What is safe staffing?


Carrie Mortrud, RN

This month I had the opportunity to visit a few nurse meetings and teach some classes about the importance for nurses to refuse unsafe assignments at their Minnesota hospital. Short staffing is a growing and widespread problem in Minnesota that is impacting patient care, and it’s become an important topic for nurses across the state.

During one meeting I was asked, “What is unsafe?”  “What does safe staffing look like?” My initial response was to push back and ask, “You tell me.  What does safe staffing look like?” But I didn’t. Instead, I responded with examples of issues related to short staffing that I have reviewed in the Concern for Safe Staffing forms submitted by Minnesota nurses.

The nurse was receptive and we had a good discussion and exchange. It was emotional, as she described how short staffing has become worse in her unit and at her hospital, and how frustrated and beat down she feels every day.

She struggled to recall a shift in recent months where she left feeling really good about the care she had been able to give that day. This weighed heavily on me on my drive home and into the evening when I was grocery shopping and cooking, and then it hit me. Has it gotten that bad that nurses don’t even know what safe looks like anymore? Has it really gotten to the point where nurses who have worked more than 25 years in the same hospital can’t even remember what safe— never mind quality, care—looks like?

So I racked my brain trying to remember my days working in the hospital and those shifts where I left feeling like I was walking on a cloud.  I was so proud of the care I gave, so confident in my career choice, and so grateful I got to do something that brought me such joy.  This is what I remember, and what I think safe care looks like.

Having time to care for patients meant began with getting a few minutes in silence to review my patient assignment through their corresponding Kardexes or Care Plans. Being able to take some notes, think of some questions, and feel like I had a photo of what each patient’s stay had looked like so far.

It included time to first get a report on each patient—a thorough report. I didn’t need to spend too long on each patient, but I just wanted to ask questions, get clarity on what the previous shift was expecting me to do, and to complete this within a half hour of walking on to the floor. During those crucial reports, we were not interrupted to assist with other tasks or patient care because other disciplines and support staff personnel were short staffed.

On the days where there was safe staffing, I was able to do quick rounds on all my patients to introduce myself, write my name on their grease board and find out how they were. I also had a minute to let them know what the game plan was for them that day and what goals we had to move them through their plan of care.

I was able to pass any and all medications within the scheduled time frame of 30 minutes before or 30 minutes after the scheduled time—not 45 minutes late or an hour late.  I was able to do pain assessments, administer pain medications, and then do follow-up assessments within an hour to see if it was successful. If the pain was not relieved, I was able to administer more if it was allowed or I had the time to call the physician to get a different medication.

When there was safe staffing and I felt like I was able to perform my job well, I was able to go back and do whatever full assessment each patient needed. If a patient needed a full head-to-toe assessment, I did that. I would be able to start some discharge teaching while doing that assessment, ask my patient about his home situation and support, and find out if he or she was scared about going home.   If my patient had been a little confused on the night shift, I was able to do a neuro check and write a note following my assessment.

I was able to get all consents for tests, scans, surgery completed and it wasn’t rushed.  I was able to answer family members’ questions about those tests, scans, and surgeries.

I was able to answer a new nurses question about chest tubes and help trouble shoot.

I was able to take the heartmate patient outside to feel the sun on her face for the first time in four days.

I got a lunch break to just “check out for at least 15 minutes” so I could use the rest of my break to think about the rest of my shift and what I needed to get done.

I was able to teach my patient about the importance of doing the incentive spirometer every 2 hours and stress that if she didn’t do it she may not “ever get out” because if a patient doesn’t deep breathe, he or she are likely to get pneumonia and a much longer hospital stay.

I was able to change an IV site that was due for rotation.

I was available to talk to the pulmonologist when he made rounds and had questions about my patient who had a tap the day before.

All my charting was accurate and completed prior to report starting.  I was able to give report, answer questions, and even help a float nurse find some equipment that had grown legs on my shift and disappeared.

Being safe doesn’t mean easy. It doesn’t mean lazy. It doesn’t’ mean I didn’t work hard. It meant I was able to deliver the care I need to, without cutting corners and putting patients at risk.

Working a shift that was safely staffed could still be crazy busy, include 17,000 steps in the shift, make you feel exhausted and make you think, “wow, that was nuts.”  But it never caused me hesitancy upon leaving because I know I forgot to do something very important, or at least delegate it to the next shift.  It didn’t make me feel terrible and like I didn’t deliver the care patients needed.  It didn’t make me cry because I’m scared I may have actually harmed my patients rather than care for them and make them better.

To my fellow nurses: please, please, try to remember back to those shifts when you had the staff and resources and ability to give safe care. The kind that made you smile, the kind that made you proud. If it’s not meeting that standard, it’s short staffed and your patients are not safe. Report it and refuse it.

–Carrie Mortrud, RN 

Patient Story

arlene townsend staffing award

Unsafe staffing costs a Florida facility $1 billion

From Trial Magazine, March 2014 issue: Trial Magazine, 3/11/14 VERDICTS & SETTLEMENTS Arlene Townsend, 63 suffered a stroke and required 24-hour care. She was admitted to Auburndale Oaks Healthcare Center, a nursing home owned by Trans Healthcare, Inc. In the three years leading up to her death, Townsend suffered numerous fall resulting in broken bones and lacerations, infections, significant weight loss, chronic constipation, skin breakdowns, dehydration, and other problems. She is survived by her adult son. Townsend’s estate sued Trans Healthcare, alleging that it had understaffed the nursing home to increase profits and failed to provide adequate care, including protecting Townsend from falls, ensuring a safe environment, and documenting changes to her condition. The court entered a judgment of liability against the defendant, and the…
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