Nurses Safety
Published Apr 2, 2004
You are reading page 2 of How Hospitals CREATED A Shortage of Nurses
Brownms46
1 Article; 2,394 Posts
I just found this article, and I feel it embodies the first article, and my thoughts also.
The Shortage of Care
A Study by the SEIU Nurse Alliance
EXECUTIVE SUMMARY
The rising rate of medical errors in hospitals is fast becoming a national crisis. Ever since the Institute of Medicine released its shocking report in the fall of 1999 showing that medical errors are responsible for 44,000 to 98,000 deaths in hospitals a year, public officials have been studying the crisis and ways to solve it.
According to hospital administrators, the problem was not inadequate staffing but rather technological changes and other factors. Only recently have they begun to concede that they don't have enough nurses on staff - which they attribute to a growing nursing shortage brought on by demographic changes. In their view, the solution is to expand recruitment and education
programs to bring more people into the nursing profession.
But what these initiatives fail to take into consideration is that understaffing was a problem long before a nursing shortage began to emerge. In fact, the industry itself created the shortage by cutting staffing levels to the point where nurses - increasingly unable to meet the needs of their patients - began to leave hospitals for less demanding and more rewarding jobs.
Recruitment initiatives may treat the symptoms, but they won't cure the disease. As long as hospitals are free to cut staffing levels to bare-bones minimums, patients will continue to be at risk - and nurses will continue to leave. Only when hospitals are bound by enforceable safe staffing standards will nurses stay in the profession.
Too few nurses are caring for too many patients in the nation's hospitals.
Nurses in hospitals and related facilities are caring for many more patients today than they did a decade ago. And because of restrictions on hospital admissions and lengths of stay imposed by managed care, the patients in hospitals are more acutely ill and in need of greater care.
As a result, nurses across America are sounding the alarm: staffing levels are too low to provide the quality of care their patients need. To determine the extent to which understaffing is having an impact on medical errors and
the emerging nursing shortage, the SEIU Nurse Alliance - more than 110,000 nurses represented by the Service Employees International Union, the nation's largest health care union -commissioned an independent polling firm to conduct a nationwide survey of registered nurses in acute care facilities.
In December 2000 and January 2001, The Feldman Group - a
Washington, D.C.-based opinion research firm - conducted extensive telephone interviews with a nationally representative sample of 800 registered nurses, as well as over-samples in six states.
The survey confirmed that understaffing is taking its toll on nurses and patients alike. Nurses don't have enough time to meet the basic needs of their patients. In hospitals and other acute care facilities, nurses bear the primary responsibility for the care and well-being of patients. It's up to them to continually assess patients, monitor their conditions, modify interventions accordingly, and teach patients to care for themselves.
However: 1- 58 percent of nurses say that at least once a week on their units, nurses do not have time to provide patient teaching and education.
2- 37 percent say that at least once a week on their units, nurses do not have time to assess and monitor patients' conditions. When nurses are overloaded, mistakes happen - and patients suffer. As nurses have less and less time to spend with their patients, medication errors and other adverse incidents have become a regular occurrence:
3- 34 percent of nurses say that patients on their units experience missed or delayed medication or treatments at least once a week.
4 - 8 percent report that the wrong medication or dosage, which can lead to serious complications, is administered to patients on their units at least once a week.
5- 10 percent say that patients on their units acquire infections, which are often the result of delayed medication or treatment, at least once a week.
Most medical errors are caused by insufficient staffing. A majority of nurses identify understaffing as the cause of medical errors. And the situation, they say, is not improving.
6- 54 percent of nurses say that half or more of the errors they report are the direct result of inadequate staffing.
7- Despite the growing attention focused on medical errors, most nurses say the rate of incidents has remained unchanged during the last year - while fully 30 percent of nurses say the errors have actually increased. The sicker the patient, the greater the risk. Hospitals are expected to allocate nursing staff in such a way that the patients with the highest acuity level - that is, the patients who are most seriously ill - receive the most care. But that is not always the case.
8- 55 percent of nurses say the methods their hospitals use to measure patient acuity do not do a good job of telling management the number of staff needed in their units.
9- 58 percent of nurses caring for mostly high-acuity patients identify short-staffing as the cause of most medical errors, compared with 46 percent of nurses with mostly low-acuity patients. The problem is systemic understaffing, not a shortage of nurses.
