Is the nurse shortage putting patients at risk?

By Karl Whitemarsh

In recent months, our research team has had candid conversations with health care organizations who report experiencing one of the worst fears of any clinical enterprise: lagging patient safety and quality indicators. Stories and studies like the ones outlined above are increasingly validating these anecdotal concerns. Now is the time to reignite a focus on quality and safety.

No serious commentator could fail to mention the recent verdict in the case of the former Vanderbilt nurse, RaDonda Vaught, and the impact her trial has had on placing patient safety squarely within a tragic spotlight.

Though the challenge is multifactorial, quality concerns are top of mind. The tightening nursing labor market is making the difficult-even-in-the-best-of-times task of staffing hospital units and clinics that much more difficult—the effect of which has the potential to jeopardize safety. As it relates to staffing levels, overtime, and contract labor, researchers over the years have reported the following:

• Each additional patient a nurse is assigned increases the likelihood of that patient dying within 30 days of admission by 7%.
• Nurses are 67% more likely to have a failure of patient safety when working overtime.
• The presence of casual or agency staff can correlate to increased 30-day mortality rates.

The overlap between patient safety and nurse retention strategies

Nursing leaders understand the critical importance of prioritizing tried and true retention strategies and streamlining the backfill of roles to stabilize the workforce. In fact, there is an argument to be made for the overlap between patient safety, how staff perceive safety, and the effectiveness of an organization's retention strategy. As the nursing supply-demand imbalance intensifies staffing-related challenges, data belie the possible emergence of a vicious cycle of nurses leaving their current position (including exiting the profession altogether) due to the perception of unsafe staffing. Data published in May 2021 and February 2022 show a consistent trend. Insufficient staffing levels is the #1 factor influencing nurses' intention to leave their current position. This at a time when safe staffing levels have arguably never been harder to ensure. 

How to ensure a strong recommitment to patient safety and trusted integrity

As organizations pivot away from just-in-time pandemic management as Covid-19 cases and hospitalizations wane, leaders have both an opportunity and an obligation to revitalize their staff's awareness of their organization's approach to issues of patient safety. Though the following recommendations are not new, health system leaders should advance all of them as part of their recommitment to the cornerstone priority in health care: do no harm.

• Recommit to a high reliability safety culture in which every patient receives the known standard of care, every time, in every setting.
• Hardwire 'just culture' through mechanisms to report and investigate safety lapses from the standpoint of systems vs. individual failings.
• Convey to unit leaders and nursing staff the actions your organization is taking to stabilize the workforce and safeguard safe staffing levels, including the necessary investments you're prepared to make.
• Prioritize education on fundamental safety protocols in new nurse orientation and, in cases where new nurses must take on a patient assignment starting day one, ensure a plan is in place to provide that education at the earliest available opportunity.
• Investigate the potential use cases of virtual care technology as part of your patient safety strategy, for example remote patient monitoring or the addition of a virtual care nurse on units with a predominantly novice workforce.