Shortage of Nurses Hurts Patients

  1. Shortage of Nurses Hurts Patient Care, Study Finds

    May 30, 2002

    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

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