AOL News Report - Nurses Need Shorter Hours, Better Work Conditions

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Nurses Need Shorter Hours, Better Work Conditions

By Maggie Fox, Reuters

WASHINGTON (Nov. 4) - Tired and grumpy nurses forget to wash their hands, give the wrong drugs to patients, and waste hours on paperwork, a panel of experts said in a report calling for shorter hours and better working conditions for the profession.

The changes -- including 12-hour limit on their workday -- would reduce medical errors and make conditions better for nurses and patients alike, an Institute of Medicine panel said Tuesday. "We need to move ahead urgently with these recommendations," Donald Steinwachs, chair of the committee that wrote the report, told a news conference."The benefits go beyond saving lives," he added, saying changes would make nurses less likely to quit or change jobs and would save money spent treating patients hurt by costly mistakes.

Steinwachs is chairman of the department of health policy and management at the Johns Hopkins University school of public health in Baltimore."No one or two actions by themselves can keep patients safe," Steinwachs added. "Rather, creating work environments that reduce errors and increase patient safety will require fundamental changes in how nurses work, how they are deployed, and how the very culture of the organization understands and acts on safety.

"The nation's 2.2 million registered nurses, 700,000 licensed practical and vocational nurses, and 2.3 million nursing assistants are the front line in caring for patients and protecting them against errors, the report said.It cited a study in two hospitals that found nurses intercepted 86 percent of medication errors before they reached patients.

Medication errors include giving the wrong drug, giving the wrong amount, giving it the wrong way -- orally versus intravenously, for instance -- or giving it at the wrong time, said Ada Sue Hinshaw, dean of the University of Michigan school of nursing.The IoM, which advises the federal government on medical matters, found in a 1998 report that medical errors cost up to $29 billion each year and kill as many as 98,000 people.

State regulators should ban nursing staff from working more than 12 hours a day and more than 60 hours per week, the committee said."Every safety-sensitive industry ... sets some sort of boundary on hours," said Hinshaw -- referring to regulations affecting truckers, train crews, pilots and a variety of other industries. The recommendations echo groundbreaking changes made by the Accreditation Council for Graduate Medical Education, which set new standards in July that limit hospital work by residents -- physicians-in-training -- to 80 hours a week.

The report said regulations setting minimum standards for staffing in nursing homes need to be updated. The report says the U.S. Department of Health and Human Services should require nursing homes to have at least one registered nurse in the building at all times. Hospital intensive care units need to aim for one nurse for every two ICU patients.

Better conditions may often mean shifting nurses' work to others -- including paperwork and moving patients around, the panel said. But some hospitals and nursing homes may need to hire more nurses, they said.

In July 2002, an HHS report forecast a 12 percent shortfall in the national supply of nurses by 2010 and 20 percent by 2015.

AOL News - Nurses Need Shorter Hours, Better Work Conditions

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Institute of Medicine of the National Academies:

Substantial Changes Required in Nurses' Work Environment To

Protect Patients From Health Care Errors

WASHINGTON, DC - Nov 4, 2003 -- The work environment of nurses, the largest segment of the nation's health care work force, needs to be substantially transformed to better protect patients from health care errors, says a new report

from the Institute of Medicine of the National Academies. The report calls for changes in how nurse staffing levels are established and mandatory limits on nurses' work hours as part of a comprehensive plan to reduce problems that threaten

patient safety by strengthening the work environment in four areas: management, work-force deployment, work design, and organizational culture.

"No one or two actions by themselves can keep patients safe," said Donald M.

Steinwachs, chair of the committee that wrote the report, and chair, department of health

policy and management, Bloomberg School of Public Health, Johns Hopkins University,

Baltimore. "Rather, creating work environments that reduce errors and increase patient

safety will require fundamental changes in how nurses work, how they are deployed, and

how the very culture of the organization understands and acts on safety. We present a

comprehensive plan to address all these areas."

The nation's 2.2 million registered nurses (RNs), 700,000 licensed practical and

vocational nurses, and 2.3 million nursing assistants constitute 54 percent of all health

care providers. Nurses are the health professionals who interact most frequently with

patients in all settings, and their actions -- such as ongoing monitoring of patients' health

status -- are directly related to better patient outcomes. Studies show that increased

infections, bleeding, and cardiac and respiratory failure are associated with

inadequate numbers of nurses. Nurses also defend against medical errors. For

example, a study in two hospitals found that nurses intercepted 86 percent of medication

errors before they reached patients.

Despite the growing body of evidence that better nursing staff levels result in safer

patient care, nurses in some health care facilities may be overburdened. For instance,

some hospital nurses may be assigned up to 12 patients per shift. Available methods for

achieving safer staffing levels -- such as authorizing nursing staff to halt admissions to

their units when staffing is inadequate for safe patient care -- are not employed uniformly

by either hospitals or nursing homes.

