Applying Research Skills

Healthcare staffing shortages may significantly impact patient’s experience. I had wittnessed my

mother’s unpleasant experience when she came to provincial hospital for healthcare. That

experience might be due to the reason that the hospital being understaffed. It can be observed

that longer wait times for appointments and treatments become commonplace, leading to

frustration and delays in receiving necessary medical attention. When healthcare providers are

overworked, patients may feel rushed or neglected, compromising the quality of care and

communication. This can lead to misdiagnoses, medication errors, and a general sense of

dissatisfaction with the healthcare system. Additionally, patients may experience increased

anxiety and stress due to the perception of inadequate staffing levels, potentially exacerbating

their health conditions. Ultimately, staffing shortages can erode patient trust and confidence in

the healthcare system, making them feel undervalued and unsupported.

To mitigate nursing staff shortages, a multifaceted approach can be implemented. One strategy

may be to invest in nurse retention through competitive compensation, flexible scheduling, and

supportive work environments. Additionally, organizations can explore innovative staffing

models, such as team nursing or patient-centered care, which can optimize staffing and improve

patient outcomes. Furthermore, investing in nurse education and training programs can help

increase the nursing workforce and address specific skill shortages. This includes offering tuition

reimbursement for advanced degrees, providing continuing education opportunities, and creating

residency programs for new graduates. Finally, utilizing technology can streamline processes,

reduce administrative burdens, and improve efficiency, allowing nurses to focus on direct patient
care. By implementing a combination of these strategies, healthcare organizations can effectively

address nursing staff shortages and ensure quality patient care.

Identifying relevant, scholarly Peer-Reviewed Articles

I searched for scholarly reviewed articles related to my chosen topic of “staffing shortages” via,

the Health Administration Database, PubMed Central and CINAHL Complete. I opted to use

keywords such as “healthcare staffing shortages”, “Nurse-to-patient ratio”, “nursing workload”,

“staff retention”, “safe patient ratios”, “burnout”, “recruitment” and “retention” patient

experience, cost of medical care, to help focus on my interest of searching in facing with

tremendous available results.

Assessing the credibility and explain relevance of the information sources

Noting my chosen topic and the criteria that are used to search for articles, I limited my search

results to show only creditable reviewed articles that have been published within the

past 5 years. I searched for articles that were completed by key publications and key authors on

the field, who were cited frequently in other journals. I also reviewed the “Abstract” and

Findings prior to further reading into the full text to ensure that they met the criteria. I only

reviewd articles that were closely related to my chosen topic.

annotated bibliography

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021).

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions,

and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-

1913. doi: 10.1016/S0140-6736(21)00768-6. https://pubmed.ncbi.nlm.nih.gov/33989553/

The key findings showed that patient outcomes after the implementation of nurse-to-patient ratio

legislation in Queensland, Australia, included: improved Mortality Rates throught the evidence

of reduction in mortality rates post-implementation. In terms of Length of Stay (LOS), the

overall findings of the study also suggested that the intervention hospitals experienced better

outcomes in this aspect. In sum, the findings indicate that the implementation of minimum nurse-

to-patient ratios not only improved staffing levels but also led to better patient outcomes,

supporting the effectiveness of such policies in enhancing healthcare quality (McHugh et al.,

2021). The methods provided a robust framework for evaluating the impact of the nurse-to-

patient ratio policy on both staffing levels and patient outcomes. The authors' implementation of

the study involved several key components aimed at evaluating the effects of the minimum

nurse-to-patient ratio policy in Queensland, Australia. Here are the main aspects of their

implementation: Registered and enrolled nurses were surveyed before and after the policy

implementation to gather information on medical-surgical nurse staffing levels in the hospitals

where they worked. This approach was chosen to ensure accurate reporting of staffing levels, as

it provided better predictive validity compared to administrative data. The authors evaluated the

impact of the policy on key patient outcomes, including mortality rates, readmissions, and length

of stay. They aimed to determine whether improvements in staffing levels at intervention

hospitals were associated with better patient outcomes. Overall, the authors' implementation was

comprehensive, combining policy evaluation with robust data collection and analysis methods to

assess the effectiveness of the nurse-to-patient ratio legislation on patient outcomes.

