Nursing was once thought of as being a noble career field to go into is now facing challenges with nursing shortage.
Nursing schools are said to have lower student enrollment than previous years. Nurses of the baby boomer era are now at the age of retiring. Many new nurses are finding the field of nursing too demanding and now are leaving to pursue other careers. Nursing is not just one set of skills listed on a resume. Nurses wear an extensive number of different hats and have a plethora of different skills that are needed to perform and provide care for patients.
The demand on nurses to perform the job of 10 people are taking a toll on this very important work force of men and women. Nurses not only perform nursing duties, but they also serve as teachers, pharmacists, and social workers. Most importantly, they are the eyes and ears of providers, and they notify doctors when something needs their attention. They are first responders when a patient’s condition deteriorates or when a patient codes. They are the first to set eyes on a patient and the last to see them when they are discharged. They help bring new life to the world and hold hands of the dying. Nurses spend the most time with patients, more than any other healthcare provider combined.
Being a nurse myself, working within a Neonatal ICU for the past 14 years, I have seen some struggles with staffing to patient ratios. Hospital administration creates a grid based on the number of patients a single nurse should take care of during their shift. An average shift consists of 12 hours, which in reality is a 12.5-hour shift due to lack of compensation for breaks.
Nursing assignments also often don’t account for the time involved in sign-off reporting, especially if a nurse has a heavy assignment. Report can take more than 20-30 minutes of the allotted time. Nurses are regularly reprimanded for exceeding the 12.5 shift hours and this has led to them punching out and remain working or giving report while not being on the clock to avoid getting in trouble. What hospital administrators don’t understand, especially when units are so short staffed, is that most nurses barely get a bathroom break, let alone two, 15-minute breaks and an uninterrupted 30-minute lunch break.
In California they have nurses called break nurses. Break nurses don’t take an actual assignment. Their job is to cover another nurse’s assignment so those nurses can take their breaks and lunch without any interruptions. That’s it, that’s their job. Just to cover an assignment for another nurse so he or she may take their allotted breaks without any interruptions. Why isn’t the rest of the country adopting these policies to staffing? In Connecticut you will find nurses working 13-hour shifts without taking any breaks. If a nurse is fortunate enough to take a break, it is often interrupted by alarms, patients, patients’ families, other co-workers, etc.
It is said that acuity drives staffing, yet it rarely does. Safety is not the number 1 priority when it comes to staffing. “Do what you can, just make it work until the next shift comes on,” is what we can hear. This is how medical errors happen. This is how patients suffer and don’t receive the adequate care they need and should be given. Florence Nightingale was a visionary and the guiding light to the nursing profession. She envisioned nursing to be a priority on the welfare of patients by creating the best conditions for healing. We as nurses today cannot fulfill her vision without prioritizing first on nursing wellness. We need to obtain support from healthcare administrators and politicians to help bring focus on establishing and implementing policies for proper staffing ratios.
In Connecticut, Public Act 23-2024 states that hospitals must create a dedicated staffing committee to develop annual nurse staffing plans. The staffing committees must include 50% of direct care registered nurses, employed by the hospital but the law fails to include much-needed mandated staffing ratios.
California became the first state to establish minimum nursing-to-patient ratios for all hospital units. AB 394 law requires a maximum number of patients that may be assigned to one nurse during their shift for each unit. This law also requires additional nurses to be assigned based on patient acuity and clinical needs. Massachusetts also enacted a law setting staffing ratios of one patient per nurse within Intensive Care Units, including Neonatal ICU, Pediatric ICU, Cardiac ICU, Surgical ICU, and Medical ICUs.
Patient safety is a priority in healthcare. Minimum staffing ratios need to be included in patient safety policies. Healthcare systems have procedures and policies in place to ensure that safe and effective care is provided to patients. Why aren’t there any safety policies applied to ensure patient safe staffing ratios in all states?
Tracy Briggs is a NICU nurse with over 14 years experience within the hospital setting. She is also a graduate student at UConn in their Neonatal Nurse Practitioner program finishing up her final year.
