Shortage of Nurses Hurts Patients

[fiestynurse]

Shortage of Nurses Hurts Patient Care, Study Finds

May 30, 2002

By DENISE GRADY

In hospitals with low numbers of registered nurses,

patients are more likely to suffer complications like

urinary infections and pneumonia, to stay in the hospital

longer and to die from treatable conditions like shock or

gastrointestinal bleeding, researchers report today.

"I estimate that hundreds or, perhaps, thousands of deaths

each year are due to low staffing," said Dr. Jack

Needleman, an economist at the Harvard School of Public

Health and the lead author of a study on staffing published

today in The New England Journal of Medicine.

The nation has a serious nursing shortage, with 126,000

jobs unfilled, 12 percent of capacity, says the American

Hospital Association. The shortage is a result of hospital

mergers, layoffs and heavy workloads. Many hospital nurses

shifted to other work. The average salary, $46,000 a year,

has not increased much in a decade. Even though hospitals

are trying to hire again, nurses are no longer available.

The new study, paid mostly by the government, is one of the

largest to look at care in relation to staffing. The

findings were based on a computer analysis of the discharge

records of more than six million patients at 799 hospitals

in 11 states in 1997. Five million had medical problems.

One million had surgery.

The research sought to find out whether there was a

correlation between how patients fared and the levels of

registered nurses and two other types of workers with less

training, licensed practical nurses and aides.

Registered nurses receive several years of training and

usually hold associate's or bachelor's degrees. Practical

nurses usually have high school diplomas and a year of

training. Aides have less training.

The researchers found that for certain aspects of care just

nurses made a difference. In hospitals with higher nurse

staffing, stays were 3 to 5 percent shorter, and

complication rates 2 to 9 percent lower than in hospitals

with lower staffing. No relation was found between

patients' well-being or length of stay and the levels of

aides or practical nurses.

Registered nurses, Dr. Needleman said, are "the eyes and

ears of the hospital" for judging whether a patient is

recovering normally.

"If something is going wrong," he said, "they can catch the

signs early, before the problem gets worse."

But problems cannot be spotted early, he added, if nurses

do not have time to observe their patients.

The president of the American Nurses Association, Mary E.

Foley, said, "We're very pleased that another large set of

research data has validated what the American Nurses

Association has been saying since the mid-90's, that there

is a direct effect on the outcome of patient care when you

have enough nurses."

As an example, Ms. Foley said, pneumonia and blood clots in

hospitalized patients often result from immobility, and

nurses help prevent such complications by turning and

repositioning bedridden patients, encouraging them to

exercise and cough and helping others to get up and walk

around. Even if nurses themselves do not do those things

for patients, they have the training and experience to know

when such help is needed and to ensure it is provided.

A senior vice president for policy at the American Hospital

Association, Carmela Coyle, said: "The study suggests that

registered nurses are key and critical to insuring good

patient care. This is something that hospitals and patients

have known for some time."

Ms. Coyle said she feared that the study would lead some

people to assume that health care problems could be solved

by laws that require specific staffing ratios, a move that

hospital trade groups have long resisted. She called such a

reaction overly simplistic.

"What you really need to look at," Ms. Coyle said, "is much

more than the number of nurses and the number of patients.

How many of the nurses have 20 years of experience or more,

and how many are right out of school? What technology is

there to support them? How sick are the patients?"

Dr. Needleman said his group made its study because the

government sought to fill a large research gap on the

connection between nurse staffing and quality of care. In

the early 1990's, nurses testified to Congress that

patients in some hospitals were endangered by managed-care

companies that were trying to save money by replacing

registered nurses with less skilled and lower paid workers.

Congress asked the Institute of Medicine to study the

issue. In a report in 1996, the institute said there was

not enough data to draw conclusions and called on the

government to finance studies.

Dr. Needleman's is one of those. It measured staffing two

ways, by the proportion of nursing hours provided by each

type of worker and by the number of hours a day the types

of workers devoted to each patient.

For registered nurses, the average number of hours a day

per patient worked out to eight. The hours included not

only time spent at the bedside, but also time spent

preparing medication, writing chart reports and consulting

colleagues or family members.

The averages include intensive care units, with one nurse

for every one or two patients around the clock.

"There were some hospitals, that if I were going to them as

a patient, I would be very concerned," Dr. Needleman said.

"The hospitals at the very low end of our sample had as

little as two hours, and some at the high end had 16

hours."

When the study compared the hospitals in the top quarter

with those in the bottom quarter on the proportion of

nursing time from registered nurses, it found that the

medical patients, as opposed to surgical patients, in the

bottom quarter had stays 3.5 percent longer, 9 percent more

urinary infections, 5.1 percent more gastrointestinal

bleeding, 6.4 percent more pneumonia and 9.4 percent more

shock or cardiac arrest.

In addition, the death rate was 2.5 percent higher for

"failure to rescue," meaning that the patients died from

conditions that might have been reversed if they had been

treated in time. Those conditions include pneumonia, shock

or cardiac arrest, upper gastrointestinal bleeding, sepsis

or a blood clot.

http://www.nytimes.com/2002/05/30/health/30NURS.html?ex=1023774646&ei=1&en=55bfa23580c7d853

[P_RN, ADN, RN]

Wow the NY Times found out there is a nursing shortage. Wonder what took them so long?