Columbia Nursing Discovers Link Between Healthcare Associated Infections and Nurse Understaffing

The Columbia University School of Nursing recently conducted a unit-level staffing study, which found an association between nurse understaffing and healthcare associated infections (HAIs) in patients. Their findings demonstrate that understaffing increases the risk of HAIs, ultimately adding billions to healthcare costs annually.

The study examined data from over 100,000 patients and found that 15 percent of patient-days had one shift understaffed with registered nurses (defined as registered nurse [RN] staffing below 80 percent of the unit median for a shift) and 6.2% had both day and night shifts RN understaffed. Patients on units with both shifts understaffed with RNs were 15 percent more likely to develop HAIs on or after the third day of exposure to these periods of understaffing than were patients in units with both day and night shifts adequately staffed. The study also found units were understaffed with nursing supporting staff, defined as licensed practical nurses and nurse assistants, and this also increased patients’ risk of HAIs.

Lead author Jingjing Shang, PhD, associate professor at Columbia Nursing, stated in a press release, “As they often serve as coordinators within multidisciplinary health care teams, nurses play a critical role in preventing HAIs, which is a top priority for improving quality of care and reducing hospital costs. Being at the forefront of infection control and prevention is a unique responsibility and opportunity for nurses, and our study shows that hospital administrators should ensure adequate nurse staffing to provide the safest patient care. This could be achieved through better nurse recruitment and retention practices, together with methods of managing burnout and fatigue.”

The study found that in understaffed units, nurses experienced excessive workloads. Distressed working conditions may compromise infection prevention practices and surveillance activities intended to recognize the signs and symptoms of infection. Continuous understaffing may negatively impact nurses’ wellbeing as well as patient care.