Wednesday 5 September 2018

Improved patient outcomes are dependent on safe nurse staffing levels as well as not substituting registered nurses with lower qualified categories of nurses and support staff. This was stressed in the International Council of Nurses’ position statement on Evidence-based safe nurse staffing which was released on August 6. “Evidence shows nurses save lives, reduce costs and improve patient outcomes.”

Nursing Responsibilities, Nursing Career, Staff Nurse

The position statement is based on evidence provided by research into nurse staffing from across the world. Safe nurse staffing is critical for patient safety as well as for quality care in all the settings where nurses work. Besides enough staff, the right mix of education, skill, and experience are also necessary to meet patient needs.

“There is clear evidence of the importance of safe nurse staffing in relation to patient safety in all healthcare sectors. Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient deaths in hospitals and poorer patient experience of care,” said Howard Catton, Director of Nursing and Health Policy at ICN. “ICN recognizes that safe staffing is a key priority and major issue of concern for many of our members and the nurses they represent.”


Evidence has shown that, besides improved patient outcomes, safe nurse staffing also leads to better nurse outcomes – including reduced workloads and enhanced job satisfaction and staff retention. The stress associated with excessive workloads has a significant impact on costs when it leads to burnout, decreased job satisfaction and increased staff turnover.

In some countries, registered nurses are being replaced by lower qualified nurses and healthcare support workers to address the shortage of nurses as well as to reduce costs.  The position paper strongly cautions against this practice. Evidence has clearly shown patient outcomes are better and mortality rates lower in hospitals that have higher proportions of baccalaureate prepared RN’s.

In contrast, replacing RN’s with other categories of health care workers is associated with poorer patient outcomes, higher hospital mortality rates as well as more adverse events such as medication errors and falls – therefore not being cost-effective in the long run.

The position paper recommends that safe staffing should be based on evidence-based planning regarding patient needs in real time. This requires quality tools to measure patient and staffing data as well as allowing for professional judgment by both the direct care providers and nursing management to determine the safe number and ratio of staff to patients. Nursing management should be in control of nurse staffing levels and be able to make adjustments as needed to ensure the patient safety.

The ICN also called on individual nurses to report unsafe nurse staffing. They should also participate in developing evidence-based tools, systems, policies and processes for safe staffing.


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