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Workforce reductions: low morale, reduced quality care.

As the number of positions decreases, the workload becomes more stressful for nurses left to pick up the slack. Mistakes are made, patient complaints increase as tensions rise, and the quality of nursing care decreases. The use of contingency staffing and overtime may increase as the workforce is reduced. Lack of job security forces acceptance of overtime, leaving less time for family life which may lead to resentment. The success of an organization is linked to employees' willingness to perform and use their skills. With deteriorating attitudes, employees will not perform at maximum effectiveness. Services do not meet established standards or customer expectations and are reflected in negative customer feedback and decreasing revenues. "There are no quick fixes. Tossing out last month's 'cure' to usher in this month's idea is a big waste of time" (Austin, 1994, p. 19). The impact from layoffs has long-lasting effects on employees, their families, and the community. Support for those displaced, and for those retained, provides a release for pent-up emotions and allows employees to get on with the work at hand. Workforce reductions will continue with the decrease in funding and the decline in patient census, but it is imperative that the quality of care be maintained. Registered nurses cannot be replaced at the bedside by UAP who do not have the specialized knowledge and skills required to provide safe and effective care (Thomas, 1995). Efforts to cut costs should be directed toward decreasing waste and eliminating redundant work, not at decreasing the number of RNs. The RN must remain the primary caregiver at the bedside to maintain quality care. Changes that remove the RN from the bedside will influence the quality of care that patients receive in the future. Increased demands and fewer, less-experienced staff result in less time for patient care. One negative patient outcome can be much more costly, directly and indirectly, than the salaries of several staff nurses.