Nurse short-staffing negatively impacts nurses, patients, and the quality of patient care. For nurses, short-staffing leads to burnout, job dissatisfaction, and mental health issues which also negatively impact their personal lives. It causes 31.5% of nurses to intend to leave their current role or the nursing profession altogether. For patients, short-staffing results in missed care, longer hospital stays, higher mortality rates, and more medical errors and infections. Ensuring adequate nurse staffing levels is important to support nurses professionally and personally as well as improve patient outcomes.

1. NURSE SHORT-STAFFING 3
Nurse Short-Staffing Has a Negative Impact On Nurses’
Professional and Personal Lives and Patient Care Outcomes
Melissa Whiting
Indiana State University
English 305T:301 Technical Writing
Professor J D Wireman
November 7, 2022
Table of Contents
1. List of illustrations 2

2. 2. Abstract 2
3. Introduction 2
3.1 Background 2
3.2 Problem/Issue 3
3.3 Purpose 4
3.4 Scope 4
4. Discussion 4
4.1 Forms of Nurse Short-staffing 4
4.2 Negative Impact of Nurse Short-Staffing On Nurses’
Professional and Personal Lives 5
Figure 1 above shows that 31.5 percent of RNs with burnout
report intent to leave their current facilities or nursing field
while only 8 percent of RNs without burnout have intent to
leave. 10
4.3 Negative Impact of Nurse Short-Staffing On Patient Care
Outcomes 10
5. Conclusion 15
6. Recommendations 15
7. References 16
Nurse Short-Staffing Has a Negative Impact On Nurses’
Professional and Personal Lives and Patient Care Outcomes1.
List of illustrations
Table 1 Themes of burnout and job dissatisfaction
Figure 1 Percentage of RNs reporting intent to leave2.
Abstract
Many studies have linked short-staffing with nurses
experiencing different personal and career problems. Hence, the

3. aim of this report is to analyze studies that explore nurse short-
staffing to negative effects on nurses’ professional and personal
lives and patient care outcomes. The findings of the report show
that burnout, demoralization, anxiety, depression, despair, and
intent to leave are some of the main consequences of having
high nurse-to-patient ratios. Furthermore, when nurses are
overstretched at work, their personal lives are also affected.
Overloaded nurses lack time to engage in leisure activities or
interact with friends and family members. The report concluded
that not having enough nurses in a facility affects nurses and
patients negatively. Additionally, the report recommended that
hospital management must hire adequate nurses and ensure units
have a relevant nursing skills mix. 3. Introduction 3.1
Background
Nurses comprise the biggest number of healthcare professionals
and spend the most time with patients. Therefore, patient care
quality heavily relies on the nursing staff. Nursing shortage is
one of the main issues affecting the ability of nurses to provide
quality care. Notably, most states in the US have been facing
increased nurse short-staffing. Among the causes of the nursing
shortage are healthcare institutions’ failure to hire enough
nurses or improve working conditions to retain nursing staff.
Many studies have linked nursing understaffing with poor
patient outcomes and personal and professional problems for
nurses. An observational multicenter study by Haegdorens et
al. (2019) found that low nurse short-staffing increase length of
stay, patient mortality, and avoidable readmissions in surgical
and medical wards. Additionally, infections and medical
complications arise while patient satisfaction decreases when
hospitals have an inadequate number of nurses (Lasater et al.,
2021). These patient safety issues occur because of short-
staffing increasing nursing workload. When facilities freeze
nurse hiring to cut costs, nursing workload elements, including
nursing task volume, nurse-to-patient ratios, non-patient tasks,
and nursing hours per patient, rise. Professionally, overworked