The nursing shortage is not causing understaffing. Instead, systemic understaffing is causing the nursing shortage. For more than a decade, managed care led hospitals to hold down nurse staffing levels, even as the average acuity level of patients rose sharply.
As a result:
- The number of hospital employees on staff for each patient discharge, adjusted to reflect the rise in acuity levels, declined by more than 13 percent between 1990 and 1999. Deteriorating working and patient care conditions led nurses to leave hospitals. As far back as 1992 (when there was actually a growing surplus of nurses), understaffing was already damaging working and patient care conditions in hospitals.
A national survey by SEIU revealed that, stretched to the limit and increasingly unable to provide the quality of care their patients needed, nurses were experiencing high levels of stress, chronic fatigue, and workrelated injuries. Nurses began to leave hospitals for less demanding jobs.
- The proportion of registered nurses working in hospitals declined from 68 percent in 1988 to 59 percent in 2000.
- Many nurses left the profession altogether, and fewer young people are entering it. Nursing school enrollment has declined in each of the last six years. As a result, the average age of working RNs has increased 7.8 years since 1983 to 45.2 today.
The industry's response to the growing shortage of RNs is making it worse.
The emerging nursing shortage promises to get much worse. By the year 2020, when baby boomers will be in most need of care, there will be a projected shortage of 400,000 nurses.
But the industry's response to the growing shortage is exacerbating the problem. Nurses are increasingly required to work excessive amounts of mandatory overtime and "float" or transfer to units where they lack the experience and training. These practices are driving more nurses out of hospitals. According to the recent survey:
- Nurses in acute care hospitals work an additional 8 ½ weeks of overtime on average per year.
- Only 55 percent of acute care nurses plan to stay in hospitals until they retire.
- 68 percent of nurses say they would be more likely to stay in acute care if staffing levels in their facilities were adequate.
The crisis will not be solved by recruitment and education initiatives alone.
Current initiatives to ease the nursing shortage by expanding tuition assistance and nursing school recruitment programs are a step in the right direction. But putting resources into recruitment and education alone will only create a revolving door.
As long as they are overloaded and unable to provide quality care for patients, nurses will continue to face high levels of frustration, stress, and injuries - and look elsewhere for careers that provide greater
rewards and satisfaction.
In today's health care industry, the financial incentives to understaff hospitals and other health facilities are as intense as they've ever been. And yet, with remarkably few exceptions, the nation's hospitals are unregulated and oversight of the quality of care is weak. To make matters
worse, no federal "whistleblower" protections or mandatory overtime restrictions exist to specifically address the concerns of nurses and other health care employees.
The only true solution: safe staffing standards all hospitals must follow.
To address systemic understaffing and improve working and patient care conditions in the industry, the nation needs laws and policies to:
- Set enforceable minimum staffing standards linked to the acuity of patients to ensure good quality care in hospitals, emergency rooms, and outpatient facilities.
Safe staffing standards should be accompanied by a ban on mandatory overtime and set maximum hours for nurses, as well as protections for nurses who blow the whistle on staffing problems.
- Establish meaningful oversight and inspection procedures for the nation's hospitals and other facilities. The industry's self-monitoring system under the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) must be reformed, and the oversight and regulations of the Health Care Finance Administration (HCFA) must be strengthened.
- Ensure that direct-care nurses and other caregivers have a voice in the development of hospital staffing plans and in the oversight and enforcement of staffing standards.
- Promote retention - not just recruitment - in the nursing profession with initiatives to mprove working conditions and strengthen the nation's job safety laws.
Ultimately the nation must also address the growing ranks of the uninsured - and guarantee affordable, quality care for everyone.
I found this article online, and it written by a Republican entrepreneur. While there are "some" true facts in his statements, please read WHY nurses have cut back hours, and HIS solutions to the nursing shortage!
This man can be seen rubbing elbows with ole bushy boy, and others! So I felt compelled to write him, and tell as politely as I could, what I thought about his "article":
http://summation.typepad.com/summation/2003/10/understanding_t.html
Understanding the Nursing Shortage
The United States is facing a severe nursing shortage that threatens the underpinnings of our health care system. We can take steps now that can provide short and long term solutions to this looming crisis.