The decade-old regulations that specify minimum standards for staffing in nursing homes

need to be updated, the report says. The U.S. Department of Health and Human Services

should require nursing homes to have at least one RN within the facility at all times. HHS

also should specify staffing levels that increase as the number of patients increases and

that are based on the department's 2001 report to Congress on minimum staff-to-patient

ratios for nursing homes. The committee recommended that nursing homes increase

internal oversight of their staffing practices and effects on patient safety whenever

staffing falls below one RN for every 32 residents, one licensed nurse per 18 residents,

and one nurse assistant per 8.5 residents per day.

Similarly, hospital intensive care units should increase internal oversight when

staffing falls below one nurse for every two ICU patients. Federal and state report

cards on nursing homes should include information on nursing staff levels, and measures

of staffing levels should be developed for hospital report cards. Whenever possible,

health care facilities should avoid using nurses from temporary agencies to fill staffing

shortages.

Long work hours pose one of the most serious threats to patient safety, because

fatigue slows reaction time, decreases energy, diminishes attention to detail, and

otherwise contributes to errors. While most nurses typically work eight- to 12-hour

shifts, some work even longer hours. At the same time, patients admitted to hospitals

typically are more acutely ill and require technologically more complicated care than in

the past. State regulatory bodies should prohibit nursing staff from working longer than

12 hours a day and more than 60 hours per week, the committee said.

Along with changes in staff levels and hours, hospital restructuring initiatives begun in

the mid-1980s led to substantial changes in how nurses work. As hospitals tried to

respond to the financial pressures resulting from modifications to public and private

insurance payment systems, their efforts altered the ways in which nurses are organized to

provide care and, in many cases, undermined trust between nurses and management. As a

key step toward improving nurses' work environments and restoring trust, the report

urges health care organizations to involve nurse leaders in all levels of management and

to solicit input from nursing staff on decisions about work design and implementation.

Nurses are in prime positions to help pinpoint inefficient work processes that could

contribute to errors, identify causes of nursing staff turnover, and determine appropriate

staff levels for each unit.

Orientation programs for newly hired nurses and continuing education programs are being

scaled back due to cost pressures, although surveys indicate that many newly licensed

nurses do not possess the overall preparation to provide care to today's patient population.

Also, many RNs are not receiving ongoing education and training to keep up with the

ongoing growth of new medical knowledge and technology. Health care organizations

should dedicate financial resources to support nursing staff in the ongoing

acquisition and maintenance of knowledge, skills, and continuing education

programs, the report says.

The committee's recommendations are made in a climate of high rates of turnover among

nursing staffs, as well as a nursing shortage that is predicted to worsen in the future.

Implementation of the recommended changes in nurses' work environments would

likely help health care organizations recruit and retain nurses, the report says. "It

may be tempting to think that these recommendations can wait for increases in the

supply of nurses, but evidence on nursing retention indicates just the reverse is

true," Steinwachs said. "Because the supply of nurses is unfortunately stretched thin

right now, they must be supported by work processes, work spaces, hours, staffing

practices, and a culture that better defends against errors and readily detects and

mitigates errors when they occur. Nurses will be more likely to stay in health care

organizations that implement the management and work-design practices

recommended in this report."

The study was sponsored by the U.S. Department of Health and Human Services' Agency

for Healthcare Research and Quality. The Institute of Medicine is a private, nonprofit

institution that provides health policy advice under a congressional charter granted to the

National Academy of Sciences. A committee roster follows.

Copies of Keeping Patients Safe: Transforming the Work Environment of Nurses are

available on the Internet at http://www.nap.edu. Copies of the report will be available

early next year from the National Academies Press; tel. [phone] or

1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News

and Public Information (contacts listed above).

INSTITUTE OF MEDICINE

Board on Health Care Services

Committee on the Work Environment for Nurses and Patient Safety

http://www.nationalacademies.org/morenews/

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Published November 6, 2003

Overworked nurses add to errors, study finds

By Patricia Anstett

Knight Ridder

Detroit-Overworked, under-trained nurses are contributing to substantial numbers of preventable medical errors in hospitals and nursing homes, a federal report released this week concluded.The report, "Keeping Patients Safe, Transforming the Work Environment of Nurses," was released by the federal Institute of Medicine of the National Academies as part of a national campaign to reduce an estimated 44,000 to 90,000 deaths in hospitals from medical errors.

The study is likely to have an impact on nurse staffing issues for years to come. Some changes would require state action, such as granting confidentiality to nurses to report medical errors and so-called near misses.

