Staff Shortage and the Importance of Adequate Staffing Level

Staff Shortage and the Importance of Adequate Staffing Level

Unit – Professional Issues and Policies in Nursing and Specialisations

Please write in simple academic language.

Please use ebscoHost and google scholar for literature search.

2750 words

APA format and references

Please write with sub headings.

Students will explore an area of concern in their professional practice, identify the problems or issues, and undertake an in-depth exploration of the problems or issues of concern. This exploration should be in the form of a critical analysis which focuses on the these identified problems or issues and how they have led to a policy

Please write about staff shortage and the importance of adequate staffing level (in Australia)

Problems associated with low staffing levels are

poor quality of care,

Medication errors

Increased stress level

Workload to other staff and so on.

Select a literature/ research article that provide the strongest evidence for your topic. Your articles must be ? 5 years old.

• Your assignment must have an introduction, a body (which is the content of the issues) and a conclusion.

• USE APA FORMAT APA guidelines. Information cited from an unreliable websites, pamphlets or magazines is not acceptable for this paper.

Marking criteria


• Student provides a clear and adequate description of the area of interest in their professional practice that has been translated into a policy ( 5)

Content and Analysis

• Provides a critical analysis of the selected problem or issue(s) (10)

• Explanation of concepts is based on scholarly literature (5)

• Provides and integrates at least 10 references in the paper, with at least 5 of which are peer reviewed journal articles (10)

• Information is gathered and synthesized to interpret the problem/issue(s (10)


• Logical and sequential arrangement of arguments and discussions (5)

• Conclusion provides summary of the paper; no new information is provided. (5)

According to our college, whatever we are writing, except common knowledge, we have to provide in-text citation, and bibliography.Therefore, if you are giving any facts or other than common knowlege please provide references. We can have up to 20 references.



Staff Shortage and the Importance of Adequate Staffing Level


The nursing shortage is a worldwide issue that poses challenges to the nursing profession and the facility planners. The ever-changing needs of customers and the way healthcare is delivered continue to force planners to rethink the estimates of nursing workforce. The main impact on the provision of nursing services includes an increase in complexity and insight of hospitalized patients, the number of severely ill patients, improved life expectancy, and more chronic lifestyle diseases (Marć, et al., 2019). The environment that nurses offer care has become complex and patients are more informed than before. The typical lack of available bed in most health care institutions has also led to many challenges that burden both the nurses and the institutions. For example, most emergency units are often full thereby increasing tensions among the staff groups (Hegney et al., 2019). Therefore, nurses often deal with issues that are unknown or unfamiliar to them. The constant workload has increased the constant burnout and emotional stress among nurses, which prevent them from providing more quality and holistic care (Combes, Elliott, & Skåtun, 2018). Besides, the increased lack of qualified and skilled nurses also remains a significant challenge to health care institutions in Australia. Although there is no enough data in Australia that depict the reasons for nursing shortage, many flags and indicators from the researchers carried out abroad can help inform decision-makers. This paper analyses the staff shortage and the importance of adequate staffing levels concerning Australia.

The Nursing Workforce

The nursing workforce continues to evolve and undergo critical changes. Australia has seen a decrease in enrolment of nurses for a few years (Sutcliffe & Dhakal, 2018). However, it is estimated that the 2018 enrolment increased and decision-makers are unsure if the trend will be sustained in the coming years.  About 40% of nurses in Australia are 40 years and above making aging a critical aspect as it depicts the potential of nurses to retire faster before belling replaced (Sutcliffe & Dhakal, 2018). This is further affected by the fewer number of students entering nursing careers in the country. Therefore, Australia remains uncertain on the supply side of the nurses in the country.

Nursing shortage is further increased by the increasingly better-qualified nurse managers and clinicians who are well placed and marketable in sectors outside health. Australia has multiple career options that weaken the demand for individual looking to enter the nursing programs (Sutcliffe & Dhakal, 2018). This can be seen among students from non-English speaking countries. Finally, the increasing demand for expertise and skills in nursing has increased in recent years (Press, Wong, & Gibson, 2015). Thus, nursing experience and qualifications are transportable and valuable assets needed in the nursing industries

Causes of Staff Shortage

  1. Workload and work environment

Work environment and workload are the significant factors that cause nursing shortage in Australia. Safety issues and unsafe working environment including harassment and bullying negatively affects the retention of nurses (Hegney et al., 2019). Recent studies show that workloads, burnout, job demands, safety issues, job dissatisfaction, lack of autonomy, and low morale are the main factors that cause nursing turnover (Press, Wong, & Gibson, 2015). The National Review of Nursing Education considers that improved treatment of nurses always leads to better nurses and patient outcome. Burnout and dissatisfaction increased due to the decline in nurse’s ability to provide quality care leading to decisions that force the nurses the leave.

