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safe staffing healthcare

From Your ANA President


HAVING WORKED in an emergency department for more than 20 years, I know what it’s like to have to think fast and move fast to save a life. But for too long, registered nurses (RNs) in many settings across this nation have been working as quickly as they can—not because they are tending to an emergency but because they are working without the staff they need. And that is wrong in every way you can think about it.

At ANA, we know that staffing is a complex, multilayered issue. But when you peel back the layers, there are some simple truths. Safe and appropriate staffing matters, and nurses’ personal experiences and numerous studies prove that it’s true.
Appropriate staffing matters to patients whose very lives depend on nursing care. It matters to nurses who desperately
want to provide quality, thoughtful, and humane care to every patient or client. No nurse should have to even consider
whether there is a corner that could be cut that won’t put our patients, ourselves, our careers, or our professional
ethics in jeopardy.

At our recent House of Delegates meeting, nurses from around the country adopted a resolution that
calls for ANA to champion an enforceable, nurse-led staffing process that includes staffing principles, minimum
nurse-to-patient ratios, the collection of nursing sensitive data, and penalties associated with facilities’
noncompliance. Staffing has always been a priority for ANA, and this recent action strengthens our commitment
to addressing this issue.

No matter what we do or where we work, we can all play a vital role in ensuring safe and appropriate staffing.
ANA has resources that can help nurses—staff and management—make their case for solid staffing. Our evidence
and strategies can be found in two of ANA’s foundational documents, Nursing: Scope and Standards of Practice, 2nd Edition and Code of Ethics for Nurses, and our newly revised ANA’s Principles for Nurse Staffing, 2nd Edition. We also have and are developing webinars and other tools that can help you navigate staffing solutions. You can learn more about legislative and other
efforts on our website,

But let me share some ways individual nurses can frame their charge for safe staffing. We can advocate for our patients’ right to being cared for in an environment with safe, appropriate staffing. We already have this skill, and our right to advocate is supported by the Code of Ethics. One provision calls on nurses to promote, advocate, and strive to protect the health, safety
and rights of patients. Another cites nurses in administrative or managerial roles as having a particular responsibility
to provide an environment that supports nursing care, including establishing policies that guard against inappropriate assignments or delegation of nursing responsibilities, activities, or tasks.

We can advocate for quality care and how we make it happen. A key tenet of nursing practice outlined in Nursing:
Scope and Standards of Practice
, speaks to the strong link between the professional work environment and the RN’s ability to provide quality health care and achieve optimal outcomes.

We can advocate for a workplace culture with shared goals. ANA’s Principles for Nurse Staffing notes that provision
of appropriate nurse staffing is necessary to reach safe, quality outcomes. This document serves as an important guide to solving staffing issues. It specifically points to the shared responsibility that RNs and healthcare organizations have in developing and maintaining safe staffing practices. (See “Issues up close” for more details about these principles.)

Everyone involved in health care should focus on doing what is best for our patients and our clients, even in these trying times. I encourage you to pick up the banner for safe staffing individually and as a group and to call for nurse-led, enforceable processes in your facilities. These documents and other ANA staffing resources can support you in your quest.

Karen Daley, PhD, MPH, RN, FAAN

President, American Nurses Association

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