New York State Nurses Association
REPORT: December 2002
Study Shows Inadequate RN Staffing Harms Patients
by Anne Schott
In hospitals where RNs had to care for more than four patients, mortality rates rose significantly, according to a new study published in the Journal of the American Medical Association. Each additional patient a nurse had to care for led to a seven percent increase in the likelihood the patient would die within 30 days of admission. Patients of a nurse caring for six patients had a 14% greater chance of dying, and patients of a nurse caring for eight patients had a 31% greater chance of dying.
"These numbers are alarming when you recognize that nurses are routinely required to care for eight seriously ill patients," said NYSNA Deputy Executive Director Tina Gerardi. "Hospitals that have accused nurses of exaggerating and described their complaints about poor staffing as merely "anecdotal" need to open their eyes. A growing body of research is now substantiating exactly what nurses have been saying. Poor staffing puts patients at risk."
Staffing Affects Burnout
The study also found that as the nurse's workload rose, job dissatisfaction and burnout rose as well. An increase of just one patient per nurse increased burnout by 23% and job dissatisfaction by 15%.
Forty-three percent of the nurses studied had high burnout scores, and a similar proportion was dissatisfied with their current jobs.
Citing an earlier study, the researchers report that 40% of hospital nurses have burnout levels above the norms for health care workers in general, and that job dissatisfaction among hospital nurses is four times greater than the average for all US workers.
One in five hospital nurses say they plan to leave their current jobs within a year. No wonder there's a nursing shortage.
The consequences of poor staffing radiate beyond patients and nurses. The researchers cite recently published figures that show replacing a medical/surgical nurse costs $42,000 and replacing a specialty nurse costs $64,000. "The heavy workloads that lead to nurse dissatisfaction and burnout are not only exacerbating the nursing shortage." Gerardi said. " They are also wasting precious healthcare dollars. It makes no sense to over burden nurses and drive them from the profession, when it is both difficult and expensive to replace them."
Thousands of Patients Studied
To arrive at their results, researchers at the University of Pennsylvania, led by Linda Aiken, studied 232,342 general, orthopedic, and vascular surgery patients and 10,184 staff nurses at 168 Pennsylvania hospitals.
They examined risk-adjusted surgical mortality rates and rates of "failure-to-rescue," which is defined as deaths in patients who develop serious complications. The study controlled for hospital characteristics of size, teaching status, and technology. Patients in the study were discharged from the hospital between April 1, 1998 and November 30, 1999.
Research Receives Wide Publicity
Newspapers across the country reported on this study, which is just the latest addition to a growing body of data that links RN staffing to patient outcomes. In an editorial, The New York Times suggested that "hospitals report their patient-nurse ratios so that prospective patients can decide where to take their chances."
Since 1997 NYSNA has been lobbying for legislation that would require hospitals to disclose their patient-nurse ratios, a measure strongly opposed
by the hospital industry. The full text of the research study is in the Journal of the American Medical Association, October 23/30, 2002; or on the Web: www.jama.com.