Nurse Staffing as the Reason for Concern



  • Focusing on nurse administrators as the key audience;
  • Studying the problem of nurse staffing;
  • Understanding the factors underlying the problem;
  • Defining the currently available solutions;
  • Determining the ultimate problem-solving tool;
  • Improving quality and reducing workplace burnout rates.

Nurse Staffing Problem

  • Drop-in nurse numbers (63%: hospitals) (“Nursing statistics,” 2017);
  • The sharp rise in the number of patients (10%) (“Nursing statistics,” 2017);
  • Time constraints and lack of qualified staff;
  • Massive drops in service quality (22%) (Agency for Healthcare Research and Quality, 2017);
  • Significant reduction in positive patient outcomes.

Potential Implications: Workplace Burnouts among Nurses

  • Chronic effects of burnout-related stress;
  • Workplace safety issues in acute care;
  • Lack of autonomy in decision-making;
  • Lack of responsibility and patient-centered care;
  • Drop-in job satisfaction rates.

Policy Description

  • The number of nurses must be adequate;
  • Nurses must provide patient-centered care;
  • Nursing facilities must disclose their staffing levels;
  • The staffing levels must allow meeting patients’ needs;
  • Nurses are encouraged to create staffing plans.

Available Management Tools

  • Several tools are used for nurse staffing management;
  • RAFAELA system: staff allocation, nursing intensity (Fagerström, Lønning, & Andersen, 2014);
  • SNCT framework: coordinating workload and quality levels (Kirby & Hurst, 2014);
  • NICE endorsement: endogeneity and causal effects (Griffiths et al., 2016);
  • These tools need adjustments to meet hospital-specific needs.


  • A relaxing environment for nurses is essential;
  • Burnouts must be prevented to enhance quality;
  • ANA nurse staffing policy helps reduce burnouts;
  • ANA suggests lowering the patient-nurse ratio;
  • Job satisfaction rates must be increased.


The issue of nurse staffing has gained significant weight over the past few decades. Because of the increasingly high demand for quality, poor opportunities for career advancement, and the related issues, a drop in the number of nurses, as well as low levels of proficiency among them, has been observed in the contemporary healthcare setting. The goal of the paper is to determine the tools for managing the dropping staffing rates in the nursing environment by reconsidering the policy suggested by the American Nurse Association (2015).

The effects of nurse staffing mismanagement are bound to be drastic. Particularly, the outcomes such as a sharp rise in workplace burnout levels and the development of associated disorders (e.g., anxiety, depression, etc.) among nurses due to high workload levels are bound to be expected. Furthermore, the subject matter is bound to trigger a decline in the number of positive patient outcomes (Agency for Healthcare Research and Quality, 2017). Indeed, a closer look at some of the outcomes that can be witnessed at present will reveal that the staffing dilemma has been affecting the quality of care, patient safety, and positive outcomes among target demographics (Agency for Healthcare Research and Quality, 2017). Therefore, one must admit that the current approach toward addressing the problem of staffing and the lack of nurses requires a major reconsideration.

The current policy suggests that an adequate ratio of patients per nurse should be determined. However, the identified regulation needs improvements since it is far too vague and, therefore, does not allow setting the quality standards that will help meet the needs of diverse populations (Agency for Healthcare Research and Quality, 2017).

Particularly, the “42 Code of Federal Regulations (42CFR 482.23(b)” (American Nurse Association, 2015, para. 3) requires that an “adequate” (American Nurse Association, 2015, para. 3) number of nurses should be present in the setting of a nursing facility. The demand mentioned above is far too nebulous to be efficient as a guideline for managing staffing issues. For instance, it is essential to introduce the framework that will allow addressing the culture-specific needs of the target population.

By establishing a dialogue with community members, a nurse is likely to develop a better understanding of the factors that affect their well-being, the threats to which they are exposed, and the tools that will help raise awareness, increase the number of positive patient outcomes, and promote independence among the target demographics (Agency for Healthcare Research and Quality, 2017). Therefore, the incorporation of the tools that will provide nurses with more time and flexibility, as well as help reduce the workload so that the nursing staff could consider the needs of every patient individually, is a crucial step toward improving the current situation.

It should be noted, though, that there are several efficient tools for defining the efficacy of staffing levels in a healthcare setting. Among the most common ones, the RAFAELA system, SNCT framework, and NICE endorsement must be listed. The identified measurement frameworks help define the staffing levels successfully and determine the threat of understaffing (Fagerström et al., 2014; Kirby & Hurst, 2014; Griffiths et al., 2016).

The RAFAELA framework can be deemed as the most recent one; it gives an opportunity to register the available resources, including staff members (Fagerström et al., 2014). Furthermore, the tool provides a chance to classify the available resources. The SNCT tool, in turn, is an important addition since it helps focus on the quality of the services (Kirby & Hurst, 2014). Finally, the NICE endorsement helps maintain the quality of care in the acute setting (Griffiths et al., 2016).

Nevertheless, further policy improvements are required. It is imperative that the staffing standards should be made more rigid. Furthermore, the policy must reflect the necessity to address the needs of diverse populations. Therefore, the current approach toward handling staffing problems could use a significant improvement. Particularly, it is imperative to introduce a measurement tool for determining the appropriate patient-to-nurse ratio for a specific nursing facility based on the needs of patients, the health issues that need to be addressed, workload, schedule, and other important characteristics of the target setting.

Thus, the quality of nursing services will rise significantly since the workload will become more reasonable than it currently is, and nurses will be provided with an opportunity to pay enough attention to the individual needs of each patient, at the same time avoiding developing workplace burnouts.


The active promotion of quality is crucial for the further improvement of patient outcomes. However, little attention is paid to providing the environment in which quality care is possible. Particularly, the problem has not been considered well enough from the perspective of nurses.

The staffing issue is linked directly to the quality of nurses’ performance. Since the subject matter is defined by the standards set by the American Nurse Association (2015), it is essential to reconsider the existing definition of staffing standards and set more efficient ones. Therein lies the significance of the topic; it sheds light on the importance of meeting the needs of both patients and nurses so that the efficacy of care could remain consistently high. As soon as an efficient strategy for managing the levels of staffing and the assignment of respective tasks to nurses is designed, a significant improvement is expected.


Agency for Healthcare Research and Quality. (2017). . Web.

American Nurse Association. (2015). . Web.

Fagerström, L., Lønning, K., & Andersen, M. H. (2014). The RAFAELA system: A workforce planning tool for nurse staffing and human resource management: Lisbeth Fagerström and colleagues describe a method pioneered in Finnish hospitals that aims to uphold staffing levels in accordance with patients’ care needs. Nursing Management, 21(2), 30-36. Web.

Griffiths, P., Ball, J., Drennan, J., Dall’Ora, C., Jones, J., Maruotti, A., … Simon, M. (2016). Nurse staffing and patient outcomes: Strengths and limitations of the evidence to inform policy and practice. A review and discussion paper based on evidence reviewed for the National Institute for Health and Care Excellence Safe Staffing guideline development. International Journal of Nursing Studies, 63, 213-225. Web.

Kirby, E., & Hurst, K. (2014). Using a complex audit tool to measure workload, staffing and quality in district nursing. British Journal of Community Nursing, 19(5), 219-223. Web.

Nursing statistics. (2017). Web.

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