Harvard Study Identifies Inadequate Nurse Staffing as Major Factor in Medical Errors

Published

Specializes in Vents, Telemetry, Home Care, Home infusion.

From ANA's Insider News:

http://www.ana.org/pressrel/2002/pr1216.htm

Doctors and general public agree shortages of nurses and overwork, stress are to blame; public still rates nurses as no. 1 in 'honesty and integrity'

Washington, DC --More than one-third of practicing physicians and 40 percent of the public say they or a family member have experienced a medical error, according to a survey reported Dec. 12 in the New England Journal of Medicine. And, while the two groups diverged on possible causes and solutions, both ranked shortages of nurses; and overwork, stress and fatigue among health care workers as "very important" causes of errors.

Specifically, the survey found that more than 53 percent of physicians and 65 percent of the public cited understaffing of nursing in hospitals as a factor in errors, while 50 percent and 70 percent of physicians and the public, respectfully, blamed errors on overworked, stressed or fatigued health care workers. The survey was conducted last spring by researchers at the Henry J. Kaiser Family Foundation and the Harvard School of Public Health.

"This study provides more evidence of the impact of nurses' working conditions on patients," said ANA President Barbara Blakeney, MS, APRN,BC, ANP. "The results point to the fact that medical mistakes are common and that both physicians and the public see inadequate nurse staffing as a significant cause of errors."

As many recent reports and studies have illustrated, nurse staffing is insufficient in many health care facilities today, resulting in preventable complications and even patient deaths in some cases. Insufficient nurse staffing also increases nurse burnout, fueling an exodus from the profession, thereby further exacerbating the growing shortage of nurses.

The NEJM study results also come on the heels of a January 2003 Consumer Reports cover story, based on a survey of nearly 21,000 readers, which reveals that an enormous variance exists in the quality of care patients receive, with much of that variability being attributed to whether a facility has an adequate staff (especially nurses) along with a well-organized care system.

"All of these studies demonstrate the need to make adequate nurse staffing a national priority," Blakeney said.

In the meantime, the nation's nurses again ranked number one for their honesty and integrity in this year's CNN/USA Today/Gallup Poll, with 79 percent of Americans rating them "high" or "very high." Nurses have been the highest rated profession since first being included in Gallup's "Honesty and Integrity" survey in 1999, except in 2001, when firefighters outranked them in wake of the Sept. 11 terrorist attacks. (Firefighters were not included in this year's poll.)

"The rating of nurses by the public as number one in 'honesty and ethics' is a real compliment because it reveals just how much trust the public places in the nursing profession," said Blakeney. "The public expects to receive quality nursing care and they trust nurses to be their advocate. That's why ANA is on a mission to transform health care facilities into safe places for patients."

In addition, Blakeney expressed hope that "the continuing affirmation of the public's respect and trust in nursing will prompt Congress and the health care industry to take action to improve the work environment for nurses," by eliminating forced overtime and other unsafe staffing practices. "What we need, in short, is the public's support on such issues, along with decision makers' readiness and willingness to act."

In addition to nurses, other top-ranking professions in the Gallup survey include pharmacists (at 67 percent, and the previously highest rated profession before nurses were included), military officers (a new addition, at 65 percent), high school teachers (64 percent) and medical doctors (63 percent). The Gallup poll was conducted on November 22-24. Go to http://www.gallup.com/poll/releases/pr021204.asp to read full report. Full results of the errors study are available at the Kaiser Family Foundation Web site, http://www.kff.org.

Up Vote Up Vote ×

From the Washington Post:

Study Analyzes Nurse Workload

Less Individual Care Linked to Likelihood of Patient Death

By Kirstin Downey

Washington Post Staff Writer

Wednesday, October 23, 2002; Page A06

Surgery patients had a greater chance of dying after procedures in hospitals where nurses have heavier patient loads, according to a study released yesterday that underscores the importance of the national nurse shortage.

