Cutbacks in nursing are harming patients
By Suzanne Gordon and Dana Beth Wienberg, 6/17/2003
ASK MOST patients about their stay in a hospital and you'll hear the same story. Nurses rush from patient to patient with barely enough time to provide basic physical care and no time to deal with patients' anxieties and fears or to provide needed education.
Nurses in Massachusetts insist hospitals are unsafe and are urging politicians to support ''the Act Ensuring Patient Care and Safe RN Staffing.'' The bill, filed by the Massachusetts Nurses Assoc mandates minimum RN-to-patient ratios on every unit and floor, bans mandatory overtime as a way to staff hospitals, and establishes a system to protect patients who need intense nursing services.
If enacted, this bill would protect patents and nurses from practices designed to protect budgets, not people. Hospitals implemented these policies during the restructuring and cost-cutting mania of the 1990s and are stubbornly pursuing them today in spite of evidence of their failure.
During the '90s, desperate to cut costs, hospitals hired consultants who sold them the fantasy that they could deliver high-quality nursing care for less money. Using the latest cost-cutting techniques from manufacturing, these consultants viewed the hospital as an assembly line, the nurse as a shift worker, and the patient as a predictable, homogenous unit of production. They ''increased'' nurses' ''productivity'' by cutting the slack - i.e., extra time with patients - out of the system and increasing nurses' workloads. When units have fewer patients than expected, nurses are often sent home and have to use up their sick days or vacation time as compensation. To avoid paying the cost of hiring more nurses, nurses are often forced to work overtime.
The result of this untested experiment? More patients are getting urinary tract infections, pneumonia, deep vein thrombosis, and bedsores. More are experiencing falls, and more are being victimized by medical errors. In a study that appeared in the Journal of the American Medical Association last October, for every additional patient over four that a nurse has, patients face a 7 percent greater risk of dying.
The cost-cutting experiment has failed because consultants and administrators do not understand that providing care for sick patients is predictably unpredictable. Empty beds don't mean empty nurses' heads and hands. If a 20-bed unit only has 14 patients, nurses do not sit idle. They use the time to help patients understand how to take their medications to prevent side effects and potentially fatal drug interactions, to take care of patients who seem stable one minute and crash the next, and to keep up with changing treatments and technologies.
The hospital industry opposes any measures to regulate staffing and assure decent working conditions for nurses. Hospital administrators claim that mandated nurse-to-patient ratios will deprive patients of needed care, will be too expensive, and will be impossible to meet because of the current nursing shortage. Given the industry's record, these objections are at best disingenuous.
Most nurses will tell you that with no barrier to flexibility, hospitals almost never give RNs the opportunity to give more care to fewer patients. Nurses are almost always asked to give less care to more and sicker patients.
There is nothing in the proposed legislation that prevents hospitals from assigning more nurses to patients than legally mandated. Indeed, the bill includes implementation of a system that requires hospitals to flex up to provide more nurses if a patient needs more care. Just as having a statutory minimum wage hasn't driven down wages, having statutory safe staffing won't drive down care.
Hospitals cry poverty yet have enough money to devote millions to nurse-cutting consultants, to CEO and executive salaries, to advertising and marketing, to bonuses to recruit foreign RNs, and to pay the higher costs of temporary and traveling nurses to replace disaffected staff who have left their jobs or bedside nursing entirely.
And let's not forget the hidden costs of inadequate nursing care. A preventable urinary tract infection can add $676 to a hospital stay, a preventable bedsore can cost between $4,000 and $70,000 to heal, and it can cost up to $12,000 for medication to treat a preventable blood clot.
The idea that there aren't enough nurses to fill mandated ratios ignores the fundamental connection between retention and recruitment. Nurses are leaving the bedside or the profession because of poor working conditions, which also discourage new recruits from entering. New nursing students and grads look at hospital conditions and begin to develop an exit strategy.
Nurses, backed by recent evidence, contend that nurse-to-patient ratios are an important first step to solving the nursing crisis.
Hospitals claim they are committed to solving the nursing crisis. Here's an opportunity to take a first step and give bedside nurses what they need.
Suzanne Gordon is author of ''Life Support: Three Nurses on the Front Lines.'' Dana Beth Weinberg is author of ''Code Green: Money-Driven Hospital Restructuring and the Dismantling of Nursing.''
This story ran on page A17 of the Boston Globe on 6/17/2003.