The United States employs over 2.2 million registered nurses (RNs) - the largest professional category in America. There are currently over 120,000 unfilled nursing positions. By 2015, another 400,000 nurses will be needed. The RN shortage hurts patient care and already leads to thousands of unneeded deaths per year.
Recommendations:
1. Direct Health and Human Services to use some of the already-earmarked Nurse Reinvestment Act dollars to market nursing as a second career. With less than a two-year degree, one can make a good living working just part-time. A concentrated marketing effort will attract more Americans to the nursing profession and help solve the long-term shortage.
2. Allow foreign nurses to take the National Council Licensure Examination (NCLEX), the test that accredits nurses in the U.S., in their country of origin. Today, qualified nurses from abroad can only take the examination on American soil, which is a significant barrier to attracting new talent. Making it easier for foreign nurses to come to the U.S. will ease the short-term burden.
Justification ...
Key imbalances
* In 1980, the average age of a nurse was 38 compared to the current 45 year old average.
* The current average age of retirement for a nurse is just 52.
* The average age of an RN is increasing more than twice as fast as all other occupations in the U.S.
* The number of students graduating from nursing school is smaller than the number of nurses that are retiring each year.
* Fewer nurses entering into the nursing field resulted in experienced nurses retiring or cutting back on hours due to the increased stress.
* The nursing profession is effectively pulling from half the population - only 10% of nurses are men.
* While the number of new nurses increased 3.7% in 2001 and 8.0% in 2002, there were still 10,000 fewer nurses in 2002 than in 1995.
Demand is increasing
Two main factors cause heightened demand for nurses:
1. Aging population. In 2000, there were 34.7 million people in the U.S. over 65 years old. By 2020, there will be over 53 million people over 65.
2. Regulatory burdens. In 2001, six new states limited overtime for nurses. Also, states like California now require all hospitals to have a one-to-five nurse to patient ratio (the average is one-to-seven today).
Wages
Nursing salaries average $47,000/year and wage increases have significantly outpaced inflation each of the last six years.
The wage increases have unexpectedly resulted in a backward-bending supply curve where many nurses have actually cut back their hours because they only want to earn a specific amount per year annually. Therefore, while higher wages attract new nurses in the long term, they create greater shortages in the short-term due to less total nursing hours.
A looming healthcare crisis can only be averted if we act now and act resolutely.
October 14, 2003 in Current Affairs | Permalink
Does this bother anyone else?
BBFRN, BSN, PhD
3,779 Posts
Yes, it bothers me. I think he forgets a lot of key points, and I wonder if he took the time to actually talk to any nurses out there. I'd be interested in his reply to you when you get it. Maybe we should all email this guy?
tiliimnrn
34 Posts
Brownmn46- I just want to tell you that I sat here and sobbed as I read everything that you posted.....I have been trying to get a rise out of some other nurses to do something. I feel so vindicated by what you wrote. I've felt that my CHOSEN career of nursing is going down the tubes soooooo fast that I can hardly hang on for the ride down. I'm not an emotional person, but what you've been writing has come directly from my mind, I swear... I don't know what to do, or say to help get other nurses involved too, and I don't know where to start. I've been looking all over the internet trying to find somewhere I can go to get a start on fighting this disease running rampent through our profession. I don't want to be the only one out there screaming, talking, warning about what is going on in the medical field....Money has definitely gotten to be more important to these institutions then patient care...I don't even call them hospitals anymore, because they aren't, they're money grubbing institutions. Thank you again for your postings, you did my heart good. Now on to the papers with this info.
mato_tom
12 Posts
non - nurse here, but intersted in the profession and the issues......
what exactly is mandatory overtime? if asked to stay for an extra hour when your shift is up and you refuse ..is that grounds for termination?
at this time do you get paid extra for OT? time and 1/2 or what? is OT based on 36 or 40 hours?
what will happen if the new labor laws concerning OT go into effect, does that mean you will not get paid extra for OT?
i ve just started looking into nursing for a career, but from what i see and hear ...i dont know.
How is it that such a large profession, has such a weak voice. What % of nurses are members of the ANA and is the ANA a total joke or what?
