Oregon Nurse Online Summer 2013 Edition
by David Cadiz, MBA, PhD, Oregon Nurses Foundation
On May 15, David Cadiz, MBA, PhD, a researcher for the Oregon Nurses Foundation (ONF), presented the results from an investigation of staffing request documentation forms (SRDFs) at the Work, Stress, and Health Conference in Los Angeles, California. SRDFs are filled out by staff nurses or charge nurses to document the occurrence of an inappropriate staffing event. The research was truly a collaborative effort involving staff from ONF, the ONA Professional Services department, and graduate and post baccalaureate students from Portland State University. The team examined over 1,500 SRDFs submitted from 2010 to 2012, representing 28 Oregon facilities and 30 units.
Substantial literature exists examining the adverse effects of insufficient staffing, but the information gathered from the SRDFs differs from the current research literature in that it captures the front-line nurse perspective by asking for their judgment as to how the inadequate staffing event affected their ability to provide care, how it compromised patient safety, and whether they were able to perform self-care (i.e., take meal and rest breaks).
To illustrate the humanistic perspective of how insufficient staffing affects individual nurses, the presentation started with a nurse’s story that was extracted from a comment written on a SRDF. The audience was captivated by the nurse’s struggle to negotiate providing quality patient care on a labor and delivery unit while being hindered by lack of staff resources. The story echoed the hundreds of other comments submitted by nurses in that this event was the ‘final straw’ in a consistent trend of insufficient staffing experiences, which suggests that this problem is likely to be under reported.
The presentation also included results that support the adverse effect of inadequate staffing on delaying or omitting patient care tasks, compromised patient safety, and missed self-care activities. For example, it is at least 2.8 times more likely that medical orders and hygiene tasks are delayed or omitted when staffing levels were insufficient to meet the intensity of patient care. It is at least two times more likely that patient care and continuity of care are compromised when it was indicated that there was not enough staff on the unit. Finally, when patient intensity was indicated as the reason for insufficient staffing, it was at least 1.6 times more likely that a nurse had to skip rest and meal breaks and perform voluntary overtime.
Through the dissemination of the research, we not only wanted to raise awareness of the negative impact inadequate staffing has on patients and the ability of the nurses to practice competent and safe care, but also the potential health impact on nurses if they are chronically unable to perform self-care during and after shifts. Another goal was to emphasize the idea that insufficient staffing goes beyond staff-to-patient ratios, but that it impacts peoples’ lives.
After the presentation, Cadiz was approached by several health care and occupational health professionals from the audience who were encouraged to see that the front-line nurse perspective was getting much needed research attention in the understaffing literature. This feedback solidified the research team’s resolve to continue to broadcast this information through additional outlets including the peer-reviewed research literature. Although there is more work to be done, the conference reinforced the need for continued investigation of staffing issues and their negative impact on patient safety, nurse practice, and nurse health. The hope is that by making the nurses’ voice heard about the issue of insufficient staffing, more emphasis will be placed on resolving the problem.