NY Times Editorial on Nursing Shortage

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    Dying for Lack of Nurses

    A report in this week's Journal of the American Medical Association says that when hospital nurses are given too many patients to care for, the patients have a much greater risk of dying. That may seem self-evident, but it has been surprisingly difficult to establish that patients suffer harm when a nurse's patient load goes up.

    Equally surprising is how little it takes to put patients in danger. Adding a single patient to a nurse's caseload seems to increase the risk of dying within 30 days by 7 percent. If a hospital increases the average nurse's patient load from four patients to six, the patients have a 14 percent greater chance of dying. Boost the patient load to eight, and the risk is 31 percent greater than with four patients per nurse. As the patient load goes up, nurse burnout rises and nurses leave their jobs.

    These findings come from a study of 168 hospitals in Pennsylvania conducted by nursing researchers from the University of Pennsylvania under a grant from the National Institute of Nursing Research, a federal agency. While its results may seem a touch self-serving to the nursing profession, they are viewed as reliable. The study questioned some 10,000 nurses and reviewed the outcomes for more than 232,000 patients who underwent common surgical procedures. High nursing patient loads may account for 20,000 unnecessary deaths a year, the researchers suggest.

    There is no easy solution. The nursing work force is aging, and hospitals are confronting a severe shortage of nurses. Many institutions are resorting to signing bonuses, hiring from abroad, demanding overtime from their own nurses or using temporary nurses at a higher cost than for staff nurses. One simple solution would be to make hospitals report their patient-nurse ratios so that prospective patients can decide where to take their chances.

    Nurses complain of low pay, heavy workloads, lack of opportunity and a demeaning relationship with physicians. Women, traditionally the backbone of the nursing profession, have many more opportunities today. If the medical establishment can't find some way to make the profession more attractive, the exodus may turn into a stampede.


    Do you feel that this is as big a problem in HH as it is in hospital nursing? Our agency is trying to limit us to seven visits per day, which is blowing the skirts up on the per visits but seems rational and fair to the full timers. We case manage our own patients, so seven visits, to a newbie like me, is pretty heavy already, though some of the per visits have been doing ten or more. Opinions on that?
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    About RoAbreu

    Joined: Sep '02; Posts: 27
    Visiting Nurse, Case Manager


  3. by   oramar
    It would be good if there were a publication that advertised nurse to patient ratios. However, this must be done with great care. Some hospitals would most certainly play games with the numbers. One nurse reported she went to a place because a 4 to 1 ratio was advertised. She then found out they were including unit secretaries and NA in that count. What if the hospitals choose to report the staffing only on the days when they well staffed? They might have a four to one ratio about once a week. The other six days you would be on your own but you would not know that until it was to late. I worked at one hospital for a short time last year. They advertised a one to six ratio on med/surg when they recruited me. That is certainly the staffing they strove for most of the time. However 2 or 3 days a week it was one to eight simply because that was the best they said they could do. In Pennsylvania LPNs must be cover for many thing by an RN. So if the ratio was 8 to 1 and half the staff was LPNs the RNs were killing themselves.
    Last edit by oramar on Oct 25, '02
  4. by   RoAbreu

    Don't I know it. I worked several years as an 11-7 Med Surg charge nurse and it was wicked difficult being responsible for the admissions, blood, pushes and PCA's on the LPNs' patients, in addition to having to run the floor, motivate the NAs, communicate with the supervisor and carry patients of my own (an expectation of the night charge).

    This was in a place where my supervisor was a "skirt nurse" who actually down marked my eval once because I "didn't wear makeup" and she felt I needed to look perkier, or something.

    I managed that job, but in retrospect I wonder how. Guess I was younger and had more energy. I shudder to think about trying it now. I don't know why young girls would want to do it anymore, and I understand those of us who are getting long in the tooth shedding it for less taxing positions.
  5. by   caroladybelle
    You got marked off for not wearing makeup...so did I!

    G-d forbid that we look natural.
  6. by   RoAbreu
    LOL... yes, G-d forbid. I had visions of makeup running down my neck when she was talking to me; I might be able to wear it now, I'm not doing "sweaty work" in HH... but I'd have been a general mess trying to wear it while doing floor work.

    Wonder how she'd have reacted if I'd come in with full Geisha makeup (G)
  7. by   Furball
    Is this a joke? Some nurses are REQUIRED to wear make up????

    Quick, hand me a basket...no time to run to the BR to hurl!!!!!:stone
  8. by   RoAbreu
    I still don't know what that was about... apparently, for her, it was not enough to be clean scrubbed and wearing a uniform (we wore whites there, too).

    I don't know that it was a requirement, but in that place, at that time, with that supervisor, there wasn't really any recourse to a bad eval. I understand she's gone now, so maybe things are better for the staff there.

    She was from Georgia, and I see caroladybelle is, too. Maybe it is a Georgia thing
  9. by   caroladybelle
    Actually my nurse manager was from California. She had been a nurse for over 30 years and had never taken a sick day (give you any cues on her anal retentive personality). She actually told us in a staff meeting that since we made more money than the secretaries that we should dress better (Do they have to crawl under beds to retrieve pt slippers, get peed on by dementia patients, and have HIV+ patients rip out their IVs and bleed on you). One day the NM showed up on the unit in a set of dress whites with a silk shirt under the jacket to "help" with pt care.

    In Nursing school (in Florida), my instructors tried to get me to wear makeup because"it makes you look sooo pretty" - yes, FL does have its share of truckstop waitress hair and makeup (think the long horn steakhouse woman). Problem being that I am whiter than white w/ red hair and freckles, and virtually all makeup on me looks like a sherwin williams paint job. Top that off with working BMT/Onco/ID - masks, isolation gear and goggles for chemo do not mix with makeup and big hair.

    And do I really want to pickup any of my oh so hottie patients, their family members, etc. I get harassed enough being single.
  10. by   lindalee
    Yes, I was corrected for not reapplying lipstick after my (rare) lunch break. :>( That same idiot head nurse once rearranged my critical patients room to "neaten it up" while I was off the floor with my other patient having a CT. Of course the patient's room had been carefully organized with what I was going to use for the code that I anticipated--and happened about two minutes after returning with my other patient. We had major words that day--oh and she no longer works with us either. Prehaps she has moved to MA. ???
  11. by   RoAbreu
    Oh, no (LOL) that was back when I was living and working in Louisiana.

    I'm glad not all managers have that regressive attitude, but I have to say I'm surprised to hear there are so many of them.


    Had a few of them in nursing school that would check nail length and hemlines and refused to let us wear socks rather than hosiery. It's a wonder any of us come out of this profession sane (or do we? hee hee)