Although the progress in the global healthcare industry, including nursing as its integral part, has been outstanding in recent decades, issues continue to exist. One of the biggest among those is inadequate staffing, which is observable even in developed countries and can have fatal outcomes. Notwithstanding the seriousness of the problem, the available research provides no consensus on its nature and possible solutions, being quite fragmentary and narrow.
The point where the studies that focus on various communities agree is the correlation between poor staffing and insufficient interaction with patients. Thus, Cho et al. (2017) mention missed care among the consequences of the lack of competent nurses in several South Korean hospitals. Porcel-Gálvez et al. (2021), who investigated Spain, recognize the dependence of the level of care on the skill mix of nurses, that is, the share of professionals, not assistants, in personnel. In German medical institutions, the quality of care also shows an inverse dependence on the percentage of assistant nurses (Winter et al., 2021). Finally, the research on an international scale proves that the correlation is global (Aiken et al., 2017; Griffiths et al., 2018). In addition, most of the investigators include higher patient mortality rates in the list of the associated phenomena.
On the contrary, the areas where various studies contradict each other also exist; the nature of the connection is among them. Specifically, some experts attempt to calculate the decrease in mortality that can result from a particular increase in skill mix (Aiken et al., 2017; Winter et al., 2021). The other, meanwhile, doubts a cause-and-effect relation, highlighting the scarcity of evidence that adding to personnel makes omitting essential procedures less frequent (Griffiths et al., 2018). The solutions the opposing sides offer, consequently, are dissimilar as well. Cho et al. (2017), for instance, state directly that “appropriate nurse staffing is required to reduce missed care and to improve patients’ experiences” (p. 347). Porcel-Gálvez et al. (2021) regard staffing level as one of the characteristics of a particular medical institution rather than an independent factor, which allows assuming that the problem is more complex.
It is noteworthy that all of the studies under review have limited scopes, which, consequently, compromises the reliability of their outcomes. Even Griffiths et al. (2018), who searched the global Cochrane library, refer only to 18 articles; regarding the others, their studies are region- or country-specific. In such a case, the large scale of a particular investigation cannot compensate for the small size of the selection. This apparently is the root cause of the insufficient consistency of knowledge on the topic, as the outcomes of various depthless investigations may contradict each other. Consequently, the type and the degree of the correlation between poor staffing and improper patient care remain on the list of the gaps in nursing scholarship.
Considering the above, the need for thorough randomized research on the issue is doubtless. It should utilize qualitative and quantitative approaches to allow for a broader perspective compared to methodologically homogenous studies. The former, notably, can be helpful in identifying and describing the nature of the relation, while the latter enables calculating its degree and presenting it in the form of statistical conclusions.
To summarize, the topic of improper staffing in nursing remains underinvestigated; the currently available research recognizes it as a problem but is not sufficiently consistent to offer universal solutions. Even the type of correlation between staffing issues and patient mortality rates is still under discussion. This determines the relevance of a large-scale study that would cover a sufficiently significant and diverse selection as well as apply various methods so that its outcomes are maximally close to reality.
Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., Maier, C. B., Moreno-Casbas, T., Ball, J. E., Ausserhofer, D., & Sermeus, W. (2017). Nursing skill mix in European hospitals: a cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality & Safety, 26(7), 559-568. Web.
Cho, S.-H., Mark, B. A., Knafl, G., Chang, H. E., & Yoon, H.-J. (2017). Relationships between nurse staffing and patients’ experiences, and the mediating effects of missed nursing care. Journal of Nursing Scholarship, 49(3), 347-355. Web.
Griffiths, P., Recio-Saucedo, A., Dall’Ora, Ch., Briggs, J., Maruotti, A., Meredith, P., Smith, G. B., & Ball, J. (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474-1487. Web.
Porcel-Gálvez, A. M., Fernández-García, E., Rafferty, A. M., Gil-García, E., Romero-Sánchez, J. M., & Barrientos-Trigo, S. (2021). Factors that influence nurse staffing levels in acute care hospital settings. Journal of Nursing Scholarship, 53(4), 468-478. Web.
Winter, V., Dietermann, K., Schneider, U., & Schreyögg, J. (2021). Nurse staffing and patient-perceived quality of nursing care: a cross-sectional analysis of survey and administrative data in German hospitals. BMJ Open, 11(11), e05113. Web.