4. nurses make medical errors, fail to prevent infections, and miss
treatments and patient surveillance (Pérez-Francisco et al.,
2020). Furthermore, they experience fatigue, stress, depression,
and anxiety. The professional and personal problems caused by
overworking force some nurses to resign or even leave the
nursing profession. The facilities suffer from worse nurse
understaffing, and the cycle continues. 3.2 Problem/Issue
The current failure of most administrators in healthcare
institutions to hire an adequate number of nurses has created a
high workload and major problems for patients and nursing
staff. To reduce professional and personal issues among nurses
and improve patient care outcomes, facilities need to eliminate
nurse short-staffing. 3.3 Purpose
The purpose of this report is to present the evidence linking
nurse short-staffing to negative effects on nurses’ professional
and personal lives and patient care outcomes. The report will
persuade hospital administrators to increase nursing staffing
levels to achieve appropriate nurse-to-patient ratios.
3.4 Scope
The report will specify the different forms of understaffing. It
will also analyze the personal and professional problems nurses
experience due to understaffing. The report also presents patient
care and safety issues emerging from nurse short-staffing.
4. Discussion 4.1 Forms of Nurse Short-staffing
The most common form of understaffing that researchers have
studied is personnel or manpower understaffing. Andel et al.
(2022) defined manpower nursing understaffing as the lack of
nurses that leads to facility units failing to conduct crucial
healthcare activities. As such, personnel understaffing is
usually described in terms of nurse-to-patient ratios. A hospital
with manpower staffing has more patients than the number of
nurses required to meet safety and quality standards. Many
hospitals have manpower understaffing in almost all their units
and departments. The majority of healthcare facilities, nursing
professional organizations, nurses, and even governments use
nurse-to-patient ratios to determine the level of understaffing in

5. an institution. Manpower understaffing affects the entire nation.
For instance, studies have revealed that by 2030, only 13 out of
the 50 US states will not have nursing shortages (Andel et al.,
2022). Furthermore, every year from 2021 to 2031, there will be
203,200 registered nurse openings, according to the Bureau of
Labor Statistics forecasts. The shortage will occur mostly
because of nurses leaving the profession and reaching
retirement age.
A less studied type of understaffing is expertise understaffing.
Even though nurse expertise short-staffing is common in
healthcare institutions across the country, it has not received as
much focus as manpower understaffing. When a facility unit or
department does not have nurses with the necessary training,
certification, or skills to carry out primary tasks, then it has
expertise understaffing (Andel et al., 2022). Registered nurses
require knowledge to specialize and work in specific hospital
units such as intensive care, oncology, obstetrics and
gynecology, surgery, trauma center, and psychiatry. Depending
on the departments that a hospital has, it might need to have
pediatric, trauma, emergency room, acute care, intensive care
unit, oncology, psychiatric, perinatal, surgical, labor and
delivery nurse, neonatal, and anesthesia nurses. Nonetheless,
most healthcare organizations have departments running without
all the relevant nursing expertise. 4.2 Negative Impact of Nurse
Short-Staffing On Nurses’ Professional and Personal Lives
The researcher conducted an informal interview among 20 co-
workers. The registered nurses were aged 24 to 61 years, 3 were
male, and 17 were female. During the conversations, the
participants discussed the issues they have experienced in their
work and personal lives because of nurse understaffing in their
facility. The main themes included burnout, job dissatisfaction,
reduced teamwork, mental health problems, relationship or
family problems, decreased productivity, and intent to leave.
Nursing understaffing increases workload, which raises
burnout significantly among nurses. Burnout occurs when

