The Challenge 

Achieving safe staffing in medical-surgical nursing is imperative for the well-being of patients and nurses alike. There is no one-size-fits-all solution to this complex balancing act. Unsafe staffing negatively impacts patient outcomes with increased incidences of missed nursing care (Nantsupawat et al., 2021), increased hospital acquired infections (Tenic, 2023) and increased mortality risk (Aiken, 2023; Bartmess et al., 2021; Dall’Ora et al., 2022). The negative impacts of unsafe staffing on medical-surgical nurses include increased burnout and turnover rates, resulting in significant costs to hospitals (Laseter et al., 2021).  An integrated staffing strategy that balances evidence-based minimum staffing standards, acuity-driven workload distribution, nurse-led decision-making, policy advocacy, and technology-driven solutions is necessary to resolve the complex balance between nurse workload, well-being and retention, and patient safety and quality outcomes.  

The purpose of the staffing position statement is to integrate evidence-based recommendations to ensure a holistic and adaptable framework that meets the dynamic needs of medical-surgical nursing practice across the United States.  

Why It Matters  

Inadequate staffing leads to a cascade of avoidable harm: increased infections, delayed medications, missed alarms, and lost lives (Nantsupawat et al, 2022; Laseter et al, 2021). Nurses, stretched to their limits, report emotional exhaustion, high turnover intentions, and plummeting job satisfaction (Laseter et al., 2021; Kelly, et al., 2021). As the largest segment of the healthcare workforce, an investment in nurses is an investment in patients - nurses are the foundation of safe, high-quality care. It’s time to redesign staffing systems to work for patients and the people who care for them.  

Our Position: Smart, Sustainable, and Safe Staffing  

AMSN advocates for a future where nurse staffing is transparent and flexible, using a model rooted in evidence, powered by technology, and led by professional nurses.  

AMSN recommends:  

• To ensure patient safety and nurse wellbeing, a direct patient care registered nurse shall not be assigned more than five patients, as a guideline. Acuity-based adjustments should modify staffing as needed to reflect patient complexity, unit-specific demands, and the nurse’s experience.    
• Hospitals should integrate validated acuity-based staffing tools (such as EHRS-based acuity tracking) to dynamically adjust staffing based on real-time patient complexity and staff experience. Rigorous testing of standardized tools results in accurate measurement ensuring reliable and trustworthy data.    
• Medical-surgical nurses should implement Nurse-Led Staffing Councils to ensure nurses, ancillary support, and their immediate managers participate in shared decision making about staffing.  
• Hospitals should invest in ancillary staff to support nurses and reduce non-nursing workload and non-nursing care implemented by professional nurses. Ancillary staff refers to personnel who provide support services to the registered nurse. The supportive staff play a role in assisting with patient care, administrative tasks, and logistical support. Examples of ancillary staff include licensed practical nurse or licensed vocational nurse, patient care technicians, medical assistants, unit clerks, transport, and phlebotomy.  
• Advocacy at state and federal levels helps to create lasting, enforceable nurse staffing regulations. Medical-Surgical nurses and AMSN have specialized knowledge of and research about safe staffing levels and the needs and experience levels of medical-surgical nurses.   

To strengthen legislative and regulatory advocacy, the AMSN Advocacy and Legislative Committee should monitor and make recommendations regarding upcoming bills that would potentially affect AMSN staffing recommendations. Monitoring is of vital importance as legislative proposals change from year to year, requiring continuous review to ensure bills continue to meet the needs of medical-surgical nurses, our hospitals, and patients in the 21st century.    

AMSN Advocacy and Legislative Committee work, and any future staffing focused work by AMSN should be made available to our legislators, both local and federal, to inform proposed legislation. 

AMSN should continue to work with organizations such as the Nursing Community Coalition to ensure that the voices of nurses carry as much weight as possible and to get our needs heard by legislators.  

• Technological advances and evolving research will lead to innovative staffing models and practices which should be considered as future solutions. Medical-surgical nurses should actively engage on all fronts to develop, implement, and evaluate innovations to improve nursing care delivery models which inform medical-surgical nurse staffing. 

Together, We Can Redefine What Safe Staffing Looks Like  

Safe staffing is a life-saving standard that should be embraced, enabled, implemented, and evaluated. Medical-surgical nurses are the heartbeat of acute care and the largest segment of the nursing workforce. Safe staffing gives Medical-Surgical nurses the support they need to provide safe, effective, quality, evidence-based care. This will ultimately lead to better care and outcomes for our patients. 

References

Aiken, L. H. (2023). Pennsylvania policy evaluation of nurse staffing legislation: A white paper. Center for Health Outcomes and Policy Research, University of Pennsylvania. Retrieved February 5, 2025, from https://www.nursing.upenn.edu/live/files/2233-pa-hospsital-staffing-white-paper-may-2023 

Bartmess, M., Myers, C. R., & Thomas, S. P. (2021). Nurse staffing legislation: Empirical evidence and policy analysis. Nursing Forum, 56(3), 660-675. https://doi.org/10.1111/nuf.12594 

Dall'Ora, C., Saville, C., Rubbo, B., Turner, L., Jones, J., & Griffiths, P. (2022). Nurse staffing levels and patient outcomes: A systematic review of longitudinal studies. International journal of nursing studies, 134, 104311. https://doi.org/10.1016/j.ijnurstu.2022.104311 

Kelly, L. A., Gee, P. M., & Butler, R. J. (2021). Impact of nurse burnout on organizational and position turnover. Nursing outlook, 69(1), 96–102. https://doi.org/10.1016/j.outlook.2020.06.008 

Lasater, K. B., Aiken, L. H., Sloane, D., French, R., Martin, B., Alexander, M., & McHugh, M. D. (2021). Patient outcomes and cost savings associated with hospital safe nurse staffing legislation: An observational study. BMJ Open, 11(12), e052899. https://doi.org/10.1136/bmjopen-2021-052899 

Nantsupawat, A., Srisuphan, W., Kunaviktikul, W., & Aiken, L. H. (2021). Nurse staffing, missed care, quality of care, and adverse events. Journal of Nursing Administration, 51(4), 205-212. 

Tenic, H. (2023). Nurse–patient ratios and infection prevention practices in acute care settings. Journal of Patient Safety & Infection Control, 41(2), 91-107.