When people talk about understaffing in nursing, they usually focus on the number nurses on a unit or on the patient-nurse ratio. Our research team consisting of Shani Pindek, Melisa Hayman, David Howard, Maryana Arvan and me recently published new research on understaffing in nursing that looked at two forms of understaffing. The paper, published in the peer-reviewed journal, Journal of Advanced Nursing, linked both forms to burnout, job attitudes and retention. It is open-access so anyone can read it.
Two Forms of Understaffing
There are two important sides to understaffing. Manpower understaffing is simply the number of people available. In nursing, it is typically measured as the patient-nurse ratio, that is, the number of patients on a unit per nurse. Sometimes the criticality of patients is factored in, considering that critically ill patients need more nursing attention and therefore more nurses. Expertise understaffing has to do with the skill mix in a unit. Is there someone with the necessary knowledge, skill, ability, and other characteristics–the KSAOs needed to accomplish all tasks. It is possible for a nursing unit to have one form of understaffing and not the other–sufficient number of nurses with skill gaps on a unit, or not enough nurses but all needed KSAOs are covered.
New Research on Understaffing in Nursing
We surveyed hospital nurses about their views on the two types of understaffing in their units, and about their experience of workload, burnout, job satisfaction and turnover intentions. Our sample of 365 nurses showed that both forms of understaffing related significantly to all of these other measures. Nurses who reported high levels of understaffing experienced more workload, burnout, job dissatisfaction, and turnover intentions. When we used complex statistics (multiple regression), we found that expertise understaffing had a stronger connection to burnout, dissatisfaction, and turnover intentions.
Most of the research on understaffing has focused on the manpower type, which is certainly important, but it does not tell the whole story. Some of the strategies to boost staffing numbers involves hiring travel nurses who might not come with all the needed KSAOs that staff nurses possess because they have longer tenure on a unit and have picked up needed skills along the way. Furthermore, the severe shortage of hospital nurses coming out of the COVID-19 pandemic resulted in a large number of hospital nurses being new and inexperienced, which can lead to expertise understaffing in the absence of manpower understaffing. Our new research on understaffing in nursing suggests that hospital administrators should keep both forms of understaffing in mind as they devise strategies to keep units properly staffed.
Image created by DALL-E 4.0. Prompt: Picture of one nurse juggling several things. Delete the patient behind the nurse.
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Dear Professor,
You have made a very important point and emphasized the situation very well. Healthcare systems worldwide are under serious threat. To enhance my academic understanding, I would like to satisfy a curiosity of mine.
When I submit such a study to reputable journals, I often receive the following criticisms and get rejected:
– It is expected that the quantitative or qualitative inadequacy of personnel would negatively impact the existing variables.
– Your study does not introduce novelty.
– Causal inferences should not be drawn from cross-sectional studies.
However, I believe that my study makes strong arguments. Where am I going wrong? Could you help me?
Bests,
What is considered a sufficient contribution varies by discipline. In industrial-organizational psychology and management journals they want papers to advance theory, be novel, and go beyond cross-sectional research designs. Our paper was published in a nursing journal where theory is less important, but a study still needed to add something not previously known, in our case the two forms of understaffing. In recent years in IO/management journals often people combine two or more studies that use different designs. One might be qualitative, another cross-sectional, and a third longitudinal or multi-source. Sometimes people will include a laboratory experiment. One strategy is to conduct a study and write it up, while continuing to conduct a follow-up study. If the first gets rejected, by then perhaps the second is complete and you can combine it with the first and submitting to a journal, while continuing on a third, etc. Each time you can use feedback from the rejections to help design the next study as often reviewers raise questions that you can address in a new study.
Thank you for your quick response and your insight. <3