Letter to the Editor by Alyssa Grumoli to OJIN topic “Patient Safety: Who Guards the Patient”

December 23, 2024

Response by Alyssa Grumoli to OJIN topic “Patient Safety: Who Guards the Patient?” (September 30, 2003).

Dear Editor,

I write in response to OJIN topics “Patient Safety: Who Guards the Patient?” and “Healthcare Reform: Nurses Impact Policy,” lobbying for safe staffing ratios across the critical care continuum. Safe staffing is multifaceted and dynamic, centered on patient acuity and turnover, as well as nursing skill mix and experience levels (Comeaux & Bumpus, 2021; Phillips et al., 2021).

We must care about safe staffing to first, protect our patients. Patients in intensive care units (ICU) are extremely ill and exceptionally vulnerable, requiring the expertise and advocacy skills of nurses to support their recovery. I imagine that many of you, like myself, became nurses to positively impact patients’ experiences during these vulnerable times. Unfortunately, unsafe staffing challenges our purpose and disturbs patient satisfaction (Perkins, 2021). The same patients we strive to support and help heal are more likely to suffer considerable harm—medication errors, falls, pressure injuries, hospital acquired infections, failures to rescue, and even death—while in our inappropriately staffed care (Eaton, 2020). Imagine, for every additional patient you take on, your chances of causing patient harm increases (Phillips et al., 2021). Moreover, inadequate staffing increases a patient’s mortality risk by roughly 5% (Eaton, 2020). I urge you to consider what this seemingly small risk means for an ICU patient already on the brink of death.

Safe staffing also means protecting ourselves. As I reflect on the substantial time and effort spent on obtaining my nursing degree and license, I realize how hard I’ve worked to become an ICU nurse. The American Association of Colleges of Nursing (AACN, 2022) strongly suggests that safe staffing increases nurses’ job satisfaction and retention rates, thereby decreasing the contemplation of leaving the profession that over half of nurses currently face. Establishing appropriate staffing will reduce the intensified stress and burnout that currently plague our profession while decreasing turnover, enhancing the delivery of high-quality care (AACN, 2022). With the projection of over 200,000 nurse job openings through the year 2031 and a cost of replacing just one nurse exceeding $37,000, imagine what this means for healthcare organizations (AACN, 2022; Perkins, 2021).

Lastly, appreciate how unsafe staffing might affect your closest family and friends. As a surgical ICU nurse, I assure you that the person hit by a car while walking the dog, the person who tripped and fell 30 feet while hiking, or the person accidentally riddled with bullets at a shooting range could be your mother, father, spouse, sibling, child, or best friend. Now, envision them unable to be provided the standard of care and potentially suffering inadvertent harm due to lack of universal legislation regarding nurse-to-patient ratios. If unsafe staffing hasn’t pulled at your heartstrings yet, it should now.

Change will certainly not occur if we don’t discuss the detrimental inadequacies of unsafe staffing. With power in numbers, all nurses should desire to champion change not only for themselves as employees, but for their defenseless patients and unintended family and friends. I encourage you to start small scale on your units and within your organizations by promoting flexible or acuity-based staffing models, as proposed by Comeaux and Bumpus (2019). By eradicating staffing as a numbers game and basing it on patients’ needs, it can become a well-thought-out process that protects not only patients and nurses, but policymakers and their loved ones.

Respectfully,

Alyssa Grumoli, MSN, RN-BC, CCRN