another look at the JAMA nurse staffing study

[-jt]

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: http://www.jama.com.

http://www.NYSNA.org

[oramar]

I hope that when they eventually have to report ratios they are forced to state real ratios and not add staff that do not do hands on care. You know how they play with grids these days. Nurses like supervisors and unit managers that do no hands on care are added in to the tally. There will be an attempt to play with ratios because that is how hospitals operate. I also don't want NA and repiratory techs added. When we say nurse/patient ratios we want NURSES only counted.

[-jt]

Ohhhh theyre so sneaky. Like when they tell the media "we dont have a shortage at the hospital - in fact, we even have more RNs than we did a year ago!" Theyre counting all the new administrators that have RN after their name. But the bills that NYSNA wrote & have been been pushing for since 1997 in NY state make the distinction in the language of the law, specifically referring to those that are "providing Direct Care" so that they cant play these games.

And the staff cant all be lumped together in the numbers either. The bill calls for separate reporting of the numbers of RNs providing direct care, the numbers of pts each RN is providing direct care to, the number of LPNS providing direct care, the number of pts each is providing it to, and the number of unlicensed assistive personnel providing direct care and the number of pts they are providing it to.

For more info, see:

Establishing Safe Staffing Guidelines

Disclosing Staffing Ratios

Prohibiting Mandatory Overtime

Encouraging Continued Competency

Increasing the Supply of Nurses

Protecting Nursing Practice

http://www.nysna.org/PROGRAMS/LEG/HOME.HTM

Nationally, the ANA has assisted the legislature with the creation of a similar bill that is currently going thru the process in Congress. It would require the same disclosure from healthcare facilities all across the country, and the facilities medicare/medicaide reimbursements would depend on it.