‘Staffing Is Not a Numbers Game’

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NJSNA: Healthcare Factors Patient Acuity, Nurse Experience

TRENTON, N.J.—February 6, 2018—Healthcare organizations should develop staffing plans based on patient needs and nurse experience, according to the New Jersey State Nurses Association (NJSNA), which represents 125,000 registered nurses and advanced practice nurses as an advocate for the profession.

Judith E. Schmidt, MSN, DHA (c) RN, CCRN and CEO of the New Jersey State Nurses Association

“We all know staffing has to change,” said Judith Schmidt, MSN, DHA (c) RN, CCRN and CEO of the New Jersey State Nurses Association. “The more patients a nurse is responsible for the greater the chance of an adverse event, such as a fall, infection or avoidable errors. Staffing is not a numbers issue because numbers don’t take into consideration the patients acuity or the nurse’s experience. Should the newer nurse be responsible for the sickest patient(s) or the same number of patients as a nurse that has many years of experience?”

Staffing should take into account patient acuity and nurse experience. Without the necessary nurse coverage, patients risk longer hospital stays, increased infections, avoidable medication errors, falls, injuries and even death. Staffing plans should be directed by a committee, which includes a majority of direct care nurses, to ensure patient safety, reduce re-admissions and improve nurse retention.

The New Jersey Legislature has introduced a bill (S-989) to establish staffing standards for nurses in hospitals, ambulatory surgery facilities, and developmental centers and psychiatric hospitals. The proposed bill outlines specific staffing ratios for patient care.

The proposed plan endorses numbers of nurses for various care situations, which is a good start, but does not go far enough. “It does not address some of the key issues that occur with staffing, such as the constantly changing needs of patients,” Schmidt said. “It’s about the accountability of nurses and nurse managers to establish staffing based on the patient needs and nurse skill levels. Staffing is not about a specific number, but the appropriate mix of how sick the patients are, which dictates how much care they need, plus the level of experience of the nurse.”

Schmidt said ratios are rigid and dictate a set number of staff, which is not the best model for optimal patient care, which constantly changes. “We need to give the nurses at the bedside the authority and the accountability for staffing their units as needed,” she said.

“Patient care loads can change in almost an instant,” she added. “When I was in the critical care unit, I was assigned three beds with two patients occupying two beds and one empty bed. One patient was acute but stable and one was unstable and needed a lot of hands-on care. This was the Department of Health and Human Services New Jersey Licensing Standard ratio for Intensive Care Units. An admission came in that was sicker than both of my patients and needed my full continuous attention. My charge nurse was able to adjust the assignments so all the patients could have the level of care they needed. In a ratio situation, where a rigid number is set, I would not have had the support I needed to help the patient. Without staffing flexibility based on patient needs, this situation could have had a very different result.”

Another key issue that is not addressed in the staffing bill is the availability of assistive personnel such as nursing assistants, transporters and technicians.  “With healthcare economics the way they are, hospitals are going to have to eliminate some of the assistive positions,” said Schmidt. “Nurses and their assistants have the most contact, one-on-one time and direct care of patients within the healthcare system.”

Because Congress hasn’t been able enact a federal law that addresses state nurse staffing, such as The Registered Nurse Staffing Act, states like New Jersey have taken action to ensure there is nurse staffing appropriate to patients’ needs and legislation that allows for flexible nurse staffing plans. Every year, NJSNA advocates for this on the national level during the annual Lobby Day on Capitol Hill with nursing associations from around the country.

“Optimal nurse staffing could mean the difference between a patient surviving or dying,” said Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, president of American Nurses Association, which has been advocating for safe staffing for many years. “Research tells us it’s that crucial. If you or your loved one were in the hospital, you’d want to be certain that the hospital was continually setting, evaluating and adjusting its nursing coverage to meet your changing needs and the conditions of all patients.”


NJSNA, which was established in 1901, is a constituent member of the American Nurses Association.  The New Jersey State Nurses Association (NJSNA) represents the interests of 125,000 registered nurses and advanced practice nurses as an advocate for the nursing profession. NJSNA’s lobbying arm continues to protect the nursing profession through legislative victories. Its nonprofit foundation, Institute for Nursing, helps nurses further their careers by providing continuing education, scholarships and research grants in addition to invaluable networking opportunities. For more information, nurses can visit www.njsna.org or contact NJSNA at njsna@njsna.org or (609) 883-5335.

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