Safety implications of different forms of understaffing among nurses during the COVID-19 pandemic

The aim of this study was to investigate the processes through which personnel understaffing and expertise understaffing jointly shape near misses among nurses during the COVID-19 pandemic.

Inadequate staffing is a chronic issue within the nursing profession, with the safety consequences of understaffing likely being exacerbated by the COVID-19 pandemic.

This study used a three-wave, time-separated survey design and collected data from 120 nurses in the United States working on the frontline of the pandemic in hospital settings.

Participants were recruited through convenience sampling in early April 2020. Eligible nurses completed three surveys across a 6-week period during the COVID-19 pandemic from mid-April to the end of May 2020. Study hypotheses were tested with path analyses.

Results reveal that personnel understaffing and expertise understaffing jointly shape near misses, which are known to precede and contribute to accidents and injuries, through different mechanisms. Specifically, personnel understaffing led to greater use of safety workarounds, which only induced near misses when cognitive failures were high. Further, higher levels of cognitive failures appeared to be the result of greater expertise understaffing.

This study highlights the importance of addressing issues of understaffing, especially during times of crisis, to better promote nurse and patient safety.

This study was the first to examine the distinct mechanisms by which two forms of understaffing impact safety outcomes in the form of near misses. Understanding these mechanisms can help leaders and policymakers make informed staffing decisions by considering the safety implications of understaffing issues.