I read the article “Perception of Adequacy of Staffing” (August 2009: 65–71) by Claudia Schmalenberg and Marlene Kramer with great interest and expectations because the topic is so relevant to present day problems and to job satisfaction or the lack thereof in our daily practice. I agree that numbers alone do not tell the whole story and that staff nurses’ “perceptions of the factors in the work environment that affect adequacy of staffing must be assessed and measured and included in the model.”

In our medical-surgical intensive care unit, we need a better solution to the staffing issue, and I am sure our problem is not unique to our hospital alone. Many years ago, our patient-nurse ratio was based on unit acuity; our 20-bed critical care unit was staffed primarily with a nursing care coordinator and an assistant nursing care coordinator, or an...

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