How Low Staffing Levels Intensify Risk Stressors for Nurses

By David Griffiths, Nurses Services Organization – a benefit partner of the Ohio Nurses Association

There’s no denying the strong correlation between nurse staffing levels and patient outcomes. Expected nursing shortages in communities across the country are poised to diminish the number of essential healthcare staff available to serve patients. And that creates stress on healthcare teams and healthcare facilities.

When a nursing unit is understaffed, nurses are faced with the possibility of providing patients suboptimal care and increasing the chance of making a mistake. These pain points have the ability to exacerbate the liability risks and challenges nurses already face in their regular routine by compounding physical, emotional and personal stressors.

Understanding those triggers and preparing for the risks they pose should not be undervalued, as they can lead, over time, to medical errors and burn-out. All of these factors can have a lasting effect on a nurse’s personal safety and career longevity.

Here are the top three categories of stress factors affecting nurses due to understaffing:


  1. Emotional Stressors

Nurses are at the center of patient care and often act as an advocate between patients and physicians, and between patients and family and friends. They are now becoming accountable for the coordination of care and providing informed discharge notes for patients, which has the potential to impact healthcare outcomes beyond the hospital walls.


Coupled with more complex patient care demands and healthcare technologies, there’s new meaning to the idea of being on the front lines of care. The emotional strain of the job can create feelings of burnout, which is driving nurses to retire early or to explore other career options. A 2012 survey revealed that about a third of nurses reported an emotional exhaustion score of 27 or more, recognized by medical professionals as “high burnout.” To avoid the consequences of this hidden stress, institutions and nurses themselves will need to have more methods to identify and overcome these triggers.


  1. Physical Stressors

Bending, lifting, readjusting patients and materials – all typical routines of the job that can become particularly complex when nurses face a greater patient load or longer shifts due to short staffing. As shifts stretch (often due to last-minute schedule changes) and as patient-to-nurse ratios increase, nurses have more opportunities to get fatigued and even injure themselves or those they care for. Added hours can also create job dissatisfaction, which stresses healthcare teams and hospital staffs. Add to this a growing aging population, with one in seven Americans age 65 or older and rising patient acuity, and nurses have a literal and much greater burden to bear.


What makes these issues more concerning is the fact that the nurse population is also aging. It’s estimated that by 2020, half of registered nurses will reach retirement age. Right now, the average age of nurses hovers around 50. It begs the question for healthcare providers everywhere: just how will our nurses be able to keep up with the pace and the workload the industry demands as their numbers dwindle?


  1. Personal Stressors

While they may not happen on the job, personal struggles can also enter the work environment when family, financial or personal health concerns hover over a nurse’s life. A recent survey showed that 47 percent of employees say that problems in their personal lives sometimes affect their work performance. While not a unique phenomenon to the healthcare industry, the implications of stress at home causing reduced workplace performance for nurses can be far greater than for the average office worker, who isn’t responsible for the health and well-being of others.

Bottom Line

This trio of stressors has nursing advocates promoting ways to help ensure staffing levels are well-managed to alleviate some of the pain points that create or amplify stress on the job. The healthcare industry has already seen, and should expect to see more, legislative action or facility provisions to address nurse staffing levels. These efforts, as well as attempts to educate and inform new and practicing nurses to explore self-care tactics, are working to reduce common stressors plaguing nurses today to better foster the positive patient outcomes for which nurses and the community strive.

About the author

David Griffiths is senior vice president of Nurses Service Organization (NSO), where he develops strategy and oversees execution of all new business acquisition and customer retention for the group’s allied healthcare professional liability insurance programs. With more than 15 years of experience in the risk management industry, he leads a team covering account management, marketing and risk management services. More at


*ONA’s members are taking on nurse staffing and quality patient care. Learn how you can make an impact here.