Although Australia has a population of nurses who are well qualified, they are prevented from making clinical decisions that are critical in the job duties of a nurse. Autonomy in nursing practice can help retain nurses, and when nurses can make their own decisions that can improve patient’s outcome, they become part and parcel of the clinical practice and keep their jobs (Combes, Elliott, & Skåtun, 2018). Besides, respect of nurses from both the patients and institutional administrators is essential in reducing turnover rates. Thus, workload often increases when nurses leave their work including double shifts and employment of casual employees.

  1. Management Systems and Organizational Structures

The understanding of nursing shortage in Australia can be determined using two factors, management systems, and organizational structures. Restructuring is considered to lead to low staff morale and a decrease in nurses’ loyalty to the institution, leading to increased rate of turnover. According to Hegney et al (2019), restructuring of nursing units and awards always lead to improved patient mortality due to loss of experienced nurses. For example, in Canada and United States, loyalty and trust of employers have been lost through structuring initiatives in the institutions. This leads to the loss of skills and knowledge as most nurses often seek employment in other healthcare institutions (Hegney et al., 2019).  Australia also faces divisional structures because the nurse executives are responsible for the quality services provided in the organization.  For example, downsizing may happen to decrease the number of nursing and to increase the number of administrators leading to the question of the primary function of health care institutions and the staff with is tasked with providing care (Sutcliffe, & Dhakal, 2018). Besides, the problem of having difficulty in resource planning and accessing administrative database for research purposes is an issue that causes turnover in Australia. For example, in Western Sidney, most administrative and registration databases cannot be accessed by nurses to be used in nursing studies.

Problems Associated with Low Staffing Levels

Nursing shortage often leads to more adverse events such as higher rates of readmission, patient dissatisfaction, and longer lengths of stays, which decrease quality of care (McNeil, Mitchell, & Parker, 2015). By focusing on optimal nurse staffing, health care institutions will be able to deliver more cost-effective and high-quality care. As long as there are nurses who can handle patient issues, patients may have experiences which influence their health negatively. According to Barber, (2016), the following problems are linked with low staffing levels:

  1. Patient outcomes

A study by Jones, and Ramsbottom, (2017) found that for every additional patient being cared for by a nurse, there is a risk of 7% of one of the patients succumbing to death within 30 days of readmission. Besides, the authors found that there was a high risk of nurse’s failure to rescue patients if they have additional patients to care for. Therefore, nurse shortage below the recommended target levels was associated with increased mortality among patients.

Staff Shortage and the Importance of Adequate Staffing Level

According to Combes, Elliott, and Skåtun (2018), patients who were admitted for cardiac issues were more likely to survive and get discharged in healthcare settings with proper levels of nurse staffs. Besides, the study found that patients who were under surgery with optimal nurse staffing were more likely to receive quality care at low cost compared to other health care institutions with less nurse staffing (Combes, Elliott, & Skåtun, 2018). Therefore, having fewer nurses who care for many patients may lead to complications caused by stress and burnout, leading to increased medical costs, low-quality care and reduced patient outcomes. Besides, enough staffing further reduces patient falls in emergency departments which also improves patient’s outcome.

  1. Patient Satisfaction

According to Hudgins, (2016), a conducive environment and adequate staffing are linked to higher scores of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS scores are primarily used to determine patient experience to determine the rate of reimbursement for each healthcare institution. The ratings are used by the Centers for Medicare & Medicaid Services (CMS) in establishing a hospital’s reimbursement rates (Hudgins, 2016). Therefore, nursing shortages have an impact on the experience of care in all health care institutions in Australia.

A study carried out in Los Angeles found that a statistical link between short staffing and patient satisfaction (Jones, & Ramsbottom, 2017). Patients can only be satisfied if they are provided with quality and holistic care regularly. The patient to nurse ration must be equal to ensure patients have the best experience during care. Thus, the level of staffing in healthcare institutions influence patient satisfaction level or influence the ability of the health care institutions to provide care in a more cost-effective manner.

