What does "safe staffing" actually mean?
We talk about safe staffing all the time, but is it simply a nurse-to-patient ratio? In the emergency department, where volume, acuity, and workload can change in minutes, the answer is so much more complicated.
In this episode, Kevin and Dr. Wolf dig into the science of ED staffing and Lisa's latest research, on safe staffing in the emergency department. The conversation takes on one of the most common assumptions about staffing: that safety comes down to counting how many nurses are on the schedule. We all know two shifts can have the same numbers and go completely differently depending on experience, skill mix, teamwork, patient acuity, workload, and the systems backing up the team.
Dr. Wolf's study asked more than 1,000 emergency nurses what actually makes an ED safe. Nurses identified 14 indicators of safety, but only eight were considered measurable, and what is worse is only three were routinely being measured in most emergency departments. So how can we claim to be "staffing safely" if we aren't measuring safety?
Safe staffing is more complicated than filling holes on a schedule, but it may also be much more measurable and solvable than we think.
Links to the staffing studies.
1. Educational Levels of Hospital Nurses and Surgical Patient Mortality
https://pmc.ncbi.nlm.nih.gov/articles/PMC3077115/ Free full text — PubMed Central
2. Implications of the California Nurse Staffing Mandate for Other States
https://pmc.ncbi.nlm.nih.gov/articles/PMC2908200/ Free full text — PubMed Central
3. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments (Medical Care, 2011)
https://pmc.ncbi.nlm.nih.gov/articles/PMC3217062/ Free full text — PubMed Central
4. Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
https://pmc.ncbi.nlm.nih.gov/articles/PMC2586978/ Free full text — PubMed Central
5. Effects of Nurse Staffing and Nurse Education on Patient Deaths in Hospitals With Different Nurse Work Environments (JONA, 2012)
https://pmc.ncbi.nlm.nih.gov/articles/PMC6764437/ Free full text — PubMed Central
6. On the Threshold of Safety: A Qualitative Exploration of Nurses' Perceptions of Factors Involved in Safe Staffing Levels in Emergency Departments
https://www.sciencedirect.com/science/article/pii/S0099176716302136 Journal of Emergency Nursing — ScienceDirect
7. Perceived Relationships Between Emergency Department Staffing Patterns and Missed Care, Missed Decompensation, and Delays in Care
https://www.sciencedirect.com/science/article/pii/S0099176725002843Complimentary access — ScienceDirect
8. The Meaning of Safety in the Emergency Department: A Survey Study
https://www.sciencedirect.com/science/article/pii/S0099176726001650Journal of Emergency Nursing — ScienceDirect
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