Budget decisions in in profit-driven healthcare are generally made based on an investment mindset, “If we spend money here, how much money will we make?”

This creates a problem for staff nurses in hospitals and nursing homes and nurse leaders who are advocating for more staff especially in chronically understaffed units. The problem is that administrators want to see objective signs of increased productivity and nurse leaders may be held accountable for proving added value of added staff.

BUT, wait! Increasing staffing won’t necessarily increase ROI because so much is going on underneath the radar. Patient advocates and healthcare consumers will be more empowered if they understand some of the hidden issues that this presents for staff nurses and nurse leaders. It is critical to understand these three points if we are going to staff hospitals and nursing homes with enough RNs, LPNs, LNAs/CNAs to provide safe, quality care not to mention customer satisfaction and job morale.

1). Many of us who work in direct care are working as fast as we can. When we don’t have time to do things right, we may take short cuts or develop workarounds. We don’t talk about them, because we are not supposed to do them. But we do develop habits. I learned a lot about this from working on a recent Root Cause Analysis, (RCA) project with Bob Latino, CEO of Reliability, INC. “Normalization of Deviance” is a term that comes from analyzing the shuttle launch catastrophe and basically is when we do things the wrong way and nothing bad happens so we keep doing it until something bad does happen. You can learn more about this in our RN Medication Error video we just released. One of the first things that should happen when staffing is increased is that we stop taking short-cuts! But since they are invisible, investors may wonder, how is this impacting the bottom line?

2) Also, many, in fact almost 90%, of the errors that occur in healthcare are not reported. In the April, 2011 issue of Health Affairs, the leading journal of health policy, published 3 articles with staggering updated statistics about preventable medical errors, (aka adverse events, aka sentinel events) in the USA. Medical errors, according to resources in this issue, are ten times more frequent than hospitals and US regulators are reporting and each year:

187,000 deaths in hospitals (other estimates as high as 400,000)!

Occur in 1 out of every three hospital admissions

6.1 million injuries in and out of hospitals

An estimated cost of 17.1 billion in 2008

An estimated social cost of 393-958 billion in 2008

The hope would be that any staffing related errors will decrease when we have enough staff. But how will we know since we’re not really talking about them in the first place?

3). Many nurses and nurses assistants I have worked with over the years do not take meal and rest breaks as they should according to human needs, labor laws and organizational parameters. Organizational leaders will often post signs about the expectation and reprimand staff when they don’t take breaks. Some resort to punching out for breaks but not taking them, i.e. going back to work. Some of us call this “Pseudo Lunch”! This problem is complicated and there are individual and organizational factors that contribute, but my point in this post is that at least some of this behavior occurs because the workload staff are assigned can not be done in the right way in the time allowed. So increased staffing is more likely to allow staff to have the time to take meal and rest breaks. Again, increase staff will be a big budget line with no obvious ROI!

Progressive and compassionate leaders understand that adequate staffing will help the bottom line because there is less liability and overall better quality and safer care. Less wasted resources, less staff turnover and less re-admissions are all benefits from adequate staffing but not necessarily easy to see.