Butler, C. R., Webster, L. B., & Diekema, D. S. (2024). Staffing crisis capacity: a different

approach to healthcare resource allocation for a different type of scarce resource. Journal of
medical ethics, 50(9), 647-649. doi: 10.1136/jme-2022-108262.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9844994/

The authors make several specific recommendations for addressing staffing shortages in

healthcare settings, particularly in the context of crisis capacity during the COVID-19 pandemic:

1. Adopt Crisis Standards of Care: When healthcare systems exhaust all mitigation strategies and

cannot maintain usual standards of care, they should shift to crisis standards of care aimed at

maximizing the aggregate benefit of scarce resources across the population .

2. Implement Standardized Policies: Institutional leaders should develop standardized,

transparent, and operationalizable policies to allocate scarce staff resources fairly. This includes

ensuring that policies are proportionate, equitable, and tailored to local contexts , .

4. Prioritize High-Value Interventions: The authors suggest prioritizing interventions that offer

high near-term value and restricting access to acute care services for patients at relatively low

clinical risk. This approach aims to maximize the overall benefit of available staff resources .

5. Support Staff Well-Being: Addressing the moral distress and burnout among healthcare

workers is crucial. The authors emphasize the need for broader efforts to promote staff well-

being at individual, team, institutional, and regional levels .

6. Engage in Transparent Communication: Clear communication regarding the rationale behind

resource allocation decisions can help alleviate the ethical dilemmas faced by clinicians and

support their decision-making processes .

These recommendations aim to create a framework that supports healthcare institutions in

managing staffing shortages while maintaining a focus on ethical considerations and population-

level benefits.

The paper's relevance to the keywords "patient experience" and "cost of medical care" can be

understood through the following points:

1. Patient Experience:

- Resource Allocation Impact: The recommendations for prioritizing interventions that provide

high near-term value directly affect patient experience. By focusing on treatments that are more

likely to yield positive outcomes for patients, healthcare systems can enhance the quality of care

delivered, even in crisis situations , .

- Transparency and Communication: The emphasis on standardized and transparent policies

helps manage patient expectations and experiences during times of resource scarcity. When

patients understand the rationale behind care decisions, it can lead to greater trust and

satisfaction, even if the care provided deviates from usual standards .

- Access to Care: The paper discusses the potential restriction of access to acute care services for

patients at lower clinical risk. While this may seem detrimental to individual patient experience,

it is framed as a necessary strategy to ensure that resources are available for those who need

them most, ultimately aiming to improve overall patient outcomes in a resource-limited

environment .

2. Cost of Medical Care:

- Efficiency in Resource Use: By advocating for the restriction of resource-intensive

interventions that offer minimal benefit, the paper addresses the cost implications of medical

care. This approach can lead to more efficient use of healthcare resources, potentially reducing

unnecessary expenditures associated with low-value treatments , .

- Crisis Capacity Framework: The framework for crisis capacity encourages healthcare

institutions to make difficult decisions about resource allocation that can help control costs

during times of staffing shortages. By prioritizing interventions that maximize population-level

benefits, healthcare systems can avoid the financial strain associated with providing high-cost

interventions that do not significantly improve patient outcomes , .

- Long-term Sustainability: The recommendations aim to create a more sustainable healthcare

system by ensuring that resources are allocated in a way that balances patient needs with the
financial realities of healthcare delivery. This can help mitigate the long-term costs associated

with staff burnout and turnover, which are exacerbated by crisis conditions , .

In summary, the paper highlights the interconnectedness of patient experience and the cost of

medical care, advocating for strategies that enhance care quality while also addressing the

financial sustainability of healthcare systems during staffing crises.

Griffiths, P., Saville, C., Ball, J., Dall'Ora, C., Meredith, P., Turner, L., & Jones, J. (2023). Costs

and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A

systematic review. International journal of nursing studies, 104601.

https://doi.org/10.1016/j.ijnurstu.2023.104601

Increases in registered nurse staffing and skill mix in acute hospitals are potentially highly cost-

effective, while reducing the proportion of registered nurses could lead to worse outcomes at

increased costs.

