In the article "Addressing Staffing Shortages in an Era of Reform," Stanford points out that at a time when change is necessary due to healthcare requirements mandatory, there is a shortage of nurses in the direct patient care field because they are offered better paying jobs to supervise clerical positions. “Health system leaders recognize that these shortfalls threaten the quality of care they can provide to patients. As a result, competition for talent is becoming more intense in different parts of the country” (Stanford, 2013). When nurses take jobs in other areas of the field, we have to find people to replace them, and when that happens, it creates a shortage on the front lines of patient care. The literature, “The Unintended Consequences of Staffing Mandates in FloridaNursing Homes: Impacts on Indirect-Care Staff,” discusses the effect staffing shortages have on direct care staff such as certified nurses, activity staff and others who they see and interact with the resident on a daily basis, (Thomas, et al. , 2010) Increasing the number of direct or unlicensed staff members, the work of indirect care members, such as housekeepers and others. minor jobs, puts the burden on the direct care staff. This created a problem as they tried to complete all the tasks assigned to them. Once again the blame for all the problems was placed on the staff, although this time they were included even staff who were not directly involved in the care of residents. Having fewer indirect care staff meant everyone had to carry out extra work duties and indirect care staff were left holding the bag with a lower than standard quality of care. Interventions Based on the findings of my research, a change is needed to ensure that these long-reliant...... middle of paper ......rtages in an era of reform Healthcare Financial Management: Journal Of The Healthcare Financial Management Association [serial online]. December 2013; 67(12):42-45. Available from: MEDLINE with full text, Ipswich, MAThomas, K. S., Hyer, K., Andel, R., & Weech-Maldonado, R. (2010). The unintended consequences of staffing mandates in Florida nursing homes: Impacts on indirect care staffing. Medical Care Research and Review, 67(5), 555-573.Yoder-Wise, P. S. (2011). Change of leadership. Leading and managing nursing care (5th ed., pp. 327-328). St. Louis, Mo: Elsevier Mosby.Xing, J., Mukamel, D.B., & Temkin-Greener, H. (2013). Admissions of nursing home residents in the last year of life: characteristics of nursing homes and variation in potentially avoidable hospitalizations. Journal of the American Geriatrics Society, 61(11), 1900-1908. doi:10.1111/jgs.12517