Negotiating safety when staffing falls short

Adequate nurse staffing is inextricably linked to patient outcomes and, although optimal staffing levels for inpatient hospital units are widely debated, staffing standards for critical care areas such as intensive care units may be less variable. Even established staffing levels cannot guarantee adequate staffing. The nursing workforce shortage has affected all areas of nursing practice, but perhaps no area more severely than critical care. New treatments and procedures increase the number of individuals requiring intensive inpatient care and emergency rooms receive increased requests for nonemergent as well as critical care. There are times when staffing fails to meet desired levels and nurses are challenged to meet their duty to the patient for safety. The purpose of this article is to identify the safety challenges posed when staffing levels are less than planned in critical care settings and discuss individual, organizational, and policy-oriented strategies for protecting patient safety.