Main findings

- Increasing the number or proportion of registered nurses in general medical and surgical wards

is likely to be cost-effective, as it is associated with improved patient outcomes and potentially

reduced net costs.

- Reducing the proportion of registered nurses in nursing teams could lead to worse patient

outcomes at increased costs, and there is no evidence that such an approach is cost-effective.
- In the current context of registered nurse shortages, the results favor investing in increasing the

supply of registered nurses rather than using less qualified staff as substitutes, especially where

baseline nurse staffing and skill mix are low.

The paper argues that in the context of registered nurse shortages, the findings of this review

support investing in increasing the supply of registered nurses rather than using lower-qualified

staff as substitutes, especially where baseline staffing and skill mix are already low. The paper

directly contradicts policies that aim to dilute nursing skill mix, and instead states that investing

in the supply of registered nurses should be the priority.

The paper indicates that improved patient experience and patient satisfaction are associated with

increased nurse staffing, though this is not the main focus of the cost-effectiveness analysis. The

paper suggests these benefits may represent "important but less tangible" outcomes that are not

fully captured by the mortality-based cost-effectiveness estimates.

Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and

retention in the United States. Nursing Outlook, 70(4), 664-678.

https://doi.org/10.1016/j.outlook.2022.04.005

This paper provides a systematic review of the current research on factors associated with

registered nurse (RN) work outcomes, including turnover, retention, and intent to stay or leave,

in the United States, and examines the inclusion of equity and wellness concepts in this body of

literature.

The study identifies individual, unit-level, and organizational factors that influence RN work

outcomes. It highlights the significance of job satisfaction, organizational commitment, and

burnout, as well as the impact of leadership, peer relationships, and work environment.
Additionally, the study emphasizes the need to address equity and promote the overall health and

well-being of RNs to improve their work outcomes and patient care.

The individual factors beyond burnout that impacted RN work outcomes, according to the paper,

were job satisfaction, organizational commitment or job embeddedness, and level of nursing

education (with RNs with graduate degrees more likely to leave). The impact of age or

generation on turnover or retention rates was mixed across studies.

According to the data, higher levels of burnout are associated with higher rates of negative work

outcomes for registered nurses, including increased turnover and intent to leave.

Positive peer/group relationships and teamwork, lack of negative workplace experiences like

abuse or hostility, and organizational factors like academic affiliation, urban location, and larger

size are associated with higher RN retention.

Effective RN retention and improved work outcomes can be achieved through a combination of

factors. Positive leadership, strong peer relationships, and a supportive work environment at the

unit level play a crucial role. Additionally, appropriate staffing levels, manageable workloads,

autonomy, and flexible scheduling contribute to job satisfaction and reduced burnout. Investing

in training, development, and career advancement opportunities can further enhance RN

retention and job performance.

Learnings from the Research

References
Butler, C. R., Webster, L. B., & Diekema, D. S. (2024). Staffing crisis capacity: a different

approach to healthcare resource allocation for a different type of scarce resource. Journal of

medical ethics, 50(9), 647-649. doi: 10.1136/jme-2022-108262.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9844994/

Griffiths, P., Saville, C., Ball, J., Dall'Ora, C., Meredith, P., Turner, L., & Jones, J. (2023). Costs

and cost-effectiveness of improved nurse staffing levels and skill mix in acute hospitals: A

systematic review. International journal of nursing studies, 104601.

https://doi.org/10.1016/j.ijnurstu.2023.104601

McHugh, M. D., Aiken, L. H., Sloane, D. M., Windsor, C., Douglas, C., & Yates, P. (2021).

Effects of nurse-to-patient ratio legislation on nurse staffing and patient mortality, readmissions,

and length of stay: a prospective study in a panel of hospitals. The Lancet, 397(10288), 1905-

1913. doi: 10.1016/S0140-6736(21)00768-6. https://pubmed.ncbi.nlm.nih.gov/33989553/

Woodward, K. F., & Willgerodt, M. (2022). A systematic review of registered nurse turnover and

retention in the United States. Nursing Outlook, 70(4), 664-678.

https://doi.org/10.1016/j.outlook.2022.04.005