In the recent NURSEWEEK/AONE research study, nurses told us that the greatest impact of the nursing shortage has been the decline in the amount of time that nurses have to spend with patients. Is this because of the lack of nurses alone, or are the systems around patient care keeping nurses from patients as well?

Now, new research has focused on quantifying the link between nurse staffing and patient outcomes. Evaluating the impact of nurse staffing on patient outcomes is no easy feat, given the many variables within the patient care environment. In the midst of our efforts to quantify the impact of RN staffing, we also need to keep in perspective the importance of the overall system for care, and especially the skills and knowledge that individual nurses bring to this equation

I have seen care environments that have systems humming like clockwork, providing the needed products, support and technology to nurses at the point of care. A full stable of richly talented, expert nursing staff carefully nurtures students and the occasional new nurse into a team culture of clinical excellence, innovation and professionalism. Leadership exists to facilitate, coach and reward the team.

I also have seen situations where the systems that support nursing care were in chaos, greatly diminishing the effectiveness and efficiency of bedside nurses, pulling them away from patient care. Nurses are stretched beyond reason to cover patient care demands. Overwhelmed by turnover, these care environments cannot give the needed support and guidance to students or new graduates, and barely survive on various forms of temporary labor to meet staffing needs. Nurses lack either the time or the necessary tenure to provide relevant organizational history. No energy is left to take advantage of any educational or professional development opportunities. Every day is a crisis. Leadership exists to put out the next fire.

Amazingly, it is possible for these clearly opposite situations to exist in the same organization. While it is a vicious cycle, it can be brought to an end. It just takes everyone tugging and pulling in the same direction.

Recognizing it when we see it: Sometimes sliding into chaos can occur without the right people noticing. The monitoring of key metrics (turnover, staffing, etc.) is essential to keeping on top of a complex nursing organization. Human resources and finance are important sources of data and assistance.

Agree on a plan: Along with the help of others, staff needs to identify short-term vs. long-term goals, with measurable milestones.

Build a sense of hope: Staff needs to understand that everyone is there to help them get their feet back under them. They need to be clear about the level of commitment to solve the problems.

Call in the troops: You'd be amazed at who can help out a unit when in crisis. Just ask for the help, and then be sure to say thanks.

Create breathing space: Units in crisis need senior leaders to take action and create some breathing space. Close beds, limit admission, divert patients and add extra help, just to give everyone a break. Yes, I know, the doctors will complain, but ask for their patience and expect their support.

Conserve energy: Don't waste nurses' time and attention on anything but what's really important. Some things can slide while you work on rebuilding a unit. Local leadership is in the best position to identify needs and buffer staff from outside pressures.

Raise the spirit: Charismatic leadership can inspire and excite and motivate. Make sure that efforts are made to recharge exhausted leadership as well as staff.

Take charge and just fix it.

Discuss this and other topics with your colleagues at www.nurseweek.com/rnvillage.