Nurses face burnout, a high turnover and patient safety errors as ‘unsafe staffing’ has become the standard, advocates say

Brenda Meadwell, a nurse in the labor and delivery department at the Bluefield regional medical center, in Bluefield, West Virginia, one of 111 hospitals owned by Community Health Systems, says she is one of many nurses around the US who work under conditions where her department is frequently understaffed.

Pennsylvania nurses inspired by teachers’ strikes to ‘fight the same fight’ Read more

“If I can’t adequately take care of my patients, that essentially puts my license on the line every day when I walk through the door,” Meadwell said. “When we are short-staffed, you don’t get to give patients the individual care they need, which could lead to missing something that could be serious.”

She said her department needs more resources, including a nurses aide, a technician and a secretary to handle reception duties currently delegated to nurses in addition to patient care.

“If you don’t have enough nurses to take care of the patients, it puts the patients at risk,” she said.

Sign up for the US morning briefing

The healthcare industry has for decades attributed widespread understaffing issues to a nursing shortage. CNN reported as far back as 2001 the US nursing shortage was “going into crisis”, and this claim is regularly repeated in media reports. But according to research and projections conducted by the US Health Resources and Services Administration, most states have nurse surpluses that are projected to grow over the next decade. Instead, nurses’ advocates say, the shortage is simply a reluctance by companies to cut profit margins by hiring enough staff.

“It’s a convenient argument for the industry to validate their underresourcing of registered nurses on the floor, simply saying there’s a nursing shortage, but there isn’t,” said Michelle Mahon, nursing practice representative and organizer with National Nurses United, the largest labor union of registered nurses in the US.

“It’s a market decision that benefits the employer,” she added.

National Nurses United and other nurse unions are pushing for states and the federal government to enact patient-to-nurse ratio laws, similar to the one passed in California in 2004, the only state currently with a minimum patient-to-nurse ratio law in the US.

According to the Economic Policy Institute, nurse injuries decreased by 30% and nurse employment increased by 15% after the law was enacted. A 2014 study published in Lancet found an increase in a nurse’s workload by one patient correlates to a 7% increase in risk of mortality.

“Outside of California, unsafe staffing is the standard of care. The California ratio law, if implemented nationally, could save tens of thousands of lives,” added Mahon. “Preventable medical error, which nurses are the safe guardians of preventing, is the third leading cause of death in this country.”

Several medical studies have found that understaffing of nurses negatively affects patients in various ways, from increased risks in infections and deaths to poor documentation, improper surveillance and failure to mobilize patients.

“We have a significant problem with correct coverage and problems with staffing when it comes to nurses getting breaks on a daily basis, every shift, every day,” said Emily Sippola, a registered nurse for 16 years at United hospital in Saint Paul, Minnesota.

Nurses aren’t getting their breaks because they don’t want to compromise the safety of their patients Emily Sippola

She noted nurses need more resources, such as a break nurse, and that understaffing leads in the short term to what’s referred to as “the nurse hangover”; fatigue and malaise comparable to a hangover from alcohol. But it also leads to long-term effects such as burnout, high staff turnover and patient safety errors.

“Nurses aren’t getting their breaks because they don’t want to compromise the safety of their patients and they don’t want to put undue work on their co-workers in order to take care of patients when there is a better solution,” Sippola said.

In the emergency room at United hospital, registered nurse Brittany Livacarri also described nurses who don’t take breaks because doing so would put their patients at risk because the department is commonly understaffed.

“There can be 20 to 30 patients waiting in the triage area to be seen with just two nurses to look after them,” Livacarri said. Depending on the influx of patients, the department sometimes has to close rooms or take care of patients in the hallway. “We try to keep the ratio at three patients to a nurse, but it doesn’t always happen.”

A spokesperson for Allina Health, which owns and operates United hospital, said in an email: “It appears based on our reports, what you are being told by the two nurses is inaccurate. We work hard to ensure a safe and supportive work environment for all our caregivers. Our staffing ratios are consistent with the level of care required in each unit.”

Community Health Services did not respond to multiple requests for comment.