The agency report is the latest of three such studies issued since 1999. The first and most widely publicized estimated the number of deaths attributable to medical errors in hospitals.

The latest report gives the public a guide to the staffing levels it should expect at the best hospitals and nursing homes.

"The evidence is so compelling between low staffing levels and high levels of errors that we ought to at least have minimum standards," said Dr. Andrew Kramer, a committee member.

States should adopt standards limiting nurses to working no more than 12 hours a day or no more than 60 hours a week, the committee recommended.

There also should be limits on temporary nurses, which studies show are linked to more medical errors, the committee said.

Studies analyzed by the committee show that nursing shortages contribute to greater risk of infection, bleeding, and heart and lung failure. Nurses commit 34 percent to 38 percent of medical errors but intercept 86 percent of the mistakes, Ada Sue Hinshaw, a member of the committee, said.

http://www.news-leader.com/today/1106-Overworked-210603.html

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Report: Nurses at risk working long hours

WASHINGTON, Nov. 5 (UPI) -- A new report by the National Academy of Sciences says patients are being endangered by nurses who are required to work more than 12 hours a day.

The New York Times said Wednesday the study, commissioned by the federal government, notes such long hours cause fatigue, reduce productivity and increase the risk the nurses will make mistakes that harm patients.

The report said many hospital and nursing home nurses and their nursing assistants work more than 12 consecutive hours, with some working double shifts of 16 hours.

The report suggests state officials should prohibit nurses from working more than 12 hours in any 24-hour period, or more than 60 hours a week.

The study said 27 percent of nurses at hospitals and nursing homes reported they worked more than 13 consecutive hours at least once a week.

The report noted many hospitals and nursing facilities have too few nurses to take proper care of patients.

http://www.allnurses.com/news/jump.cgi?ID=6020

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My employer had the audacity to ask us to agree to cut our continuing ed imbursements by 60%, utilize mandatory ot as a staffing alternative, and increase the number of pts that can be assigned to RNs. And they actually asked for that permission with a straight face. lol. At the next negotiations session, theyre getting copies of all these articles as our answer for why we are not going to allow any of it.

ANA Commends IOM Report Outlining Critical Role of Nursing Work Environment in Patient Safety

Study reinforces call to eliminate mandatory overtime; improve staffing levels, work environment Washington, DC -- The American Nurses Association (ANA) applauded the Institute of Medicine (IOM) for a report, released yesterday, which shows a clear link between the nursing work environment and patient safety, and recommends improvements in health care working conditions that would lead to safer patient care.

The study, Keeping Patients Safe: Transforming the Work Environment of Nurses, builds on the recommendations made in the groundbreaking To Err is Human IOM study, released in 2000, which found that as many as 98,000 patients per year die as a result of medical errors.

"ANA has long contended that improved patient safety and quality of care cannot be achieved without investing in and valuing nursing," said ANA President Barbara Blakeney, MS, APRN,BC, ANP. "This study provides even more evidence that urgent action is needed to improve nurses' working conditions, and that by doing so patients will be protected from preventable errors."

Based on the study's findings and recommendations, Blakeney noted that Congress needs to take urgent action on several pending legislative measures that would improve the nursing work environment. These include bills that 1) mandate safe nurse/patient ratios, 2) severely limit the unsafe practice of mandatory overtime, and 3) provide sufficient funding for nursing workforce development.

"Nurses and patients across America are calling on Congress to take action that will improve nursing care in this country and hold health care facilities accountable for the staffing decisions they make," said Blakeney.

The study notes upfront that the typical nurse's work environment poses "many serious threats to patient safety - in all four of the basic components of all organizations - organizational management practices, workforce deployment practices, work design, and organizational culture."

The study also finds that because "multiple components and processes" of health care organizations create situations that increase the risk of medical errors, "multiple, mutually reinforcing changes in nurses' work environments" are needed to combat the problem. Chief among those changes are that a "culture of safety" in nursing needs to be "created and sustained."

ANA agreed wholeheartedly with the study's finding that many hospitals are not staffed with adequate numbers of nurses, a practice that endangers patients, and the finding that unsafe work practices and workspace design pose threats to patient safety. ANA further agreed with the report's conclusions that "piecemeal approaches" will not work, that additional research is necessary and that this research must be part of an ongoing process.

In particular, ANA supported the report's recommendation to limit the number of hours a nurse can work to 12 hours in any 24-hour period and 60 hours in any seven-day period - the same limits being proposed by the Safe Nursing and Patient Care Act of 2003 (H.R. 745, S. 373). As evidence, ANA pointed to a study conducted by Dr. Ann Rogers at the University of Pennsylvania, in partnership with ANA, which was outlined in the IOM report. Dr. Rogers' study found that once shift duration exceeded 12 consecutive hours, error rates increased significantly.