I realy think its going to take a 180 degree turn in attitude of the avg nurse for things to improve....its all well and good and warm and fuzzy that the patient must come first and you do this job so you can help people and blah blah blah......but you are getting screwed, how can you help people when you are miserable at work and stressed out. With such massive numbers i dont see how nurses cannot get thier voices heard, except that perhaps the woman dominated profession is just too passive.
oramar
5,758 Posts
This certainly sounds like the usual industry baloney. "Nurses are reducing their hours because there wages have gone up so fast." Yup, this guy is in bed with the hospital CEOs for sure. We all make far to much money as far as managment is concerned. As for me, I have reduced my hours because the job is so freaking difficult and that is pretty much true across the board. Matter of fact, I did not work for over three years for the exact same reason.
I found this article online, and it written by a Republican entrepreneur. While there are "some" true facts in his statements, please read WHY nurses have cut back hours, and HIS solutions to the nursing shortage!This man can be seen rubbing elbows with ole bushy boy, and others! So I felt compelled to write him, and tell as politely as I could, what I thought about his "article":http://summation.typepad.com/summation/2003/10/understanding_t.htmlUnderstanding the Nursing ShortageThe United States is facing a severe nursing shortage that threatens the underpinnings of our health care system. We can take steps now that can provide short and long term solutions to this looming crisis.The United States employs over 2.2 million registered nurses (RNs) – the largest professional category in America. There are currently over 120,000 unfilled nursing positions. By 2015, another 400,000 nurses will be needed. The RN shortage hurts patient care and already leads to thousands of unneeded deaths per year.Recommendations:1. Direct Health and Human Services to use some of the already-earmarked Nurse Reinvestment Act dollars to market nursing as a second career. With less than a two-year degree, one can make a good living working just part-time. A concentrated marketing effort will attract more Americans to the nursing profession and help solve the long-term shortage. 2. Allow foreign nurses to take the National Council Licensure Examination (NCLEX), the test that accredits nurses in the U.S., in their country of origin. Today, qualified nurses from abroad can only take the examination on American soil, which is a significant barrier to attracting new talent. Making it easier for foreign nurses to come to the U.S. will ease the short-term burden.Justification ...Key imbalances• In 1980, the average age of a nurse was 38 compared to the current 45 year old average. • The current average age of retirement for a nurse is just 52. • The average age of an RN is increasing more than twice as fast as all other occupations in the U.S. • The number of students graduating from nursing school is smaller than the number of nurses that are retiring each year. • Fewer nurses entering into the nursing field resulted in experienced nurses retiring or cutting back on hours due to the increased stress. • The nursing profession is effectively pulling from half the population – only 10% of nurses are men.• While the number of new nurses increased 3.7% in 2001 and 8.0% in 2002, there were still 10,000 fewer nurses in 2002 than in 1995.Demand is increasingTwo main factors cause heightened demand for nurses: 1. Aging population. In 2000, there were 34.7 million people in the U.S. over 65 years old. By 2020, there will be over 53 million people over 65. 2. Regulatory burdens. In 2001, six new states limited overtime for nurses. Also, states like California now require all hospitals to have a one-to-five nurse to patient ratio (the average is one-to-seven today).Wages Nursing salaries average $47,000/year and wage increases have significantly outpaced inflation each of the last six years. The wage increases have unexpectedly resulted in a backward-bending supply curve where many nurses have actually cut back their hours because they only want to earn a specific amount per year annually. Therefore, while higher wages attract new nurses in the long term, they create greater shortages in the short-term due to less total nursing hours.A looming healthcare crisis can only be averted if we act now and act resolutely.October 14, 2003 in Current Affairs | Permalink
The United States employs over 2.2 million registered nurses (RNs) – the largest professional category in America. There are currently over 120,000 unfilled nursing positions. By 2015, another 400,000 nurses will be needed. The RN shortage hurts patient care and already leads to thousands of unneeded deaths per year.
• In 1980, the average age of a nurse was 38 compared to the current 45 year old average.
• The current average age of retirement for a nurse is just 52.
• The average age of an RN is increasing more than twice as fast as all other occupations in the U.S.
• The number of students graduating from nursing school is smaller than the number of nurses that are retiring each year.
• Fewer nurses entering into the nursing field resulted in experienced nurses retiring or cutting back on hours due to the increased stress.
• The nursing profession is effectively pulling from half the population – only 10% of nurses are men.
• While the number of new nurses increased 3.7% in 2001 and 8.0% in 2002, there were still 10,000 fewer nurses in 2002 than in 1995.