The Pittsburgh Post Gazette
The Private Sector: Less understaffing wanted
Proposed legislaton might fix problem of lax patient care due to hospitals short-staffing nurses
Tuesday, November 12, 2002
By Marilyn Hostetter
Let's be clear about the crisis in our hospitals. It's chronic understaffing -- not a shortage of nurses -- that's driving the decline in patient care and driving nurses out of our hospitals.
The study released in the Oct. 23 Journal of the American Medical Association confirms what nurses in Pennsylvania have been saying all along: Understaffing in hospitals is putting patients at risk and causing the shortage of nurses willing to work in hospitals.
The study led by Linda Aiken of the University of Pennsylvania, which analyzed data drawn from 168 Pennsylvania hospitals, establishes a clear link between nurse staffing and the safety of patients, as well as the job satisfaction of nurses. It found that each additional patient over four in a nurse's care resulted in a 7 percent increase in both patient mortality and deaths following complications, and a 23 percent increase in nurse burnout. If a nurse is responsible for eight patients -- not uncommon in many medical-surgical units in Pennsylvania -- there is a 31 percent greater chance of a patient dying and a 92 percent chance that the nurse will suffer from burnout.
More than a decade of managed care has left our hospitals chronically underfunded and understaffed. As staffing levels declined, nurses were asked to care for more, and more severely ill patients with less support, more paperwork and more technologically complex procedures and equipment. Understaffed and unable to provide the care their patients need, nurses began to leave hospitals for more rewarding careers somewhere else.
The scope of the problem is staggering: Of the nation's 2.7 million licensed nurses, only 1.3 million are working in hospitals today. Nationwide there are 126,000 unfilled nursing positions in hospitals.
None of this is news to RNs who work in hospitals. In an independent poll of nurses in Western Pennsylvania commissioned by District 1199P/Service Employees International Union earlier this year, more than 75 percent of the nurses responded that staffing in their units was inadequate to meet patients' needs. Ninety-four percent say inadequate staffing is why there is a shortage of nurses willing to work in hospitals.
The hospital industry has offered "solutions" that focus on recruiting and training new nurses, but this misses the mark. Yes, we need to recruit more nurses. Yes, we need to find a way to pay for their education. But the crisis we face in our hospitals today demands that we first address the chronic understaffing that is its primary cause.
In Pennsylvania, we have the opportunity to take a major step toward fixing the problem with the Safe Staffing and Quality Care Act now before the Legislature. This bill would require all hospitals in the commonwealth to annually submit and post for public review a plan that is certified to provide safe levels of registered nurse staffing. The bill requires that the hospital's staffing plan include input from their nurses -- who are in a position to know best what is needed. And the plan must include procedures for taking into account the degree of sickness of patients as it affects nursing requirements. Equally important, the bill would require that hospitals meet minimum nurse-to-patient ratios -- one RN to four patients in medical-surgical units -- in order to assure patient safety.
This legislation is the first important step toward relieving the crisis in health care. Passage of this bill will ensure that Pennsylvanians can rely on adequate staffing in our hospitals to care for them and their loved ones. And, by relieving much of the stress and overwork from the shoulders of our nurses, this legislation will stop the revolving door that's sending nurses out of our hospitals.
Marilyn Hostetter, R.N., of Harrisburg is coordinator of the Harrisburg-based Nurse Alliance of Pennsylvania, an 8,000-member affiliate of Pennsylvania's Health Care Union, District 1199P/Service Employees International Union.