Safe staffing

Healthcare workers, unions, and advocates have been warning of a staffing shortage for years, long before COVID-19 entered the picture. Nurses and health professionals are leaving the workforce because they are no longer willing to endure unsafe and unsustainable working conditions created by profit-seeking hospital executives.

We must address how we got here if we are going to recruit and retain the next generation of healthcare workers. Fighting for better working conditions now isn’t just about current healthcare workers; it’s about the future of healthcare.

To learn more about the causes of the staffing crisis and how we can solve it, see our Healthcare Staffing Shortage Taskforce Report and our Staffing Crisis Fact Sheet.

What is safe staffing?

Nurses and health professionals want what their patients need. Safe staffing means that all patients have the attention and care they need because every member of their care team has a safe workload.

Safe patient care relies on a team of health professionals. Any plan to address safe staffing must include the whole care team. Staffing plans must be developed by valuing the expertise of the people who care for patients every day.

There are three primary approaches to safe staffing. The most effective plan will include all three:

• Staffing ratios that set the floor, not the ceiling, for safety by capping the number of patients assigned to one worker;
• Staffing committees with robust worker input to create staffing plans to meet the unique needs of individual facilities; and
• Public reporting of staffing levels to hold hospitals accountable and to keep patients informed.

To learn more about approaches to safe staffing, see our State Approaches to Safe Staffing Fact Sheet.

Why does safe staffing matter?

Without safe staffing, healthcare workers are forced to make impossible decisions every day. Do they review the discharge instructions with a patient or respond to the flashing call button? Do they help a patient get to the toilet safely or get another patient their medication on time? These are real decisions with real consequences for patients and workers.

Decades of research have established links between unsafe patient loads and worse outcomes for patients.

Adding just one more patient to a nurse’s workload can cause:

• A 16 percent increase in each Medicare patient’s chance of mortality in a medical-surgical unit;[1]
• A 48 percent increased risk of readmission within 30 days for pediatric patients;[2]
• A 5 percent decrease in likelihood of surviving in-hospital cardiac arrest;[3] and
• An Increased risk of multiple kinds of infections.[4]

Because safe staffing levels decrease rates of readmission and infections, many studies have found safe staffing to produce significant cost savings for hospitals.

• A 2021 study estimated that an average staffing ratio of 4:1 in med-surg units would result in a $720 million annual cost savings for hospitals in the state of New York due to a reduction in hospital days and readmissions.[5]
• A 2012 study found that if hospitals in Pennsylvania reduced the average level of nurse burnout by 30 percent, they could prevent more than 6,000 infections, saving up to $69 million annually.[6]

Safe staffing also improves working conditions for healthcare workers.

In a meta-analysis of 17 relevant studies, researchers found that in better nurse work environments characterized by adequate staffing and resources:

• Nurses had a 28-32 percent lower probability of job dissatisfaction, burnout or intention to leave their job.[7]

In a time when 1 in 3 nurses has considered leaving their job due to stresses of the COVID-19 pandemic,[8] hospitals and policymakers must understand that safe staffing is essential for retaining health professionals. Efforts to retain healthcare workers by creating safer and more sustainable working conditions ensure that efforts to recruit new workers into the field can produce lasting results.

The AFT fights for safe staffing through state legislation, national legislation and collective bargaining. To learn more about our policy recommendations for staffing, see our Healthcare Staffing Shortage Taskforce Report and check out this piece about AFT healthcare affiliates fighting for safe staffing through state legislation.