Unsafe staffing events and their effect on nursing fatigue and stress levels

Purpose:
The purpose of this presentation will be to show and describe a relationship between unsafe staffing events, nurses' ability to take meals and rest breaks, practice self-care, and their fatigue levels.

Background/Significance:
Unsafe staffing events affect a nurse's ability to take meals and rest breaks and manage their fatigue level. This fatigue can lead to burnout, staff turnover and job dissatisfaction. Unsafe staffing events can be seen as a predictor of unit or hospital wide staffing problems. Nursing turnover in medical surgical specialties is at 24%, as such it is imperative that nursing retention be made a priority.

Methods:
Unsafe staffing reports (n=34) were reviewed between 2010-2014 in one large university hospital to encourage homogeneity in policies and procedures surrounding meals, rest breaks and the process of filing unsafe staffing reports. These reports were then categorized into 4 subsets to be further analyzed which included: 1) events where the nurse was unable to take a meal or a rest break, 2) events where the nurse was able to take a meal, 3) events where the nurse was able to take a rest break and 4) events where the nurse was able to take their meal and rest breaks. The language in the staffing reports was also reviewed for thematic analysis.

Results:
Out of the 34 total reports 85.2% (29) of the reports indicate that either a meal or a rest break was missed due to unsafe staffing. Further, a full 52.9% (n=18) of reports have the reporting nurse missing both a meal and rest breaks. Out of 29 reports that have a missed meal or rest break, 27 have qualitative data and the language used indicated a much higher level of stress than the reports that did have a meal and rest break. Three key contextual factors emerged from the data 1) high patient acuity needing additional staffing above grid (n=9, 33.3%), 2) insufficient staffing of registered nurses (n=12, 44.4%) and 3) insufficient staffing of support staff (n=6, 22.2%).

Conclusions and Implications for Practice:
The rate of RN turnover in med-surg areas is the highest it has ever been. We need to begin to not only understand why but also to listen to the nurses on the front line. This presentation humanizes those experiences that are contributing to turnover and gives us a starting place for change.