6. nurses are emotionally, mentally, and physically fatigued from
engaging in more tasks than they can handle based on their
resources, skills, and time (Pérez-Francisco et al., 2020).
Therefore, both manpower and expertise short-staffing are
associated with burnout. Compared to other occupations,
healthcare workers are at increased burnout risk, as they work
with the sick and dying every day. Hence, short-staffing raises
the likelihood of burnout even further. The higher the number of
patients and responsibilities a nurse has, the higher the burnout.
Chronic stress from overworking eventually turns into burnout.
Research shows that around 34.8 percent of American nurses
experience emotional burnout at one point in their careers
(Pérez-Francisco et al., 2020). Burnout contributes to 31.5
percent of nurses leaving the profession (Pérez-Francisco et al.,
2020). Out of the 20 RNs that participated in the informal
interview, 8 reported experiencing burnout within the last year,
and 12 did in the ten years.
Burnout has many symptoms and implications. In their
cross-sectional research, Putra and Setyowatia (2019) found that
29.80, 24.5, and 24.3 percent of nurses with burnout had
emotional exhaustion, personal accomplishment decrease, and
increased depersonalization, respectively. Specifically,
depersonalization occurs when a nurse has negative feelings and
attitudes toward patients because of burnout. One interview
participant said,
‘
Sometimes I’m so overwhelmed by my duties that I
resent my patients. I feel like they are disturbing me when they
need my help.’
Other nurses feel that they are not achieving their personal and
professional goals. A combination of depersonalization and
emotional exhaustion results in some mental health issues.
According to Putra and Setyowatia (2019), 31, 14, and 4 percent
of nurses with emotional fatigue and depersonalization also
have insomnia or anxiety, impaired social functioning, and
depression, respectively. Self-esteem can also reduce due to

7. burnout, as indicated by four percent of nurses (Putra &
Setyowatia, 2019). Besides, burnout is also associated with
physical illnesses, including joint pain, headaches, and
gastrointestinal problems. Nurses might, therefore, request time
off work frequently.
Burned-out nurses are demoralized, dissatisfied with their jobs,
and unable to achieve high job performance. They might ask for
time off frequently. Low nurse staffing is one of the three
major causes of job dissatisfaction. The other two factors are
unfavorable work environment and low benefits. Furthermore,
understaffing, which causes nurses to work overtime often, and
the inability to take breaks was a factor that research subjects
cited as their main source of job dissatisfaction (Senek et al.,
2020). In the US, research revealed that 24 percent of RNs
working in hospitals were dissatisfied with their jobs, 27
percent of nursing home nurses, and 13 percent were working in
other settings (Lasater et al., 2021).
High job dissatisfaction is not an issue in the United States
only. It is also a problem in many European nations. For
example, according to studies, 56 percent of RNs in Greece are
dissatisfied with their jobs because the patient-to-nurse ratio is
at least 10:1 (Senek et al., 2020). Similarly, a patient-to-nurse
ratio of 8 to 1 and above in Ireland and England led to nurse
dissatisfaction rates of 42 and 39 percent, respectively (Senek et
al., 2020). The consequence of dissatisfaction is demoralization
among 63.8 percent of 4770 RNs surveyed by Senek et al.
(2020). Having excessive workloads due to nursing shortage
makes nurses fear making errors and exposing patients to safety
issues. The nurses are anxious about their next shifts because
they are always exhausted and overwhelmed regardless of their
time management skills. Moreover, expertise understaffing
creates unhappiness among nurses. Performing duties that are
beyond one’s daily responsibilities causes discontent. For
example, a nurse in the informal interview that this researcher
conducted:
‘

