on July 18, 2023 Insider Clinician GuestAuthor Clinical Experience

The High Cost of Low Staffing

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Across America, nurses working at the bedside are increasingly expected to complete more tasks in less time with greater workloads than ever before. The number of patients each nurse is assigned to care for are inching higher each year (Ecpi University, 2023) at the same time as many hospitals are cutting or reducing staffing. Cuts from other essential healthcare departments including respiratory therapy, phlebotomy, ancillary staff, nutrition services, and more have also been depleted. Hospital systems face a variety of financial market pressures, so they must adapt in order to continue profiting as a healthcare business. This, in turn, has adverse effects on the nursing staff they rely on to satisfy patient satisfaction scores and additional performance metrics. 


There are few states that regulate nurse-to-patient staffing ratios in the inpatient sector (American Nurses Association, n.d.). As staffing shortages affect the availability of individualized care, nurses are expected to fill in the gaps and perform other departments’ job responsibilities (Berlin et al., 2023). These additional tasks are added to an already full plate of nursing task lists, so patients may not experience the high quality healthcare services they deserve when nurses are overwhelmed and forced to make quick judgments regarding task prioritization. Sometimes, certain procedures and care tasks will fall by the wayside simply because there is not enough time in the 12-hour shift. 


For example, I’ve heard of hospitals making do without a full staff of respiratory therapists and have been offloading time-intensive tasks, such as cleaning the oral cavity of intubated patients, on ICU nurses. This requires nurses to undergo extensive training with medical device representatives during their shifts to learn how to use the appropriate products, as well as learn how to perform the necessary directions, which results in increased work-related stress – no wonder burnout in the nursing profession is skyrocketing (Berlin et al., 2023). There is simply not enough time to consistently brush the teeth of critically ill patients who are being mechanically ventilated in the intensive care unit. Inconsistent oral hygiene will ultimately increase rates of ventilator associated pneumonia, causing increasing healthcare costs, resources, and mortality rates. 


I’ve also heard of occasions where unions who represent Environmental Services (EVS) in hospitals created new workplace procedures in response to the COVID-19 pandemic, leaving RN’s with more work. During the height of the pandemic, EVS workers stopped servicing COVID positive hospital rooms and only serviced public areas like hallways, public nursing spaces, and lobbies. While this was a reasonable response to an unprecedented event—we all wanted to stay COVID negative!—the result was to place yet more burden on top of already overworked nurses, which was to routinely take out trash and soiled linen to the trash room. Sometimes, I got the feeling we were being treated as a hospital catch-all, where we were expected to fill in the cracks in the healthcare system and stop people from falling through. 


Needless to say, it does not feel good to be expected to perform at 110% from the moment you step through the hospital doors. It feels very alienating, like you are not accomplishing enough even as you are performing the functions of three people. Some shifts, no matter how hard I worked, there were always one, two, or more tasks left over for the next oncoming nurse — the list felt never ending! And, while part of this was due to the increased demand for healthcare services under the COVID-19 pandemic, it was also due to the shifting of organizational resources which placed more work on nurses’ plates and less work elsewhere. 


Because of my experience, I’ve grown to appreciate the impact of technology in the workplace. Programs or products which automate tasks and streamline procedures are lifesavers, sometimes quite literally! Take for instance prepackaged oral care kits, which make oral cleanings far easier to perform or, electronic medical charting software which enables providers and nurses to keep track of medications, imaging tests, and blood work results in real-time.


However, I am still waiting to see a solution from leadership for the problem of staff responsibilities. While technology certainly drives efficiency, it can also encourage a management mindset where they think nurses can do more with less. This might work in the short term, but in the long term this will only drive nurses out of the profession, leaving new  grads to figure it out for themselves. According to some healthcare professionals, the ratio of experienced nurses has changed from 80% experienced to 80% inexperienced on their teams (MBA Podcast Ep. 29).


A new combination of time-saving technologies and organizational restructuring could be exactly the change we need to ensure nursing can be a stable career, and that nurses can do what they do best: care for their patients. 









Amanda McDonald

Amanda is a registered nurse with over 5 years of experience caring for ICU, med-surg, and ambulatory patients in the hospital and outpatient setting. She is a newly certified Family Nurse Practitioner and is looking forward to her transition into her next stage of clinical practice. She is located in Chicago, IL and is excited to provide care for her community.

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