The International Council of Nurses (ICN) has released a new position statement on Evidence-based safe nurse staffing which calls for increased investment in safe, effective and needs-based nurse staffing levels in order to improve patient outcomes and create positive practice environments.
“There is clear evidence of the importance of safe nurse staffing in relation to patient safety in all healthcare sectors. Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient death in hospitals and poorer patient experience of care,” said Howard Catton, Director of Nursing and Health Policy at ICN. “ICN recognizes that safe staffing is a key priority and major issue of concern for many of our members and the nurses they represent.”
Research shows an increase of one Registered Nurse (RN) per 10 beds is associated with an 11-28% reduction in death 30 days following a stroke and with an 8-12% reduction one year following the stroke. Evidence further demonstrates that hospitals with higher proportions of baccalaureate prepared RNs have better patient outcomes and lower mortality rates.
In addition, inadequate staffing levels can lead to lower job satisfaction, increased levels of stress, staff burnout, a higher inclination to leave and increased staff turnover. This also has resource implications which a number of studies have shown are very significant.
The substitution of healthcare support workers for RNs and the development of new non-RN roles have been implemented in some countries as a possible solution to address a shortage of RNs and to reduce the wage bill. However, research shows that substituting RNs for less qualified cadres of workers may worsen patient outcomes and may not be cost-effective.
“Patient safety and the health of the nursing workforce are two sides of the same coin,” said Catton. “Many nursing associations are concerned that staffing decisions are being driven by financial considerations rather than improved patient outcomes and practice environments. IN order to deliver quality, patient-centred care, there is a real need for positive practice environments with an adequate number of staff, manageable workloads, managerial support, high quality leadership and the ability of nurses to work at their full scope of practice.”
The position statement, which was developed with the input of international experts and in consultation with ICN’s members associations, sets out both principles and key elements of approaches to ensuring safe staffing which is intended to help and support all those involved in determining staffing levels and ensure there is clear nursing leadership on this vital issue.
It calls for:
• establishment and implementation of safe nurse staffing systems based on real-time patient information
• sufficient healthcare funding to deliver needs-based safe nurse staffing
• effective staffing systems based on both patient safety and the health and wellbeing of staff
• public awareness of the impact that safe nurse staffing has on patients, families and communities
• an end to the creation of substitute roles for Registered Nurses
• promotion on nurse staffing research that includes economic analysis
The evidence presented in this new ICN position statement goes hand-in-hand with similar issues raised in two recently released ICN publications: one on nurses’ salaries and the other on retention of nurses. These show that many nurses around the world have experienced a real terms’ fall in their purchasing power over the past 10 years, and that when nurses are enabled and supported to do the job they were trained to, they are less likely to leave the profession.