The Impact of Understaffing in Healthcare: A Nurse's Perspective

We’ve all seen, heard, and felt the impact of understaffing in healthcare facilities, especially in regard to nurses. I have seen several articles recently about nurses on strike due to low staffing. The most recent strikes I read about were at Robert Wood Johnson University Hospital in New Brunswick and also Kaiser Permanente, which includes several hospitals in multiple states. One of the union presidents stated, “We need better staffing so that we can keep workers safe on the job and continue providing top-quality care for our patients.” Her statement could not be truer, and I truly wish we could go back to the basics of focusing on patient centered care. We all know that’s easier said than done. I mean, since COVID, all business categories are short staffed, the BIG difference is that lives are at stake in the healthcare industry. I can deal with my DoorDash order being delivered with a few mistakes, but I can’t deal with an accidental health emergency due to unsafe nurse to patient ratios.

I graduated from nursing school in 2013 and worked on a medical-surgical floor for a year and then moved on to be an ER nurse and also a “per diem” or “PRN” (as needed) float nurse for 8 years. As a per diem nurse, my sole job was to go to numerous hospitals and floors that were short staffed to make up for the staffing deficit. I would say, the first few years of my nursing career were still patient focused, but then it slowly started shifting to patients becoming “customers”. Switching patients to customers changed the whole vibe of how we cared for our patients. We’d have daily meetings at the nursing stations looking at metrics and how we could become profitable. Some of the metrics were well worth discussing and improved patient care, others were money and survey focused. Saving money also means, working with bare minimum staff. What can we get by with? Nurses are often required to chart on certain items in patient’s charts that we, most likely, don’t even have time to physically do because of the required charting and patient load. Most often than not, I would come in for a per diem shift and take one or two patients from each nurse on the floor, rather than taking a whole assignment from one nurse. The nurses were taking on more than they should have. I also witnessed several beds being closed due to a lack of nurses. We have the beds, but no one to take care of the patients, so ER patients would wait in the lobby until someone got discharged or more nurses would come in. Same for patients being admitted. The patient would be admitted in the ER and then wait in the ER for a day or two until a bed would open up on an in-patient floor. The only other option is to have a nurse take more patients than he/she really should. This, sadly, happens more often than not. Nurses are pressured, told, and expected to take on way more than they can handle.

So, what happens when a nurse takes on more than he/she can handle? The patients are negatively affected. Nurses get pulled into so many different directions at one time and are constantly rearranging priorities in their heads. Who needs what when and which one is the most important? When nurses are in a time crunch and rushing, mistakes get made. Some mistakes, minor, while some can be life threatening. When that load is lightened by safe and proper staffing, nurses can get to what needs to be done, while also having some extra time to care for patients on an emotional level. Patients are already in a fragile state, being sick, they don’t need a nurse rushing in and out, throwing pills in their face and ripping those terrible telemetry stickers off their chest. I had numerous times, as a nurse, where I would want to sit and talk with a patient, who really wanted/needed to talk, but my only choice was to rush off to the next room because there just wasn’t enough time.

Nurses (well, most nurses- I can admit there are some Nurse Ratcheds out there) made a vow to take care of patients and aid in their healing. When nurses feel like they’re not carrying out the purpose of their job, and that’s for any job, there’s a sense of dissatisfaction and purposelessness. Morale then diminishes, treatment of patients becomes lax, and employees quit. On top of that, most staff nurses feel they are not paid enough, especially being short staffed. It’s pretty normal to think, if I’m doing more work and taking on the job of two nurses, shouldn’t I be paid more? I remember my first few months in the ER, I remember thinking, these nurses do EVERYTHING! They give meds, they perform CPR, they chart, they get vitals, they are communicating with doctors, social workers, and housekeeping, they call cabs, they search each refrigerator on the floor for a turkey sandwich, then they have to find mustard for that turkey sandwich, they clean rooms, they get hit or “hit on” daily, they wipe butts, they update family members, they witness death, they eat lunch right after rubbing the back of a vomiting patient, they pick patients up off the floor after falling, they walk miles a day, they change their scrubs after having a patient with bed bugs… the list goes on and on.

I am thankful to be a nurse and so grateful for the nurses I have met over the years. It’s not an easy job, and not everyone can do it, so shout out to all of you nurses out there (whoop whoop!!!). Healthcare would not be the same without you. I hope that one day a nurse’s worth will be valued as it deserves. If our nurses are treated right and given safe patient ratios, then the patients will ultimately win. Patient care will be patient focused once again.

“As a nurse, we have the opportunity to heal the mind, soul, heart, and body of our patients, their families, and ourselves. They may forget your name, but they will never forget how you made them feel.” -Maya Angelou