Nurses have always been in the business of providing excellence in patient care, but recently nurses have come under increased pressure to improve delivery of quality care to help meet new value-based care objectives. Because nurses are at the forefront as the most patient-facing representative, they are in a position to heavily influence the patient experience. The connection between nurse satisfaction and quality of care cannot be ignored. Research shows that for every 10% of dissatisfaction among nurses, patient referrals to a hospital decrease by 2%.1
The Impact of Staffing on Nurse Satisfaction
Nurse satisfaction is affected by several factors, but staffing decisions that impact work schedules play a major role. According to research, nurses who work excessive amounts of overtime are more prone to produce lower quality work and have decreased happiness levels, which can ultimately impact patient satisfaction.2
Fatigue and stress as a result of working extensive periods of overtime can result in serious and potentially life-threatening medical errors. In fact, compared with nurses working shorter hours, nurses working greater than 12.5 to 13 consecutive hours report increased odds of making an error or sustaining a needle stick injury.3 Some experts estimate an astonishing 400,000 deaths are caused by medical errors each year.4
In addition, a study found that the most frequently cited root cause for sentinel events reported by Joint Commission-accredited hospitals is human factors, which include staffing levels, skill mix, competency assessment, fatigue and more.5
The Staffing Process
Nurses who feel engaged and empowered in their roles are more effective and report better patient care.6 Engaged nurses are committed to their work, their peers and their workplace, and they believe they can deliver good patient care outcomes in the environment. Providing the opportunity to have a voice in their schedule is part of creating the engagement and empowerment necessary for good outcomes.
Research has shown that providing nurses with control over their work schedule can enhance their sense of control and predictability, as well as improve the quality of work life.6 Innovative and unique workforce technology systems give nurses the opportunity to take more control over their schedules and avoid burnout. It is difficult in manual or out-of-date systems to provide opportunities for nurses to easily and quickly access the staffing system to indicate preferences, alter schedules and indicate availability for other shifts. Without this ability to become involved in the scheduling process in a meaningful way, scheduling can be an impediment to nurse engagement and empowerment.
Achieving a better work-life balance is critical to nurse satisfaction, and self-service options that empower the nurse to participate in the schedule assist in finding that balance. Nurses feel empowered when they have access to innovative tools that allow them to participate in important decisions such as open shift management and mobile access. Such access can help drive morale, improve productivity and elevate quality of care.
Ensuring a fair and equitable workload is an important way for nurse managers to set up their staff for success. Staffing plans and assignments should align each nurse's knowledge, skill levels and certifications with patient needs to enable nurses to spend more time at the bedside, which reduces errors and improves patient outcomes. Having the optimal number and skill mix of nurses ensures that they are not handling too many patients or being assigned to patients outside their training/expertise, which can increase mistakes, stress and burnout.
Balancing the workload requires scheduling decisions that pair up staffing needs to things like patient acuity or census numbers by the day or hour. Newer workforce technology systems take into account the characteristics of the nurse (e.g., experience, education, competencies and potential fatigue factors), specifics about the patient (e.g., complexity and family dynamics), and information about the environment (e.g., availability of support staff and layout of the unit).
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Fostering a Positive Work Environment
A balanced workload also empowers nurses to engage in career development that contributes to long-term satisfaction. Equitable and balanced staffing is conducive to integrating the mentorship and support that is needed by nurses in various points of their career.
The same workforce technologies can help foster a positive work environment for nurses by determining how to recruit, retain and develop a nursing staff with the right competencies and skills to meet future demands. For example, workforce metrics can be used for trend analysis to help uncover gaps in staffing and to identify additional staffing strategies that can be implemented to deliver better patient care. Being able to identify staffing needs provides a way to engage, empower and ensure the highest potential performance from nurses.
Understanding is the First Step
Healthcare is about people caring for people, so understanding the connection between nurse satisfaction and patient satisfaction is critical to making further progress toward improving the quality of care for patients. Implementation of workforce technologies that enable self-service options to reduce overtime, balance the workload of the nursing staff and enable long-term recruitment and performance strategies will ensure that nurses have work satisfaction. This in turn will help improve patient care.
1. McHugh MD, et al. Nurses' widespread job dissatisfaction, burnout and frustration with health benefits signal problems for patient care. Health Affairs. 2011;30(2):202-210.
2. Stimpfel A, et al. The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs. 2012;31(11):2501-2509.
3. Rogers AE, et al. The working hours of hospital staff nurses and patient safety. Health Affairs. 2004;23(4):202-212.
4. Allen M. How Many Die from Medical Mistakes in U.S. Hospitals? ProPublica September 13, 2013. http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals
5. The Joint Commission. Sentinel Event Data Root Causes by Event Type 2004-2014. http://www.jointcommission.org/Sentinel_Event_Statistics/default.aspx
6. Laschinger H, et al. The Influence of Nursing Unit Empowerment and Social Capital on Unit Effectiveness and Nurse Perceptions of Patient Care Quality. J Nurs Satisfaction. 2014; 44(6):347-52.
Karlene Kerfoot is the chief nursing officer at API Healthcare.