Before COVID-19, critical care nurses worked in poorly staffed care settings. When the pandemic hit, the number of patients assigned to each nurse, the patient-to-nurse ratio, increased. For the past 20 months, the stretched workforce has continued to accommodate patient influxes, creating an unsafe environment for nurses and patients alike.
What can the public do to support nurses? I propose that community members contact their state representatives and advocate for legislation and regulations that ensure safe staffing.
Poor staffing profoundly degrades the quality of care a patient receives. As patient-to-nurse ratios increase, the time dedicated to each patient decreases. Staffing shortages are related to increased infection rates, delays in resuscitation and unexpected deaths. Staffing shortages not only impact patients but nurses as well.
Increased patient loads affect nurses’ performance and how they feel about their work. In a seminal study, Linda Aiken and other researchers identified that nurse burnout increased in hospitals with high patient-to-nurse ratios and decreased in facilities with low patient-to-nurse ratios. Since then, the connection between poor staffing and burnout has been repeatedly recognized, illustrating the negative impact on a nurse’s well-being and intention to resign.
In a survey conducted by the American Association of Critical-Care Nurses, 92% of 6,000 acute and critical care nurses indicated their careers would be shorter than anticipated due to the pandemic. As nurses leave hospitals, staffing shortages continue to increase. The relationship between burnout and increasing patient-to-nurse ratios is cyclical. The public can break this cycle.
Community members can ensure a nurse at their bedside by contacting their state representatives and advocating for legislation that creates safe patient-to-nurse ratios. California passed such legislation and, as a result, has decreased patient mortality and increased nurse retention. The public must educate state representatives to create similar improvements in their communities.
In addition, the public must demand that their representatives advocate for staffing transparency. Medicare.gov provides the public with critical information regarding the performance of hospitals that receive Medicare reimbursement. The website provides infection and complication rates but does not include patient-to-nurse ratios. By advocating for publicly reported staffing ratios, communities can choose facilities that prioritize patient outcomes.
The COVID-19 pandemic spotlighted the chronic problem of poor staffing in care settings and the resulting implications. Now we can improve healthcare systems by educating our representatives that staffing ratios matter to our communities. By supporting new standards of care, nurses and patients can focus on healing.
Jason Fry
Jason John Fry, Salt Lake City, formerly worked at University of Utah Health as a registered nurse in the COVID ICU and neurological ICU and is now a student registered nurse anesthetist at Loma Linda University.