What is an official nursing shortage? Basically, it’s when the demand for nurses outweighs the supply, and one common measure of this is nurse - to - patient ratios. However, federal law does not mandate “safe” nurse - to - patient ratios, and neither do laws in 49 states. California is the only state that requires these minimums:
- Operating room, 1:1
- Emergency room, 1:4
- Medical - surgical facilities, 1:5
The American Nurses Association (ANA) supports a more flexible model in which nurses create a staffing plan for each unit, accounting for the intensity of patients' needs, layout of the unit, resources available, experience levels, and other factors. But since the COVID-19 pandemic, many nurses have shared in online forums, social media posts, and even the workplace break room that they do not feel supported by the ANA and have not seen the organization work to implement ideal staffing ratios.
Whichever staffing model is used, nursing shortages affect nurse - to - patient ratios in the same way: too few nurses end up caring for too many patients. This increases the risk that mistakes will occur, patient care will suffer, and nurses will burn out trying to keep up.
In this article, we share some thoughts on how the nursing shortage has affected healthcare and tips to help nurses protect themselves and their patients.
Why Nursing Shortages Happen — and the Impact of COVID-19 on Nurse-to-Patient Ratios
While the United States has endured stretches of nursing shortages since 1900, the continuing COVID-19 crisis has only exacerbated the problem. The COVID-19 pandemic has caused added stress and burnout to nurses as they care for the sickest of the sick, without adequate resources such as personal protective equipment or at times not being able to see their families for long periods of time to prevent exposing them to the virus. Additionally, nurses who are currently working are working long hours due to the lack of nurses available to work.
The ANA states that by 2022, there will be more registered nursing jobs available than any other profession. And new reports suggest that 1.2 million new RNs will be needed by 2030. Factors that affect the current nursing shortage include:
- Retirement: As of 2018, the average age of a registered nurse is 50 years old. By 2022, 500,000 baby boomers are expected to have retired.
- New opportunities: More nurses are leaving their jobs to explore roles beyond the bedside.
- Sicker patients: Increased patient acuity levels require patients to receive specialized care due to increasing health complications. The higher the acuity level, the more attention and frequent observation the patient requires.
- Stress and burnout: Workload imbalances, double shifts, and last - minute requests to move departments and specialties create unhealthy levels of stress.
- A decrease in nurse educators: Nurses can’t get trained without other nurses to teach them.
- Location: Only 16% of nurses live in rural areas, where 52 million Americans need healthcare.
The Impact of a Nursing Shortage on Patient Safety
As a nursing shortage worsens, nurses are responsible for more patients yet work longer hours without appropriate rest. "Hospitalized patients are sicker than they have ever been, and nurses are administering medications around the clock, coordinating with specialists, and performing nursing interventions,” explains Aaron Sebach, PhD, DNP, MBA, CRNP, SFHM, and director of graduate nursing programs at Wilmington University. “Consequently, as the number of hospitalized patients has increased, and the nursing shortage continues to worsen, patient safety is at risk," he adds.
The impact on patient safety includes:
- Decreased quality of care
- More medication administration errors
- Higher patient mortality
- Lower patient satisfaction scores
The Impact of a Nursing Shortage on Nurses
The nursing shortage continues to be a big problem in healthcare due to high nurse turnover rates, lack of nursing educators, and lack of job satisfaction due to working under stressful conditions.
As the shortage worsens, nurses historically tend to:
- Work longer hours
- Have a high patient to nurse ratio
- Be unable to provide high - quality care to patients
- Feel overwhelmed, overworked, and undervalued
- Resent management, unions, and nursing organizations for not feeling supported
- Be at risk of making more mistakes
6 Ways Nurses Can Cope with a Nursing Shortage
So what do we do now? "Increased working hours of nurses and the number of shifts worked has a tremendous impact on the mental and physical well - being of nurses," emphasizes Sebach. Here are some ways he suggests you can confront a short - unit head - on:
1. Plan Your Assignments
By planning your assignments, you can prioritize activities by the level of importance and complete the tasks in that order. For those activities that you can delegate, make sure to work with the other team members, such as the nursing assistants, volunteers, and caregivers, to get them done.