  • Readmissions

Many studies have examined the influence of nurse shortages on the level of patient readmissions in hospitals. A study by Cheng et al., (2015) found that the readmission rate was higher by about 8% with heart failure due to the additional patient per nurse which increases the workload of nurses. The study interventions also aimed to help improve the rate of mortality among patients, and his study found that a 20% increase in nurse staffing had about 18 fewer deaths for every 1000 discharged patients (Cheng et al., 2015). Therefore, the higher rate of staffing has a lower hospital readmission and lower post-discharge emergency department visits.

Staff Shortage and the Importance of Adequate Staffing Level

The main goal of nurses is to offer high quality and safe care to patients. An increase in staffing may provide nurses an opportunity to better engage in discharge activities which are critical in preventing the rate of readmission (Press, Wong, & Gibson, 2015).  The readmission activities may include facilitating transitions to outpatient care, medications for disease management, delivering discharge education, and identifying changes in patient conditions that may need interventions(Press, Wong, & Gibson, 2015).Therefore, inadequate staffing makes it hard for nurses to provide adequate care, leading to medical errors and missed care.   Although adequate staffing does not guarantee competence in nursing care or nursing delivery, it increases the ability of nurses to engage in other aspects of nursing care including patient’s discharge.

  1. Nurse Burnout

Nurse burnout is primarily caused by job stressors in all health care departments. A heavy workload often causes distress including exhaustion, anger, and cynicism. Nurses facing burnout or stress may not perform their roles and responsibilities in the right manner since their cognitive and physical resources are reduced leading to inferior performance (McNeil, Mitchell, & Parker, 2015).  This means that nurses need a conducive environment for working and adequate staffing may help reduce workload in health care delivery.


A study by Liu, While, Li, and Ye, (2015) found that nurses who cared for additional patients were linked with about 28% of increased nurse burnout and 20% of the increased level of dissatisfaction. The study also showed that there is a correlation between nurse burnout and inadequate staffing (Liu, While, Li, & Ye, 2015). Besides, nurse burnout often increases nurse turnover which usually cost healthcare institutions thousands of dollars every year. Thus, inadequate staffing often reduces the quality of care and increases the cost of healthcare.

Reducing nurse-to-patient ratios will help increase the quality of care. Such an instance reduces work and improves quality, which also influences the life of nurses (Liu, While, Li, & Ye, 2015). Organizations in Australia need to adopt minimum nurse-to-patient ratios despite the difficult implementation and widespread scepticism in healthcare sector.

Importance of Adequate Staffing Level

The national benchmark in Australia regarding nurse-patient ration is unknown because of the legal vagaries seen from one state to another. However, healthcare institutions in Australia are required to operate with adequate number of nurses who are registered or licensed. The hospital departments are needed to conduct supervisions to ensure there is sufficient availability of nurses who can offer appropriate care to all patients.

i.               The Right Ratio

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The Australian Association of Nurses supports the support provided to nurses to empower and ensure adequate staffing in every unit. This enables healthcare organizations to develop staffing levels based on account of patients, the number of admissions, and availability of resources including technology and ancillary staff, layout of the unit, the experience of nurses, and the transfers and discharge during shifts (Sutcliffe, & Dhakal, 2018). Therefore, Australian government needs to develop the required minimum nurse-to-patient ratios to bring sanity in the healthcare institutions.  For example, in care units, nurse-to-patient ratio is recommended to be in the ration of between 1:2 or 1:4 or fewer to ensure all patients are cared for in a more cost-effective and holistic way (Sutcliffe, & Dhakal, 2018).

ii.              Improved Safety

The national campaign on the patient to nurses’ ration looks to ensure safe staffing for both patients and nurses across the world. Recent research has indicated that appropriate staffing is critical in reducing burnout among nurses, reducing healthcare costs, increasing safety outcomes, reducing readmission rates and medical errors, enhancing both patient and nurse satisfaction levels and improving the HCAHPS scores (Press, Wong, & Gibson, 2015).Adequate staffing helps to improve patient outcomes and get the maximum value from nurses. The nurse-to-patient ratios need to be adjusted to guarantee the provision of quality care. Health care institution can develop career development programs that require aspiring nurses to further their career and encourage other individuals to join the nursing profession. The Australian health care sector needs reforms that can help develop more holistic approaches that may cater to patient’s needs.

