The American Society of PeriAnesthesia Nurses (ASPAN) has a responsibility to define principles of safe, quality nursing practice in the perianesthesia setting.  A critical nursing shortage is emerging that is uniquely different from shortages previously experienced.  The new nursing shortage is fueled by many different factors: fewer nurses entering the workforce; acute nursing shortages in certain geographic areas; job dissatisfaction; and, a shortage of nurses adequately prepared to meet certain areas of patient need in a changing health care environment.

 The acuity of patients entering the hospitals is steadily increasing as is the need for med/surg and intensive care unit (ICU) beds.  The stark outcome is the number of medical/surgical (Med/Surg), emergency, critical care, operating room, and perianesthesia nurses available to meet the needs of patients is inadequate.

Background

1.      Postoperative patients are unable to be transferred to general medical-surgical inpatient units.

2.      Critically ill patients who have had surgery are unable to be transferred to the appropriate intensive care units.

3.      Patients scheduled for surgery experience delays or cancellations due to the lack of professional nurses and staffed beds.

4.      Perianesthesia nurses are directly impacted when they are required to work on-call and are mandated to stay overtime to care for these patients.

5.      Perianesthesia nurses are leaving the profession due to increasing nurse to patient ratios and extended work hours.

6.      Decreasing operational budgets often result in the elimination of support staff, thereby increasing the nursing workload with non-nursing functions/tasks.

Position

It is therefore the position of ASPAN that:

1. ASPAN’s Position Statement on Minimum Staffing in Phase I PACU to promote patient safety is supported and upheld.
2. ASPAN’s Position Statement on On-Call/Work Schedule is supported and upheld to ensure a safe patient environment. 
3. ASPAN’s A Joint Position Statement on ICU Overflow Patients, developed by ASPAN, AACN and the ASA’s Anesthesia Care Team and the Committee on Critical Care Medicine and Trauma Medicine, is supported and upheld.
4. Mandatory overtime should not be routinely used to manage the inefficiencies in the system related to lack of beds and staffing.

In addition, ASPAN also recommends the following actions:

1. Federal and state funding be expanded for nursing education at the baccalaureate, masters, and doctoral levels.
2. Federal and state funding be expanded for nursing research related to recruitment, retention, and increased nursing job satisfaction.
3. Federal and state funding be targeted for continuing education to support required education and professional growth.
4. Federal and state funding be appropriated to market the nursing profession to middle and high school students by creating paid work experience programs. 
5. Federal and state governments should have increased reimbursement for health care facilities.

Expected Outcomes

1. It must be recognized that the primary responsibility of the perianesthesia nurse is to provide the optimal standard of care to the perianesthesia population.
2. Staffing will be in accordance with ASPAN’s Standards of Perianesthesia Nursing Practice.
3. The perianesthesia nurse will be able to practice nursing in a safe environment.
4. Increased funding for generic and advanced nursing education will enhance the ability to recruit and retain entry-level and experienced nurses.
5. Increased reimbursement for healthcare facilities will enable an increase in hiring and retention of professional nurses, and promote professional nursing growth. 

Approval of Statement