There is a shortage of registered nurses that has been going on for many years now, and that, along with increased workload, is a potential threat to the quality of patient care. Insufficient staffing is becoming commonplace throughout the United States, which raises stress levels, impacts job satisfaction, and drives nurses away from the profession. And those who stay in the profession know that these factors have a detrimental affect on the quality of patient care, the least of which is not spending enough time actually taking care of patients.

Hospitals across the country are embracing patient safety by utilizing tools such as nursing scorecards and core measures, but because Medicare reimbursement is tied to the results of many of these, hospital administrators still look at the bottom line. Part of that bottom line is tied to registered nurse (RN) staffing and how much nurses get paid. The first thing hospital administrators usually cut is patient care staff.  It's the easiest solution to quickly reducing costs. But, who and what does it impact? In the short-term, it impacts quality of care, patient safety, and nurse satisfaction. How many studies do we need to realize that if you make your front-line staff happy, your patients are happy?  Studies have shown that increased registered nurse staffing has a positive effect on patient care quality. High nurse-to-patient ratios causes dissatisfaction, resulting in high registered nurse turnover rates. In addition, major problems ensue as patient complications are not as easily detected because there are not enough nurses to do so, and those that are present are overworked, stressed, and fatigued. Medication errors, inpatient falls, and complaints increase because there are not enough nurses. The result is that it costs administrators more money in the long term as a result of having to replace nurses,  patient outcomes that are below standard, and claims made in response to medical errors, if not actual litigation.

It appears to be only getting worse because even though baccalaureate nursing program enrollment has increased, it is still not sufficient to meet the demands. The average age of an RN was 46.8 years of age in 2004, and baby boomers are currently starting to reach their 60s. By the year 2030, more than 20 percent of the population will be over 65, and the number of registered nurses is not keeping up with a rising elderly population.

There are various initiatives underway across the country to address the nursing shortage. Recruitment and retention strategies, as well as creating healthy work environments, grants to increase the number of students and faculty, and campaigns to promote the profession of nursing are all underway. But even if we see a decrease in the nursing shortage, and RNs are readily available, will administrators decrease the nurse/patient ratio thereby increasing their cost of doing business? Hospital administrators across the country are willing to spend money on building hospitals with more private rooms, waterfalls, and valet parking and in general competing for market share. But are they really willing to spend money to affect quality patient care? They may have to. There is a nationwide trend of state efforts to regulate how hospitals make decisions on nurse staffing.[1] The legislation varies, but many predict that in five years, legislation will have at least been introduced in all 50 states.[2] There are efforts to educate hospitals on how to make decisions regarding nurse staffing, but if hospitals are not proactive, they may find themselves being mandated to do so.

[1] Thrall, T. (2008, April ). Nurse staffing laws: Should you worry? Hospitals and Health Networks, 82(4), 36-39.

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