Staff Shortage and the Importance of Adequate Staffing Level

Policy Responses to Nurse Staffing Shortages

The growth of employment of registered nurses and enrolment in nursing schools has shown an ease in nursing shortage in Australia. However, inadequate staffing remains to be a health care concern since the supply of nurses is less compared to their demand in the healthcare sector. Many policies can be implemented to deal with nursing shortage in Australia as explained below:

i.                Mandatory staff to patient staffing Ratios

Nurse to patient ratios are aimed to reduce the nurse workload and guarantee the provision of quality care. The development of nurse to patient ratios as state laws would help reduce the additional patient nurses are assigned to in hospitals (Watson, 2016).   This will address the imbalance between nursing resources and patient needs. In the United States, the Massachusetts Association of Registered Nurses advocate that the mandatory nurse to staffing ratio should be 1:4 for all health care institutions (Watson, 2016).  However, the policy may reduce staff flexibility and scheduling. Besides, mandatory ratios may increase the cost required to employ more nurses. The policy will also burden smaller community health care organizations because they have patients with less chronic conditions.

ii.              Nursing Intensity Billing

Rather than using Nurse-to patient ratio, the Massachusetts Association of Registered Nurses recommends the use of Nursing Intensity Billing as the best policy to address issues of nursing shortages (Watson, 2016).   The policy considers the intensity of care that should be given to a particular patient. Since hospital financial decisions are based on payments received from patent care, changing nursing profession to a revenue center from a cost center would help change the relationship between nurses and hospitals. For example, the intensive unit care costs and routine care unit costs should be put in different categories (Watson, 2016).  The use of revenue codes for billing would help differentiate between ancillary services and accommodation services. Thus, Medicare and other players in the health sector need to reimburse health care organizations based on a given nursing care instead of bundling care within a room. This will help hospitals to benefit from a more equitable system of payment because the charges used in caring would be the same as those used to care for individual patients.

            A policy to develop a national model for reimbursement and nursing intensity billing would correct the issue of considering nursing care as a fixed cost. Thus the nursing intensity billing would unbundle nursing care billing and costs from the traditional room and board charge and determine costs based on the care received by each patient (Watson, 2016). This brings in the cost-to-charge ratio to determine payment since the Australian pays for actual costs and not based on the services delivered. The major advantage of the policy is that it will pay on the basis of performance to help solve the issue of nurse shortage. As a reimbursement mechanism or a value-based-purchasing, it will pay for the performance of nurses (Watson, 2016). However, the major disadvantage is that it may lead to poor care and prevent care in the rural settings.

iii.             Recruitment of temporary staff

The temporary staff policy can be used by healthcare institutions in Australia to cater for nursing shortages in the country. Traveling nurses and per diem nurses can be used based on the contracts they sign to help fill and accommodate the short-term staffing needs in health care institutions.  However, despite the prevalence of these nurses, most health care institutions in the US have reduced the use and reliance of temporary employees because of the issues with quality and costs (Barber, 2016). However, with the lack of nurses in the industry, most health care organizations continue to rely on temporary staff.

Staff Shortage and the Importance of Adequate Staffing Level

Other studies have reported the use of float pools or internal staffing agencies to help meet their staffing requirements. This has helped in cost saving since the internal-agency nurses are paid lower compared to other staff nurses who perform similar tasks (Barber, 2016). The private pools often source for nurses looking for flexibility or fewer hours helping hospitals to achieve greater confidence in caring for patients. This strategy may help hospitals to reduce temporary staffs and allow staffs who want extra shifts with lower staff nursing rates.

Staff Shortage and the Importance of Adequate Staffing Level

  1. Development of undergraduate nursing education

Training of student nurses is a critical strategy to help health care institutions grow and develop their nurses. Hospitals need to develop training initiatives by opening new schools or expanding training capacity to help increase the performance and commitment of employees (Jones & Ramsbottom, 2017).The St. Joseph’s Hospital and Medical Center in the United States developed a nursing intern program aimed to prepare student nurses who later become employees in the hospital (Jones & Ramsbottom, 2017).


The nursing shortage poses challenges to the nursing profession and the facility planners. The constant workload has increased the constant burnout and emotional stress among nurses, which prevent them from providing more quality and holistic care. Safety issues and unsafe working environment including harassment and bullying negatively affects the retention of nurses.  Besides workloads, burnout, job demands, safety issues, job dissatisfaction, lack of autonomy, and low morale are the main factors that cause nursing turnover. Besides, respect of nurses from both the patients and institutional administrators is essential in reducing turnover rates. Thus, the level of staffing in healthcare institutions influence patient satisfaction level or influence the ability of the health care institutions to provide care in a more cost-effective manner. Australian hospitals need to develop the required minimum nurse-to-patient ratios to bring sanity in the healthcare institutions.  This would improve patient outcomes and get the maximum value from nurses.



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