1

The Nursing Shortage and its Effect on Patient Care

The Nursing Shortage and its Effect on Patient Care

Kara Kiscadden

School of Nursing: James Madison University

NSG 462: Issues in Contemporary Nursing

Professor: Dr. Delawder

November 12, 2021

Abstract

Nurses are a critical asset to the healthcare system. Nationwide, it’s expected that one million

more nurses will be needed by 2030 (Behring, 2021). This shortage has been an ongoing issue

for the last decade, for multiple reasons. Some of the factors contributing to the nursing shortage

include retiring baby-boomers, increasing number of nurses looking to advance their practice,

and an increase in patients, leading to burnout among nurses. The quality of care that patients

receive is directly affected by this shortage. While nurses want to provide the best patient care

possible, it’s not always easy to do so with high nurse-to-patient ratios. The nursing shortage

leads to reduced quality of patient care causing increased safety risks, complications, and

mortality rates.

Keywords: nursing, patient safety, nurse-to-patient ratios, patient outcomes, nurse

staffing
 3
The Nursing Shortage and its Effect on Patient Care

Factors Contributing to the Nursing Shortage

It is no mystery that there is a shortage of registered nurses (RN) nationwide, but what is

the reason for it? There are multiple factors contributing to this national shortage. The first

component is the increasing number of retiring baby boomer RN’s. The baby boomers made up

about one third of the RN workforce and started retiring within the last decade. Each year, it’s

estimated about 60,000-70,000 nurses are retiring, leading to loss of clinical experience,

leadership, and mentorship (Buerhaus, 2021).

The next factor leading to the shortage is the increasing rate of nurses looking to advance

their practice. The desire to become a Nurse Practitioner has led to a decrease in registered

nurses by about 80,000 from 2010-2017 (Auerbach et al., 2020). This has led to new graduate

nurses working as registered nurses in the clinical setting for about a year and then pursuing an

advanced degree while simultaneously working. After they graduate from their advanced

practice degrees, they are advancing their careers.

Finally, there has been an increasing number of patients in both the inpatient and

outpatient settings. This increase has led to inadequate staffing, which has in turn caused burnout

among nurses. It has also led to nurses feeling overwhelmed and questioning their own career

path (Buerhaus, 2021).

Effects on Patient Care

Safety

The nursing shortage has a direct effect on the care patients receive, including increased

safety risks, complications, and mortality rates. Safety is a main priority when it comes to patient

care, but with an increasing patient workload on nurses, it is hard to ensure nothing is missed.
 4
The Nursing Shortage and its Effect on Patient Care

Basic fall precautions may not always be implemented leading to patients injuring themselves

during their hospital stay. Some of the fall precautions put in place to ensure safety include call

light within reach, raising appropriate side rails, setting bed alarms, and the use of appropriate

walking devices within reach. These interventions are simple, but can be easily missed if a nurse

has multiple high acuity patients

Complications

Another effect of the nursing shortage on patient care are complications acquired during

their hospital stay. Some of the complications include hospital acquired infections, like

pneumonia, urinary tract infections (UTI), and pressure ulcers. Hospital acquired pneumonia is a

serious lung infection that patients can develop during their hospital stay if not taking

preventative measures. It can be more severe due to patients’ lower immune systems as well as

the fact that the germs causing this type of pneumonia, tend to be more resistant to treatment

(2021). Although pneumonia is a serious lung infection, there are preventative interventions that

nurses can take to reduce the risk of this including: elevating the head of the bed to prevent

aspiration, provide adequate oral hygiene, using the incentive spirometer, and promoting

ambulation. All of these measures can help in the prevention of this infection but can be easily

missed due to nurses being overworked.

The next complication that can be easily prevented are UTI’s. According to the Centers

for Disease Control and Prevention (CDC), 75% of UTI’s in hospitals are due to urinary

catheters. In order to prevent catheter associated urinary tract infections (CAUTI), it is

imperative that the duration of using the indwelling urinary catheter is minimized. It’s also

important that the catheter be properly cared for and inserted using aseptic technique. The risk of

patients developing these infections are increased with high nurse-to-patient ratios.
 5
The Nursing Shortage and its Effect on Patient Care

The final complication are pressure ulcers. Pressure ulcers are injuries to the skin, and

sometimes deeper tissue due to prolonged pressure on bony prominences. They are common

among patients who are bed bound or in hospitals for an extended period of time. Pressure ulcers

can be prevented by repositioning and turning bed bound patients, providing adequate nutrition,

and ensuring patients are dry, clean, and moisturized. Many times, pressure ulcers can go

unnoticed and continue to progress to worsening stages when patients are not being properly

cared for.

Mortality Rates

The lack of nurses leads to an increase in mortality rates due to medication errors while

nurses are fatigued, and overcrowded hospitals leading to increased duration of hospital stay. An

overworked nurse is more likely to commit a medication error, due to fatigue. Medication errors

can involve mixing the wrong medications, administering the wrong medications as well as

infusing medications at an inappropriate rate (JE, 2021). All of these errors can be fatal for

patients.

Conclusion

Overall, the nursing shortage can lead to multiple negative patient outcomes including

increased safety risks, complications, and mortality rates. It’s extremely important that

appropriate nurse-to-patient ratios are implemented among hospitals in order to decrease

potential risks and to improve the quality of patient care.

References

Auerbach, D., Buerhaus, P., & Staiger, D. (2020). Implications of the rapid growth of the nurse

practitioner workforce. Health Affairs, 39(2), 273-279.

https://doi.org/10.1377/hlthaff.2019.00686

Behring, S. (2021, August 11). What's causing the American nursing shortage? Healthline.

Retrieved November 15, 2021, from https://www.healthline.com/health/nursing-shortage.

Buerhaus, P. I. (2021). Current Nursing Shortages Could Have Long-Lasting Consequences:

Time

to Change Our Present Course. Nursing Economic$, 39(5), 247–250.

Centers for Disease Control and Prevention. (2015, October 16). Catheter-associated urinary

tract infections (CAUTI). Centers for Disease Control and Prevention. Retrieved November

15, 2021, from https://www.cdc.gov/hai/ca_uti/uti.html.

How nurse staffing affects patient safety and satisfaction. Eastern Michigan University Online.

(2019, October 10). Retrieved November 14, 2021, from

https://online.emich.edu/articles/rnbsn/nurse-staffing-affects-patient-safety-

satisfaction.aspx.

JE, R. T. L. H. B. H. (2021, August 6). Medical error reduction and prevention. National Center

for Biotechnology Information. Retrieved November 15, 2021, from

https://pubmed.ncbi.nlm.nih.gov/29763131/.
 7
The Nursing Shortage and its Effect on Patient Care

U.S. National Library of Medicine. (2021, November 2). Hospital-acquired pneumonia:

Medlineplus medical encyclopedia. MedlinePlus. Retrieved November 15, 2021, from

https://medlineplus.gov/ency/article/000146.htm.