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Nurse Staffing in the United States Coursework

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Updated: Jun 6th, 2022


Currently, the workforce of the United States is severely understaffed for health workers, especially nurses. The nursing profession is one of the most challenging across the board. Today, nurses play a variety of roles: they not only conduct standard procedures but also take up the responsibilities of a counselor, health promoter, and patient advocate. Given the inadequate patient-to-nurse ratio, it is readily imaginable how overwhelmed nurses probably are. What could definitely help to improve the situation is effective staffing management. Ideally, it would help nurses avoid burnout, keep a healthy work-life balance, and stay alert and concentrated on the job. This, in turn, would account for more precision and accuracy in the workplace. This essay covers current staffing trends in nursing, staffing frameworks, and acuity as well as gives an explanation of an effective skill-mix and non-productive FTEs.

Challenges in nurse recruitment are at an all-time high: in 2019, there is still a vast number of job openings to be filled. Most hospitals depend on new graduate nurses to apply for these jobs. Sadly enough, as many as 57% of newly graduated health workers cannot keep up with the straining work pace and leave their facilities in their first two years on the job (Avant Health Professionals, 2019). This trend is fairly alarming, especially given that the retirement rates among nurses are also on the rise. In 2019, more nurses than ever choose to quit the field altogether, which leads to dangerously low staffing levels. When experienced nurses leave, they no longer can pass down their clinical expertise and institutional knowledge, therefore, depriving younger nurses of an opportunity to receive meaningful mentorship. Understaffing also accounts for unsafe conditions for both nurses and patients. The most understaffed units are medical-surgical, emergency room, and operating room. Currently, US hospitals are trying to balance out the situation by inviting international nurses from developing countries.


One of the key roles of a nurse staffing manager is evaluating acuity and putting together a schedule accordingly. In the nursing field, acuity levels refer to the urgency of a situation regarding a patient (Thomas, 2015). Measuring acuity levels helps nurse managers set adequate staffing levels. Without an appropriate system in place, patients may be deprived of the amount of care that matches their most dire needs, which in turn, would lead to the aggravation of their conditions. Building a system that takes acuity levels in consideration is especially important at understaffed facilities. The general logic is usually that higher acuity patients, i.e. patients who are severely ill, need more intensive care. On the other hand, patients with more predictable health outcomes and who are doing better overall should receive less frequent care. A proper understanding of acuity and adequate response are vital to managing multiple patients in the clinical setting.

Staffing Frameworks

There are four key staffing frameworks in the nursing field based on the criterion of the availability of resources:

  1. The least resourced model: a facility heavily relies on low-qualified personnel and agency staff;
  2. The moderately resourced basic model: a facility mainly relies on auxiliary nurses; they do not work after hours as much as those within the first model;
  3. The moderately resourced professional model: a facility employs fewer less-qualified personnel. For registered nurses, it means more workload as well as working overtime;
  4. The most resourced model: a facility capitalizes on highly qualified personnel and leverages instability in nursing teams (Africa, 2017).

Effective Skill Mix

The nursing skill mix refers to the percentage of highly qualified specialists in a nursing team. Thus, a poorer mix stands for a small share of professionals while a richer mix means that a greater number of professional nurses are present on the team. Ideally, medical facilities should strive for enriching their teams, attracting, and retaining high caliber cadres. Having proper academic and professional background implies not only practical knowledge but also interdisciplinary, transferable skills such as critical thinking and therapeutic communication. A team with a large share of professional nurses promotes continuing education as the rest of the team feels the need to keep up with the part that is most qualified. Moreover, as recent studies have shown, having professionals on the team positively correlates with better patient outcomes, i.e. lower mortality rates as well as lower readmission rates (Thomas, 2015). It is argued that there are two strategies that a hospital may adopt to ensure enrichment. First, a hospital might consider attracting experienced nurses through external and internal advertisement. The other option is to try and grow cadres with the required skill set within the organization.

Non-Productive FTEs

One of the key concepts of nurse staffing management is the concept of productive and non-productive hours. Typically, non-productive time includes vacation and holidays, sick leave, staff development and meeting, orientation for newcomers, new equipment orientation, and more (Young, White, & Dorrington, 2018). It can also be time spent on improving nurses’ professional expertise as attending training sessions and further nursing education. In facilities that hire traveling nurses, commuting is seen as part of non-productivity. Generally speaking, non-productive hours do not add value to various processes; yet, they are paid according to the current policies (Mason, Gardner, Outlaw, & O’Grady, 2015).


Africa, L. M. (2017). Transition to practice programs: Effective solutions to achieving strategic staffing in today’s healthcare systems. Nursing Economics, 35(4), 178.

Avant Health Professionals. 2019 trends in nurse staffing. Web.

Mason, D.J., Gardner, D.B., Outlaw, F.H., & O’Grady, E.T. (2015). Policy & politics in nursing and health care. Amsterdam, Netherlands: Elsevier Health Sciences.

Thomas, T. (2015). Management and leadership for nurse administrators. Burlington, MA: Jones & Bartlett Publishers.

Young, C., White, M., & Dorrington, M. (2018). Nurse staffing improvements through interprofessional strategic workforce action planning. Nursing Economics, 36(4), 163-194.

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