Perceived Relationships Between Emergency Department Staffing Patterns and Missed Care, Missed Decompensation, and Delays in Care.

Introduction: When emergency department staffing is inadequate, patient care may be missed. Information regarding the association between missed care and staffing is lacking in the emergency department setting. This study aimed to explore considerations for and configurations of staffing patterns and their relationship to missed care, missed decompensation, and delays in care.

Methods: This study used an exploratory qualitative approach with data derived from focus groups and analyzed using qualitative content analysis. A total of 39 emergency nurses in varied roles attending a national conference were recruited. The Consolidated Criteria for Reporting Qualitative Research checklist was used to guide the reporting of this study.

Results: Participants reported information grouped into 5 major categories: ratios, staffing patterns, work ethic, role of administration, and missed care. Both staff and charge nurses reported a preference for a 1:3 nurse-to-patient ratio, with higher patient ratios described as leading to missed care, missed decompensation, and delays in care.

Discussion: The individual and institutional elements of staffing decisions may have a significant impact on patient outcomes in the form of missed care, missed diagnoses, and delayed care. Staffing decisions may also affect the psychological health of emergency nurses by fostering burnout. Across roles, nurses perceive a disconnect between the ED environment and staffing plans generated by persons outside the department. Future research should focus quantitatively on relationships between staffing patterns and patient and nursing outcomes.