Invest in nursing: the backbone of health care systems

Abstract

This issue of JBI Evidence Synthesis coincides with International Nurses Day—an opportunity to honor those at the forefront of patient care delivery, providing nursing across the care continuum and across the lifespan to people across the globe. This year and last, COVID-19 has brought to light the extraordinary nature of what nurses do—despite facing unique stressors related to the pandemic—in the provision of innovative, person-centered care with expertise, courage, compassion, and dedication. The pandemic has exposed weaknesses in health care systems that nurses and nursing science have long been reporting. This issue of JBI Evidence Synthesis is organized around the theme of workforce/workplace issues critical to optimizing the contribution of the nursing profession to quality patient care. The well-being of nurses is integrally tied to the health systems in which they work and to the strength of the profession in advocating for conditions that promote quality care. Staffing and its relation to patient and nurse outcomes Complementing a strong body of research, mostly from the United States and European countries,1-8 the systematic review by Assaye et al.9 on the impact of nurse staffing on patient and nurse workforce outcomes in acute care settings specifically includes studies from low- and middle-income countries. Within this context, the findings reinforce the critical link between staffing and patient safety. The authors conclude that the higher the nurse workload, the higher the rates of in-hospital mortality, hospital-acquired infections, and medication errors. The importance of the science that has linked staffing with patient safety must be examined in relation to the number of unavoidable deaths. In the United States, the third-leading cause of death is medical errors,10 a rate much higher than in comparable countries that illustrates the importance of this area of study. The Lancet Global Health Commission's study on health care quality in low- and middle-income countries estimated 5 million deaths per year because of poor-quality health care.11 In addition to affecting patient outcomes, there is strong science that inadequate staffing also influences nurse outcomes. The review by Assaye and colleagues9 found that lower nurse-to-patient ratios and higher nurse workloads were linked to high levels of burnout, needlestick and sharps injuries, absenteeism, and intention to leave the job. This is similar to other studies that have linked staffing to burnout,5-8 job dissatisfaction,7,8 and intent to leave.8 These outcomes read like symptoms, and if so, what is the malady or maladies? Science points to the work environment. A supportive and empowering work environment improves nurse retention and job performance, and reduces burnout. Addressing the nursing shortage with tailored recruitment and retention strategies As nurses and midwives make up more than one-half the health care workforce worldwide, and the World Health Organization estimates a shortage of nearly 9 million nurses,12 it is critical that we examine workplace issues affecting the recruitment, retention, and engagement of nurses. There is no one-size-fits-all approach, and we must turn to the evidence to guide us in tailored approaches appropriate to the population and context. Two scoping review protocols in this issue aim to do this: “Retention strategies and barriers for millennial nurses”13 and “International nursing students’ and new graduates’ experiences of transition to the nursing workforce.”14 Both populations have unique strengths, interests, and needs. Millennial nurses have higher levels of burnout and exhaustion compared with other generations,13 and more than 50% leave the workforce within two years. Millennials comprise about one-third of the nursing workforce15; finding retention strategies that meet their needs will be an important strategy in addressing the shortage and ensuring adequate staffing. International nursing students who sub