8. Only three nurses in the facility are trained on wound
VAC procedure. I’m one of those nurses, and I’m pulled out of
my responsibilities thrice weekly to attend to wound VAC
patients. Complications might require the procedure to take at
least an hour. The constant disruptions and work overload have
stopped me from enjoying my job.’
Burnout and job dissatisfaction from short-staffing lead to
problems in nurses’ personal lives. In a cross-sectional survey
study, nurses reported that experiencing demoralization,
despair, and burnout in the workplace had a negative effect on
their personal lives (Senek et al., 2020). Due to understaffing,
nurses are overstretched during all their shifts, and they barely
have breaks to rest, eat, or drink. The nurses become
emotionally and physically sick to the point of developing
illnesses. Furthermore, when a facility is understaffed, the
available nurses must take more overtime shifts. For that
reason, nurses lack time to spend with family and friends or
even engage in hobbies. Apart from that, overworking affects
mood, and some nurses report being moody when interacting
with their friends and relatives. As mentioned earlier, anxiety,
depression, and insomnia are some consequences of burnout.
These mental health disorders not only hinder RNs from
fulfilling their career duties but also their personal
responsibilities. Some nurses even associate their marital
problems with overworking due to short-staffing (Senek et al.,
2020). Being miserable both at work and home only worsens the
emotional, mental, and physical states of overworked nurses.
According to research, 31.5 percent of RNs that leave their
occupation do so because of burnout (Francisco et al., 2020).
Findings by Lasater et al. (2021) are also consistent, with high
nurse-to-patient ratios, long working hours, and burnout being a
major factor that drives nurses out of the profession. In addition
to burnout, other implications of short-staffing, such as job
dissatisfaction, insomnia, anxiety, depression, frustrations, and
strained personal lives, make some nurses resign. Francisco et

9. al. (2020) noted that some nurses start by leaving their units and
facilities before leaving the field. On the other hand, some just
leave the profession after working in the same unit and
organization for years. Notably, when RNs cannot handle the
implications of understaffing, they start planning their exit. For
instance, some participants in a study conducted by Francisco et
al. (2020) disclosed that they are already getting qualifications
in other sectors to prepare to leave nursing. According to the
RNs involved in the research, they cannot continue to work for
an understaffed facility that is making them experience mental,
physical, and family strains (Francisco et al., 2020).
Table 1 presents the themes of burnout and job dissatisfaction
that nurses experience when they are short-staffed.
Table 1
Themes
Findings
Supporting Quotes
Burnout
One of the symptoms of burnout that nurses experience when
they are understaffed is depersonalization
“Sometimes I’m so overwhelmed by my duties that I resent my
patients. I feel like they are disturbing me when they need my
help” (Participant 2, RN).
Job dissatisfaction
Nurses are constantly disrupted when a unit does not have
enough nurses with specific expertise, such as wound VAC
procedure training
“Only three nurses in the facility are trained on wound VAC
procedure. I’m one of those nurses, and I’m pulled out of my
responsibilities thrice weekly to attend to wound VAC patients.
Complications might require the procedure to take at least an
hour. The constant disruptions and work overload have stopped
me from enjoying my job” (Participant 20, RN).

10. Figure 1 shows the percentage of nurses with intent to leave
their current hospital comparing nurses with burnout to those
without burnout.
Figure 1 above shows that 31.5 percent of RNs with burnout
report intent to leave their current facilities or nursing field
while only 8 percent of RNs without burnout have intent to
leave.
4.3 Negative Impact of Nurse Short-Staffing On Patient
Care Outcomes
A high nurse-to-patient ratio and spending lower nursing
hours per patient were found to increase missed care when
researchers studied 4,086 American nurses across ten hospitals
(Griffiths et al., 2018). Notably, nurses missed different forms
of care when they were understaffed and overloaded with
responsibilities. About 76 percent of US nurses missed patient
ambulation (Griffiths et al., 2018). Thus, patient ambulation is
the care element that nurses miss the most due to short staffing.
Additionally, compared to clinical care tasks, planning and
communication including counseling, educating, conversing,
and comforting patients were missed more frequently (Griffiths
et al., 2018). When nurses were assigned a high number of
patients, they also failed to attend interprofessional meetings,
provide mouth care, evaluate patients upon admission, do
documentation, or develop care plans often (Griffiths et al.,
2018). Clinical care was not missed as often as emotional
support care. Nonetheless, Griffiths et al. (2018) pointed out
that overstretched RNs still omitted care in patient monitoring,
drug administration, bathing, feeding, and turning patients.
Various effects of understaffing hinder nurses from
completing psychological support and clinical care duties. A
research study by Lasater et al. (2021) showed that due to
understaffing, nurses were constantly interrupted making them
miss patient care. Others associated missed care with lacking
enough time during their last shift to finish important clinical

