Some situations are totally out of your control. You show up for work, but there are not enough nurses on staff during your shift to meet all of the patients’ needs. As a nurse, your ethical obligation to provide safe patient care does not change under these circumstances, but there is only so much you can do without more help.
When your employer fails to hire enough nursing staff or others don’t show up for work, your ability to meet the required level of care can be compromised. Unfortunately, these situations can seriously impact your career because understaffing can jeopardize your nursing license if you make a mistake or someone complains.
What is Understaffing?
Understaffing, also known as short-staffing, happens when the number of patients on a unit is greater than the unit’s maximum capacity for the number of nurses as established by quality and safety standards. While understaffing was becoming a problem before the pandemic hit, it has become even more common in nearly every hospital, clinic, and other medical facilities since.
When care facilities are understaffed, nurses may not be able to provide patients with the level of care they need, and these situations place the nurses’ licenses at risk. AACN Publishing recently released a survey involving more than 9,300 nurses. Of those surveyed, only 24% of the nurses felt they received adequate staffing more than 75% of the time.
What are the Possible Repercussions of Understaffing?
Studies have shown that when intensive care units have higher staffing levels, the rates of pressure injuries and infections go down. A different study showed when one additional patient is added to a nurse’s care list, urinary tract infections, and surgical site problems go up.
In general, when nurses are stretched too thin, they simply cannot meet every patient’s needs. They may be unable to comply with professional nursing standards and state regulations. Through no fault of their own, they may face complaints and disciplinary action from the state nursing board.
Common Errors That Short-Staffing Can Cause
When a unit or facility is understaffed, the likelihood of mistakes and omissions increases. Some of the most common problems that can occur when the patient-to-nurse ratio is too high include:
Patient falls – When patients ring for a nurse who can’t respond quickly enough, they may try to do things on their own. Transferring from a bed or chair or using the bathroom can lead to a fall and serious harm to the patient.
Medication mistakes – Nurses are trained to follow detailed instructions. When a nurse is overworked, they may miss a detail they would normally catch. An overtired nurse is more likely to make a costly mistake.
Increased incidence of bed sores – Repositioning a patient to avoid bed sores normally requires at least two staff members. When pressed for time, a nurse may try to move a patient on their own. The nurse might hurt their back as a result. The alternative is to wait for help which increases the patient’s chances of developing sores.
Work burnout – Even with adequate staffing, working as a nurse can be mentally and physically exhausting. Burnout can lead to serious errors that can cost a nurse their career, license, and future.
Patient complaints – When a patient must wait for pain medication or a nurse doesn’t respond quickly when called, the patient is more likely to report lower overall satisfaction. Negative reports can harm nurses and the facilities that employ them.
Facing a Nursing Board Can Lead to Losing Your Nursing License
Each state has a nursing board that decides who is eligible and qualified to receive a nursing license. These boards also handle complaints and investigations to determine if a nurse should be reprimanded, their license placed on probation, or if their license should be suspended or revoked.
The primary objective of these nursing boards is to promote patient care and safety by ensuring all nurses meet the standards set by the Nurse Practice Act (NPA). Nursing boards must balance protecting the public’s safety, health, and welfare with ensuring each nurse has the right to practice nursing.
If a nurse violates the Nurse Practice Act, the state nursing board has the authority to discipline the nurse, including revoking the nurse’s ability to continue working as a nurse. Each complaint is considered independently based on the unique circumstances surrounding the complaint. If the state body determines the nurse violated the NPA, it has a wide range of options ranging from formal discipline to license revocation.
So, How Can a Nurse Protect Their Job and Their License in Understaffing Situations?
In a short-staffing scenario, a nurse may need to prioritize which aspect of patient care they must complete first. If questioned by the nursing board, the nurse’s decision-making process and considerations can become a deciding factor in the investigation process.
If possible, a nurse might be able to advocate for patient safety by meeting with their employer to address understaffing concerns. Even if you have no say in staffing decisions, speaking out about staffing problems could help protect your license and your career.
Can a Nurse Refuse an Assignment Due to Understaffing?
The short answer to this question is no. A nurse cannot refuse to accept an assignment. If you are in an understaffing situation that may lead to a patient complaint or nursing standards accusation, write a letter or email your supervisor and report the understaffing. Keep a copy of your correspondence so that if something happens, you have proof you expressed concern.
If your facility is consistently understaffed, you may be better off finding a different facility. Remember, you can find another job, but you cannot get another license.
Nurses Bear the Greatest Burden of Short-Staffing
When a facility is understaffed, these situations can cause serious problems for both patients and nursing staff. The burden of primary patient care falls on nurses’ shoulders and if the unit is short-staffed, nurses don’t have the bandwidth to provide prompt, quality care for additional patients.
If you are struggling with understaffing at work or facing a complaint you relate to your work environment, talk to an experienced nursing license defense lawyer to learn more about your legal rights. Not every lawyer understands the complex procedures required by the Nurse Practice Act, so be sure to find a lawyer with the skills and knowledge required for success in this area of law.
As a Licensed Registered Nurse, Attorney Lorie Brown Can Help Address Understaffing Conditions That May Be Jeopardizing Your Nursing License
Most people don’t understand the challenges nurses face every day. Nursing can be a demanding career—physically, emotionally, and even financially if your license is threatened by the state nursing board. As a licensed registered nurse, I fully appreciate the work you do and the situations you encounter. After beginning my career as a nurse, I’ve devoted my legal practice to protecting nurses who are facing legal issues.
Understaffed work conditions can lead to medication errors, documentation mistakes, patient accidents or harm, and even problems with difficult co-workers. Despite their work environment, nurses are expected to meet all standards of care and report unsafe conditions related to patients and nursing staff.
I’ve represented more than 1,000 nurses and health care professionals, and many times they admit they should have reached out sooner for a consultation and advice about how to handle staffing or other work situations. If you are concerned about your work environment, or you are facing a disciplinary investigation, contact me online or call me at (317) 465-1065 today.
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