As a nurse myself, I have experienced first-hand the struggles of the shortage. My first experience was that of a student and that was nearly 15 years ago. The community college that I started my nursing education with was in El Paso, Texas. It was very difficult to be able to get accepted into the program because they only offered 35 slots and entrance was only given every two years.
You had to compete with your GPA in the non-nursing courses, write an essay to the nursing faculty, and pray you got accepted. This was because of the nursing shortage. There were only three instructors and these 3 women taught every single class. Not enough faculty members to teach were one of the reasons for the shortage at that time.
Now let’s fast forward a few years. With a move to a new city and state I made a career and educational move as well. I completed my Bachelor of Science in Nursing and eventually became a Director of Nursing (DON) at a 120-bed nursing home. As the DON, one of my main responsibilities was staffing the home. Pynes & Lombardi (2011) discuss some common mistakes that new managers make when it comes to the interview process. They identified exactly what was happening to me in that I had “several openings and a short time in which to fill them (Pynes & Lombardi, 2011.) Of course, I had some problems, but through prayer, trial and error I learned how to be more selective. James 1:2-3 (NKJV) says “My brethren, count it all joy when you fall into various trials, knowing that the testing of your faith produces patience.” What I found in my interviewing of potential staff was that there were not a lot of candidates applying, the pay was low, and the nurse-patient ratio was extremely high.
The facility I worked for focused on the numbers. Are there enough “licensed bodies” in place to provide the nursing hours that were required by the state? That was the bottom line. Seventy-five percent of the time I was forced to hire a nurse that I felt was unqualified for the position. I was uncomfortable with hiring a nurse who had no experience working with the elderly. I had concerns about their assessment skills of an older adult patient. I wanted nurses who could provide quality care. The administrator wanted nurses who could help meet the nursing hours. There was no motivation in investing in staffing quality nurses when reimbursement was still given whether providing care at the minimum levels versus care at a higher level of excellence (Fox & Abrahamson, 2009.) I remember the administrator keeping an unqualified nurse on staff that had made several serious mistakes simply because “she was the only nurse available to cover a shift on short notice.” The nurse had not checked on a resident at all during her 12 hour shift and discovered him dead in his bed the next morning when she went in to check his blood sugar. The resident was a full code and CPR was not initiated. The main focus for the administrator was only to meet the required nursing hours for the day regardless of the skills of the nurse.
Ferguson & Lloyd (2017), argue that staffing is not just important when providing healthcare, but “safe staffing is critical for positive patient and population outcomes.” High acuity patients require more nursing care than those that are low acuity. As a young nurse fresh out of nursing school I was very interested in cardiac care. I began working at the local hospital of which I worked as a Student Nurse Tech (SNT) while in nursing school. As a SNT we worked alongside the licensed Registered Nurses (RNs) and Licensed Vocational Nurses (LVNs) in order to gain experience. As an SNT you pretty much worked wherever you were assigned. One evening I came on shift and discovered that it was just myself (the unlicensed student) and one RN working on the cardiac step-down unit with 13 patients. The normal staffing ratio would include 1 RN, and LVN, and a nursing assistant. With the type of critical patients on the unit the RN was very frustrated because these patients are all mid-level to high acuity. This was unsafe for the RN whose license I worked under and the patients we were caring for. At this time acuity-based staffing solutions were not being used. Ferguson and Lloyd (2017) see acuity-based staffing as a means to help with decision-making when it comes to admissions, transfers and discharges. Nursing informatics is a field that is focusing on these types of issues. Even in my two year working as a DON, I was faced with the same problem. Having residents on mechanical vents, tube feedings, frequent blood sugars with minimum staffing becomes frustrating and sometimes unsafe. Taking control of admissions, discharges, and transfers in a systematic manner could have prevented one nurse from having so many high-acuity patients.