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Understaffing: “to tell or not to tell” – The Patient!

May 13, 2013

Nurses face many ethical dilemmas every day.ethics1

Our decisions are reached using guiding ethical principles. Among those principles is beneficence which supports the belief that our actions should promote “good”. The result of beneficence is nonmaleficence which is to do no harm. These culminate in an overarching guiding ethical principle which many consider to be the highest ethical principle – respect for others.

There is a very thought provoking article in the May 2013 issue of the American Journal of Nursing entitled: Telling patients about staffing levels. The author, Douglas P. Olsen PhD, RN, presents a case study of an understaffed unit and challenges the reader to decide “to tell or not to tell” the patient.

Here is the Case Study he presents:

“It’s a very busy Monday. Because of chronic difficulty in recruiting staff, the unit has only three-fourths of its RN positions filled. In addition, Mary Evans, an experienced nurse who always helps less experienced staff with their patients while carrying a full caseload herself, has called in sick.

Linda Smith is 68 years old and two days post-op from hip replacement surgery. As you enter her room, 45 minutes after she first requested pain medication, you can sense her irritation—but worse than that, you can see from the grimace on her face and her guarded movements that she’s in pain. After several days of good nursing care, you’ve let her down, and you consider telling her about the staff shortage. But you wonder: Is it right to disclose today’s short staffing to Ms. Smith?”(Olsen, 2013)

Read the authors discussion of the decision-making process that takes place when deciding “to tell or not to tell” by following this link: Telling patients about staffing levels

If you were short-staffed to the degree that Mary Evans describes and it was hard to find the Time to Care

What would you do?



Olsen, D. (2013). Telling patients about staffing levels. American Journal of Nursing. 113(5), 62-64. doi: 10.1097/01.NAJ.0000430239.60186.d1

2 Comments leave one →
  1. Marc permalink
    May 13, 2013 7:12 PM

    What would be gained by telling her “we’re short staffed”? I may feel better because I’ve gotten that off my chest or placed blame but I haven’t done anything to help Linda Smith. If asked I would explain the staffing situation, otherwise, stick to taking care of Ms. Smith.

  2. Kevin Devine, RN MSN permalink
    May 14, 2013 12:57 PM

    I can remember being a new nurse and having very similar experiences. It’s not that you don’t want to provide quality care, but because of staffing you are just swamped and can’t get to things as quickly (without risking safety) as you like. I can remember saying things like “I’m really sorry but we’re short today”. I think patients have gotten more savvy, hopefully they would appreciate the honesty of such a response and perhaps allow for a broader discussion if the patient, or their family desired it, that’s when I’d ask the manager to step in and address quality or staffing plan concerns.

    In OptiLink we have an “alert” (it’s a little red exclamation point) that indicates (to staff, not to the public) that the unit is outside of it’s expected care model. The majority of my clients choose not to have the alert on. Their rationale…”Everybody knows when we’re short, why advertise it?”

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