Nurse Staffing and Patient Care Quality

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From a business perspective, decision-makers at health care facilities do not want to schedule too many nurses on a given shift. This prevents nurses from being on a shift with nothing to do, which can cost the facility money that is not being offset by revenue from patient care. However, the problem with this perspective is that it can lead to health care facilities understaffing nursing shifts. When understaffing occurs, patients may not get the care they need because there are simply not enough nurses to care for the patients receiving care. Therefore, it is the role of the nurse manager or the individual who determines the staffing levels and schedules to ensure there is a balance between the needs of the patients and the needs of the facility as a business.

It is important for health care professionals to understand the seriousness of the need to ensure the appropriate level of staffing. From the perspective of nursing as a service industry, particularly in the context of providing care for patients’ health, inadequate staffing levels have greater negative implications than patient satisfaction. Inadequate nurse staffing levels can impact the quality of care provided to patients, especially during end-of-life care (Cho, Kim, Yeon, You, & Lee, 2015). When the quality of care is diminished due to inadequate staffing levels, patients may not get adequate care, which can result in negative patient outcomes (Cho et al., 2015). For many patients, it is a nurse’s responsibility to not only keep an eye on patients and report changes, but to provide medications and assist with self-care tasks such as hygiene and feeding. Therefore, if patients do not get the nursing care they need, they may experience delays in recovery or health complications (Cho et al., 2016). In other words, inadequate staffing can result in a decrease in patient health or delays in health improvement.

However, there are negative implications from a business perspective, as well. Specifically, if a nursing shift does not have adequate staffing, the nurses who do work on the shift may be overworked. When nurses are overworked and shifts are understaffed, individual nurses are more likely to experience burnout, which can lead to higher rates of turnover (Cimiotti, Aiken, Sloane, & Wu, 2012). This is problematic for a number of reasons. If nurses are experiencing burnout, there is a higher likelihood of missed care and patients not receiving the care they need (Cimiotti et al., 2012). Just as in any job, it is frustrating when nurses are overworked and not receiving the support they need from managers and other administrators. In addition, nurse burnout and high turnover is problematic from a business perspective. Nurses who quit must be replaced, which costs money both for hiring and training. In addition, the nurses who remain must do extra work in order to accommodate the loss.

When health care facilities ensure appropriate staffing, everyone involved benefits. Patients receive the care they need and deserve. Nurses will be more satisfied in their jobs, which reduces turnover. In addition, with appropriate staffing levels, nurses have support from fellow nurses, which can help ensure accountability for the care they provide, which further increases the quality of care for patients (Gordon, Buchanan, & Bretherton, 2008). That is, if nurses have support through adequate staffing, errors are more likely to be caught and prevented, resulting in a higher quality of care. Appropriate nurse staffing levels are essential to quality patient care. From the perspective of patient care, nurses are needed to provide care to patients. From the perspective of the facility as a business, understaffing has numerous negative implications. While it may appear to save the facility money in a short-term context, it is financially detrimental to the facility as a long-term strategy. Therefore, appropriate staffing should be a high priority for all stakeholders at any health care facility.


Cho, E., Lee, N-J., Kim, E-J., Kim, S., Lee, K., Park, K-O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International Journal of Nursing Studies, 60, 263-71. doi: 10.1016/j.ijnurstu.2016.05.009

Cho, S-H., Kim, Y-S., Yeon, K. N., You, S-J., & Lee, I. D. (2015). Effects of increasing nurse staffing on missed nursing care. International Nursing Review, 62(2), 267-74. doi: 10.1111/inr.12173

Cimiotti, J. P., Aiken, L. H., Sloane, D. M., & Wu, E. S. (2012). Nurse staffing, burnout, and health care-associated infection. American Journal of Infection Control, 40(6), 486-90. doi: 10.1016/j.ajic.2012.02.029

Gordon, S., Buchanan, J., & Bretherton, T. (2008). Safety in numbers: Nurse-to-patient ratios and the future of health care. Ithaca, NY: ILR Press.