For example, there were 31 percent more patient deaths per month after common types of surgeries, such as gall-bladder removal or hip replacement, at hospitals where each nurse cared for eight patients than when each nurse cared for four patients, according to the University of Pennsylvania study, which was published today in the Journal of the American Medical Association.

The report follows a study published in May by the New England Journal of Medicine saying that patients who received more hours of care from a registered nurse had a lower risk of health complications and were less likely to die than patients who received fewer hours.

The nurse shortage has been attracting the attention of legislators in Washington and in state capitals. Last year about 13 percent of all U.S. nursing jobs went unfilled, in part because of demographic changes. The average hospital nurse is 45 years old, and too few young nurses are entering the pipeline to replace them as they leave the profession. By the year 2020, when many of today's nurses will be retiring, there could be a shortfall of more than 400,000 nurses, according to the Labor Department.

Nurse-retention problems are compounding the shortage, said Linda H. Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, which conducted the study. Aiken said that many nurses report constant overwork and understaffing on hospital wards, prompting many to leave the profession each year.

"Nurses report greater job dissatisfaction and emotional exhaustion when they're responsible for more patients than they can safely care for," Aiken said. "Failure to retain nurses contributes to avoidable patient deaths."

Aiken said that unlike other industries in which businesses have been compelled by market forces to offer benefits such as flexible hours and child-care assistance to keep valued workers, many hospitals have declined to do so. Instead, they have instituted forced overtime and reduced staffing to cut costs, she said.

Richard H. "Rick" Wade, a senior vice president at the American Hospital Association, a trade group representing about 4,600 hospitals nationwide, did not dispute the University of Pennsylvania study, and he described Aiken as a "respected researcher." He said the association's members are acutely aware of the problems posed by inadequate staffing.

"Our number one issue today is the workforce shortage, and when you boil it down, it's recruiting and retaining nurses," Wade said. The industry is taking steps to try to solve the problem, he said, referring to a report recently commissioned by the association that outlines ways hospitals can make themselves more attractive employers.

Wade said the hospital industry is aware that many nurses are working "harder than they should be" and that it has become apparent that some hospitals "have not maintained as attractive a work environment as they should have."

"But it's not the majority," he said.

Meanwhile, Labor Secretary Elaine L. Chao, who has called the nursing shortage a "crisis," plans to use federal job programs to steer would-be nurses into the health-care industry. In July, Congress passed the Nurse Reinvestment Act, which is to provide federal money to help pay for nursing training and forgive education loans for trainees who agree to work in areas with acute shortages. President Bush has signed the law, but Congress has not yet appropriated money to fund the program.

Sen. Barbara A. Mikulski (D-Md.) co-sponsored the legislation, calling it an effort "to deal with the nursing crisis in a serious way." In Maryland about 2,000 nursing jobs, or more than 15 percent, are unfilled, she said.

"For years, they tended to overwork and underpay these women," Mikulski said about the hospital industry. "There was a lack of respect in how they were treated. . . . In some ways, it's a crisis of their own doing."

Many nurses have been urging industry leaders to take steps to make work more attractive to today's nurses rather than focusing on recruiting new nurses, saying that bringing in workers who quickly leave fails to solve the problem. About 500,000 registered nurses have left the field in recent years, according to Susan Bianchi-Sand, director of United American Nurses, the labor arm of the American Nurses Association.

Nurses have taken their concerns to state legislatures. More than 20 states have enacted or seriously considered laws mandating that hospitals maintain certain patient-to-nurse ratios. California, for example, passed legislation last year establishing fixed nurse-patient ratios for hospitals statewide. Public hearings to discuss implementing the law are scheduled to be held over the next three months. Maine and Oregon have banned mandatory overtime for nurses, according to the nurses association, and nursing trends and patterns are the subject of state study in Florida, Mississippi, North Dakota, Tennessee, Texas, Arkansas and Pennsylvania.

© 2002 The Washington Post Company

Up Vote Up Vote ×
+ Join the Discussion