and local regulations Staffing the Heavy workloads were associated with analysis and identification of health care negative impacts on the nurses. In a organization human resource requirements, multivariate model, patient severity and recruitment of personnel to meet those nurse and hospital characteristics were requirements and initial placement of those controlled, nurse burnout was the only persons to ensure adequate numbers, variable with a significant relationship with knowledge and skills to perform the urinary tract infection (0.82; P = .03) and organizations work(ANA ,1999). surgical site infection (1.56; P < .01) Electronic medical records can infection. Hospitals 30% burnout reduction streamline documentation (Staggers, Weir had a total of 6,239 fewer infections, $68 and Phansalkar,2008) for it saves nurses million annually (Cimiotti, Aiken, Sloane, time resulting in reduced staff requirements &Wu, 2012). Thus, level of staffing was and overtime (Turisio & Rhoads, 2008). linked to burnout. Therefore, the nurse This may also improve nurse working administrator should put measures in place condition resulting to higher job to reduce burnout among nurses to enhance satisfaction and lower turnover (Bolton, patient safety. Gassert, & Cipriano, 2008). Staffing There is need for federal funded principles include assessment of programs to invest in the nursing profession management, nursing and patient needs, by expanding nursing faculty and schools, and final decisions should not rely on the increase incentives in hospitals with type of pay or only the number of patients. acceptable nursing practice environment, Nurse staffing requires a multi- clinical training sites and adequate nursing dimensional approach to assessment and

INTERNATIONAL CONFERENCE OF KERTA CENDEKIA NURSING ACADEMY-2019 10 evaluation of staffing needs (Kalish, Friese, The issue of nursing shortage has been Choi, & Rochman, 2011). of concern to many researchers for many The administrator can develop a plan decades; yet, the solution is far from being through benchmarking. Benchmarking is achieved. The recent investigations of its the continues measuring of process product impacts not only to the patient but also or service compared with those considered considering the nurse outcomes may solve industry leaders in order to find and the problem. This is because the nurses are implement ways to improve the product, leaving the profession as a result of the process or service. negative experience they encounter in the Benchmark own NHPPD against other profession. In my opinion, improving the organization with similar patient population work environments of nurses and to form part of evidence-based decision increasing the incentives may retain nurses marking. Consider skill mix, the percentage in the profession and also attract young of RN Compared to LPN. For instance, in people into the profession. critical care unit require more RN skill mix than in the nursing homes. No of staff REFERENCES support if less the nursing hours needed will Agency for Healthcare Research and be more (Kelly.2012). Quality. (2004). Hospital Nurse Provision of practical and written Staffing and Quality of Care:Research philosophy to guide staffing and scheduling in Action.Issue 14. Rockvile, MD. activities. Conduct staffing studies to Agency for Healthcare Research and determine staffing needs related to skill Quality (AHRQ). (2004). Surge mix, number, time and workload capacity education and training for a requirement (Roussel, 2013). Although, qualified workforce.Bioterroism and many studies have been done in different Health system preparedness, issue context, each institution need to research on brief no.7 04-p008. Rockvile, MD. their organization due to variations in Aiken.L, H., Cheung.R,B& Olds. D, M. different environments. (2009). Education policy initiativesto Nurses are the main source of care to address the nurse shortage in the patients. Factors contributing to nurse United States of America.Health shortage are restructuring for economic Affairs. Milwood.28(4)W646-56. reasons, budgets and staff in cuts, Aiken, L.M., Clarke, S. P., & Sloane, D.M. mandatory overtime, heavy workloads, (2000). Hospital restructuring: Does it poorly prepared managers, nurse to nurse adversely affect care and outcomes? hostility, poor nurse to doctor relations, Journal of Nursing Administration. changing legislation, negative media 30(10) 457-465. stereotyping. Helpful strategies to deal with Aiken, L.M., Clarke, S. P., & Sloane, D.M. staff shortage is improve scheduling, safer Lake.E,T &Chang, T.(2008). Effects staffing, nurse voices to be heard in the of hospital care environments on workplace, collaboration with nurse and patient mortality and nurse doctor, diversity training, management and outcomes.38(5)233-9. development involve nurse in public Aiken, L. H., Sloane, D. M., Lake, E.T., et communication (Tomey, 2009). al (1999). Organization and patient outcomes of inpatient AIDS care. CONCLUSION Medical Care. 37(8) 760-772

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