"This study indicates that the elimination of 'mandatory overtime' is essential to safe patient care and healthier nurses," said Blakeney. And mandatory overtime could be eliminated if Congress were to pass the Safe Nursing and Patient Care Act."

ANA also agreed with the report's overall call for more visible leadership role for nurse managers. "However, it is ANA's consensus that nurse leaders must also actively seek direct-care nursing staff and support them to have a greater voice and additional opportunities to participate in decision making," Blakeney said. "In short, wherever and whenever possible, frontline nurses must be engaged in any decisions that affect their work life and patient care."

Blakeney was particularly adamant about the need for a greater link between management practice, the work environment and safety, and she pointed to one potential solution that was also highlighted in the IOM report - the American Nurses Credentialing Center (ANCC) Magnet Recognition Program, which focuses on excellence in nursing services - as a means of achieving safer patient care.

Currently, close to 90 acute-care hospitals have earned Magnet recognition. Facilities designated by ANCC as "Magnets" have proven track records for retaining nurses, even during shortages, because they put a high premium on nursing leadership. Average nurse retention in Magnet facilities is twice as long as that of non-Magnet institutions. Furthermore, patients in Magnet facilities experience fewer negative outcomes, shorter lengths of stay, and increased satisfaction with their health care services.

ANA further supported the recommendation that hospitals and nursing homes directly involve nursing staff at the unit level in determining and evaluating staffing needs. This is a recommendation that ANA has long been making, and it is outlined in ANA's Principles for Nurse Staffing. ANA published the principles in 2000 to assist nurses in determining appropriate staffing. Used as guidelines, the principles not only take into account the number of patients but also look at other staffing considerations, such as the experience level of unit nurses, the severity of patients' conditions, and the availability of support services and resources. In addition, the principles are the basis of proposed federal legislation, S.991, the Registered Nurse Safe Staffing Act, introduced in the Senate last May.

Finally, while agreeing that the report speaks to creating a culture of safety in nursing care, Blakeney advised the committee to "take on a broader view" of the overall work environment with an eye toward "creating a work culture where excellence in nursing care - and not simply patient safety - can survive and thrive." This atmosphere exists in Magnet facilities, which have been shown to recruit and retain more nurses while also providing excellent and demonstrably safer nursing care, she added.

"The nation currently is experiencing a nursing shortage, with more than one million new nurses needed by 2010," Blakeney noted. "Many studies have confirmed that a lack of adequate nurse staffing does result in greater patient mortality. This latest study not only builds on these other studies but it also strengthens the link between nursing care, the work environment and greater patient safety. It is now up to key decision makers to take action and devote the resources necessary to implement these recommendations - in order to recruit and retain nurses and keep patients safe."

In addition to To Err is Human, the IOM's recommendations also follow those from a second report: Crossing the Quality Chasm: A New Health System for the 21st Century (IOM, 2001). This report focuses on patients' experiences and how "microsystems" of care, including nursing units, should be modified to reduce errors. The current report differs by focusing primarily on health care organizations and their work environments.

http://www.ana.org/pressrel/2003/pr1105.htm

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[oramar]

As usual you posted some fascinating stuff in this thread a while back. I meant to comment on it at the time I first read it. Was surfing a little today and rediscovered it. That part about protecting nurses from more than 60 hours a week makes my jaw drop. The most hours I can tolerate is 24 in a week. More than that and I risk sever burnout. It would kill me if I worked 60 in two weeks.

[Katnip, RN]

All these articles have great points. But these dangers have been known and published for years. Who listens?

[lee1]

How many nurses here are working more than 40 hr per week???

As I have aged working only a rare increase in my hours is tolerable. Although I do see that some nurses who work 12hr/ 3 days per week (considered full time with full time benefits) at one hospital can and do an additional 12 hr slot at another hospital. Most of these people though I don't think are doing it continuously unless their is some overwhelming financial problem. Those that do risk major burnout IMO

Money certainly is NOT everything but of course does help ones lifestyle, IF, you have any time to enjoy it.

[Dplear]

I have worked many years if doing 72+ hours in a week. Did not bother me i the least. I still can work weeks lilke that if I wanted to and it honestly does not affect my skills or abilities. This is something that is highly individual and I do know that There are nurses that cannot handle more hours just as there are those of us that can. I would be incensed if someone told me I could only work x hours a day if I wanted to work more. That is my choice not theirs. And before anyone says anything I have been nursing 17 years now and granted I only work 36 hurs a week right now but that is so I can stay home with my kids more now that they are entering late elementary/junior high years. (I still do occasional ageny jobs on the side to pay for vacations and extra's)

Dave