How To Keep Patients Safe Despite Staffing Shortages

A shortage of healthcare workers is the biggest threat to patient safety in the United States, according to a new U.S. News and World Report article. 

Healthcare staffing levels are currently below pre-pandemic levels; there are fewer nurses, physicians, lab techs, and nursing assistants working in hospitals today than there were in 2019. By January 2022, more than 1 in 6 U.S. hospitals reported critical nursing shortages. Experts estimate that staffing shortages will intensify over the next 18 months, or longer.

Hospitals and healthcare organizations throughout the country are struggling to fill open positions while working to meet the needs of their patients. In the long run, recruiting and onboarding new and experienced healthcare workers can help alleviate the pressure on existing staff and promote patient safety. 

But hiring (and training) additional staff takes time, and it’s crucial for facilities to prioritize patient safety in the present. It’s time to double down on processes and practices that have been proven to boost patient safety. 

Why Staffing Shortages Negatively Affect Patient Safety

Fewer staff equals fewer people to meet patient needs. Two nurses can usually provide excellent care to a group of six to ten moderately ill patients, especially if they have support from nursing assistants. If one nurse must care for all six to ten patients alone, though, each patient will likely receive less attention. Some care might be missed as the sole nurse rushes from one patient to another.

Studies have consistently shown that short staffing increases infections, patient falls, and medication errors, which in turn increases length of stay, patient and family dissatisfaction, mortality rates, and hospital readmissions.

Extra staff is always the best solution to staffing shortages. When additional staff is not available, however, it’s absolutely essential to support existing staff. Weed out and eliminate any unnecessary tasks, and help staff direct their energy toward two high-value activities that are known to promote patient safety: hand hygiene and purposeful rounding.

Emphasize Hand Hygiene

Healthcare-associated infections (HAIs) are a leading cause of patient harm. Over one million HAIs occur in the U.S. each year, and at any given time, 1 in 31 hospital patients has a healthcare-associated infection, according to the U.S. Centers for Disease Control and Prevention (CDC). 

Excellent hand hygiene can dramatically decrease the risk of HAIs, which is why the World Health Organization (WHO), CDC, and other health organizations continually stress the importance of hand hygiene. Unfortunately, most healthcare workers don’t cleanse their hands as often as they should, and hand hygiene rates typically decline when staff are stressed and overwhelmed. It's easy to unintentionally neglect hand hygiene when rushing from one patient’s bedside to another’s to answer a call light, for instance. 

Electronic hand hygiene systems that automatically monitor healthcare workers’ hand hygiene performance allow staff to notice (and address) less-than-ideal hand hygiene. Hospitals that use the SwipeSense electronic hand hygiene monitoring system have reported significant improvements in hand hygiene rates — and significant declines in healthcare-associated infections. A community hospital noted a 49% reduction in HAIs after one year of using SwipeSense. 

Institute Regular Nurse Rounding

The Agency for Healthcare Research and Quality lists scheduled hourly rounds as a Best Practice in Fall Prevention. In fact, regular, intentional rounding — essentially, checking each patient at least once an hour — has a host of patient safety benefits, including decreased patient falls, increased patient satisfaction, and improved pain control. 

Research on hourly rounding at 14 hospitals notes significant improvements to patient safety, including:

  • 52% reduction in patient falls
  • 14% decline in skin breakdown
  • 40% decrease in patient calls for pain management

Regular rounding helps existing staff effectively meet patient needs because it allows them to proactively, rather than reactively, assist patients. In most facilities, rounding staff members assess and address each of the “6 Ps” during hourly rounds: pain, position (repositioning the patient, as needed), personal care needs (including toileting assistance, if needed), proximity of belongings, (ensuring that patient belongings are accessible, as needed), pumps (checking IV pumps and other medical equipment), and promise (letting the patient know what will happen next and when they can expect your next visit). 

Automated nurse rounding technology can help hospital leaders and staff determine a baseline for nurse/patient visits – and then collectively organize clinical workflows to support regular nurse/patient interactions. Analyzing reliable data on staff movement allows hospital leaders to address inefficient workflows and provide just-in-time support. These insights also support purposeful rounding and bedside reporting, two evidence-based practices that allow nurses to streamline care.

It will take time to increase healthcare staffing. In the meantime, prioritize practices that have been proven to promote patient safety, including hand hygiene and hourly rounding.