11. care. Nurses even lose vital patient care data when handing over
during shift changes due to inadequate time. The failure to
complete care tasks leads to poor quality of care. Short-staffing
is such a significant cause of compromised care that only
approximately 30 percent of nurses in a study said they would
refer their relatives and friends to their facility (Lasater et al.,
2021).
Frequently missed care due to high nurse-to-patient ratios
reduces patient safety significantly. Failure to rescue and
elevated patient mortality rates have been linked to nurse
understaffing in many studies. Specifically, 30-day adjusted
mortality tends to rise when the short-staffing of nurses causes
missed care. According to research, missed care increases by 10
percent when a nurse is assigned one additional patient; thus,
resulting in a 10 percent surge of 30-day adjusted mortality
(Ball et al. 2018). Aside from missed care, nursing overload
often means that nurses do not have adequate time to offer
complete care. Missed clinical care such as necessary treatments
and procedures, patient surveillance, turning patients, poor
handover, feeding, and administering drugs on time reduce
patients’ survival rates, especially those in critical conditions or
who have undergone surgery. Medical errors also occur more
frequently. All these negative consequences of understaffing
lead to more patients dying after surgery or within 30 days of
hospital admission. Pérez-Francisco et al. (2020) also link
patient safety issues including falls, bed sores, and hospital-
acquired infections, which arise from low staffing levels to
higher patient mortality rates.
There is a growing body of evidence indicating the
increase in healthcare-associated infections (HAIs) globally
including in the US and the most common cause is inadequate
nurse staffing (Shang et al., 2019). Although HAIs including
ventilator-associated pneumonia, central line-associated
bloodstream infections, surgical site infections, and catheter-
associated urinary tract infections are preventable, not having
enough nurses in shifts and units increase HAIs by 11 to 15

12. percent (Shang et al., 2019). High nurse-to-patient ratios
overwhelm RNs leaving them with burnout and insufficient time
to prevent infections. Hospitalized and surgical patients need to
be monitored regularly and carefully to prevent and detect any
infections. Some patients cannot turn on their own; thus, they
develop bed sores when the nurses fail to change the patient’s
lying position. Wounds also need frequent cleaning and
bandaging to keep dangerous bacteria away. However,
overstretched and burned-out nurses might forget or lack time to
do the necessary procedures to avoid the main forms of HAIs.
For instance, nurses must change the catheter, check surgical
sites, and provide oral hygiene to patients on ventilators to
prevent related HAIs. HAIs increase comorbidities, medical
bills, psychological problems, loss of employment, and
mortality among patients.
Among other factors, HAIs increase the number of days
that a patient stays in the hospital. McHugh et al. (2021)
conducted an observational study whose results showed that
patients stayed in the hospital for 4.0, 4.1, and 4.5 days when
RNs had fewer than 5, 5 to 6, and more than 6 patients,
respectively. Additionally, for every extra patient assigned to a
nurse, there was a five percent increase in the likelihood that
the length of a patient’s hospital stay would increase by one day
(McHugh et al., 2021). Since nurses spend the most time at the
bedside than all the other healthcare professionals, they are
responsible for monitoring patients to ensure they recover
within the expected time. As a result, having more patients
under their care than the recommended number lowers the
amount of time for patient surveillance. Besides, overloaded
nurses have burnout and reduced concentration.
A combination of patient safety and care issues such as missed
care, medical errors, comorbidities, and HAIs raises patient
length of stays. Patients are required to stay longer in the
hospital to treat new illnesses and infections caused by
decreased patient surveillance. The longer patient length of
stays due to nurse short-staffing has been observed in neonatal