2. Organize Your Shift According to Your Assignment
When you have obtained a report on your patients, take a few minutes to determine what type of care your patients will need, especially for those you have determined to be of high priority. By determining what your patients will need, you can gather the necessary supplies, and if anything is missing, you can request it before entering the patient's room.
3. Remember That You Have a Team
Remember to delegate accordingly and ask for help when needed. Also, when you finish with your activities, don't just sit down. Make sure to help the other members of the team. Sharing tasks promotes camaraderie and teamwork and gives your team an extra set of hands in difficult situations.
4. Protect Your Future
Staffing shortage or not, it is always a good idea to consider having your own individual medical malpractice insurance policy and to make sure the coverage you have is up to date, especially if your hours and specialties have shifted. While an extra layer of protection is beneficial under any circumstances, having your own policy can be crucial if you are facing a malpractice claim and disagree with your employer about what happened. Your own policy means you get your own lawyer, who is protecting only your interests, not those of your entire workplace. An individual policy can also help you if you’re named in a board action, which employer malpractice policies typically don’t cover. Having coverage you can count on means you shouldn’t have to dip into your personal savings to defend yourself or to pay any settlements, if a claim is filed against you.
5. Take Care of Yourself
Sebach states that nurses should perform at least one self - care activity each day. “Self - care is not a selfish thing to do, as you need to be mentally and physically ready to care for patients and deal with situations that can add stress to your already stressful day," he explains. Sebach recommends you incorporate these healthy integrations into your daily routine (some for just 30 minutes):
- Journaling: Jot down anything that you may have experienced during your shift, and make sure to date these entries in case you may have to refer to them in the future.
- Physical exercise: Many nurses find relief in classes that can allow them to release stress such as boxing, Zumba, or even spinning.
- Mindfulness exercises: Learning techniques that can help de - stress and keep a positive mindset can help in keeping with a positive attitude.
- Adequate rest: Getting the appropriate amount of sleep is vital for feeling good, and to allow you to be super productive
- Healthy diet: While “eating our feelings” (often with a big bowl of mac and cheese) tends to be a default coping strategy, the best foods for you are those that can boost your immune system, lower your blood pressure, or increase serotonin levels (hint: try a warm bowl of oatmeal!). Foods rich in magnesium (spinach and salmon) can reduce headaches and fatigue.
6. Communicate When You Feel Unsafe
If you are working understaffed, without breaks, and past your shift, you must communicate these issues with management. You may think that they know what is happening, but how can you be sure without communication?
If you are working in an unsafe environment that may cause harm to you or your patients, you need to verbalize your concerns because, ultimately, you have patients and your nursing license to protect. In fact, take those worries to an email, so you have documentation.
Start with speaking to your charge nurse or nurse manager. If you feel they haven't addressed your concerns, the next person to contact is the Director of Nursing, Chief Nursing Officer, or the Director of Nursing Services. Also, know who your facility's compliance or safety officer is. Healthcare compliance officers are responsible for ensuring that healthcare entities meet laws, regulations, guidelines, and best practices.
In addition to charting your patients closely, document every conversation with management, including:
- Names of the people you spoke with
- What concerns you voiced
- What resolution, if any, was reached
This documentation is for your records and may come in handy if you're ever sued.
It is hard to predict when the nursing shortage will slow down or end, or when the COVID-19 pandemic will become a thing of the past. However, nurses are trained to deliver high - quality patient care, but with the added stress and burnout that a nursing shortage causes, it can be hard to mentally or physically be able to.
Continue to advocate for patient safety and proper working conditions because although many hospitals are offering extraordinary incentives to nurses to work, for many nurses it is not about the money, but about having positive patient outcomes and sanity.