13. intensive care, surgical, and adult medical units. A study across
New York hospitals found that changing the current nurse-to-
patient ratios of 1 to 6.3 to 1 to 4 would lower the lengths of
stay considerably; therefore, cutting down millions of dollars
(McHugh et al., 2021). For instance, hospitals could save at
least 117 million US dollars within a year if a nurse looked
after four patients only (McHugh et al., 2021). Making sure a
hospital unit has enough nurses and expertise saves money for
the facility and the patients due to shorter lengths of stays.
Low nurse staffing levels also increase preventable patient
hospital readmissions. Research shows that 20 percent of
Medicare patients are readmitted less than 30 days after hospital
discharge (McHugh et al., 2021). The readmission rate rises to
34 percent if it is 90 days after discharge (McHugh et al., 2021).
Preventable readmission causes negative financial, physical,
and psychological effects on patients. Although the causes of
patient hospital readmissions are many, nurse short-staffing is a
major factor. Notably, nurses caring for a large number of
patients are unable to complete some important clinical
activities. For example, such nurses fail to monitor patient
changes, educate patients on disease management, and assist in
transitioning the patient to outpatient services. As such, when
patients are discharged from the hospital, their conditions
relapse because the patients do not adhere to medications or
lifestyle changes.
Some of the patients also miss their outpatient care since the
nurses did not have time to provide proper education during
discharge. McHugh et al. (2021) claimed that 30-day
readmission rates for heart failure patients rose by seven
percent when the workload of a nurse increased by one more
patient. Moreover, hospitals with high nursing staff levels
decreased readmission rates for heart failure and pneumonia by
10 percent and by 12 percent for hip and replacement patients
(McHugh et al., 2021). Without a doubt, there is strong
evidence that the level of nursing staffing has a huge impact on
the readmission rates of different medical conditions.

14. Patient dissatisfaction is another issue directly linked to nursing
short-staffing. All the issues that nurses face when they are
overloaded including burnout, demoralization, personal life
problems, and intent to leave reduce patient care and safety. As
such, patients have negative experiences in the hospital, which
makes them dissatisfied with care. Missed care, readmissions,
high mortality rates, healthcare-associated infections, and
failure to rescue are linked to low patient satisfaction according
to various studies (Hong & Cho, 2021). Nurses interact with
patients from the time they are admitted to the hospital to the
time they are discharged. Therefore, the quality of care that
nurses provide greatly influences the type of experience a
patient gets. 5.
Conclusion
This report analyzed the evidence linking nurse short-staffing to
negative effects on nurses’ professional and personal lives and
patient care outcomes. Various studies presented strong
evidence of the effects of nurse short-staffing on nurses and
patients. Burnout symptoms such as emotional exhaustion,
personal accomplishment decrease, and increased
depersonalization are common among overloaded nurses.
Moreover, nurses experience high job dissatisfaction,
demoralization, and despair when they work in understaffed
units. Burnout and other professional problems hinder nurses
from having hobbies or spending time with their family and
friends. Burned-out, dissatisfied, and overstretched nurses are
unable to provide quality and safe care. Hence, patient
mortality, readmission, healthcare-associated infections, missed
care, and patient dissatisfaction rise. Nonetheless, the main
limitation of the report is the failure to discuss studies that
contradicted the presented evidence. 6.
Recommendations
The conclusions of this report propose that healthcare
administrators should consider having low nurse-to-patient
ratios to improve their nurses’ working conditions. High nurse
staffing levels will prevent nurse burnout, job dissatisfaction,

15. low morale, and high turnover. Hospital managers also need to
ensure that nurses are not overworked to prevent patient
mortality, healthcare-associated infections, readmission, missed
care, and patient dissatisfaction. Therefore, hiring enough
nurses and ensuring they have relevant expertise is necessary to
improve patient care and safety and nurses’ well-being.
7.
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17. Percentage of RNs reporting intent to leave. RNs with burnout
vs RNs without burnout
RNs with burnout 31.5 RNs without burnout 8
Burnout/without burnout
Percentage of RNs reporting intent to leave