Published May 15, 2004
hospital nurse staffing and quality of care
hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according research funded by the agency for healthcare research and quality (ahrq)
although hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes, increasing staffing levels is not easy. major factors contributing to lower staffing levels include the needs of today's higher acuity patients for more care and a nationwide gap between the number of available positions and the number of registered nurses (rns) qualified and willing to fill them. this is evident from an average vacancy rate of 13 percent.
this report summarizes the findings of ahrq-funded and other research on the relationship of nurse staffing levels to adverse patient outcomes. this valuable information can be used by decisionmakers to make more informed choices in terms of adjusting nurse staffing levels and increasing nurse recruitment while optimizing quality of care and improving nurse satisfaction.
making a difference
hospital nurse staffing and nursing-sensitive outcomes
nurse workload and job dissatisfaction
cost impacts of adverse events
strategies for improvement
the patient safety initiative and hospital nurse staffing
Thank you for the article link. One of the concerns described in the article related to providing additional nurses (for mandated nurse/patient staffing) was a decrease in ancillary staff and/or RNs picking up additional non nursing duties. My hospital doesn't have any staffing ratios, but I can tell you that we have a skeleton ancillary crew (patients freq tell me that their rooms/trash baskets aren't cleaned for 2 days), and nurses already perform many non-nursing duties so I'm not sure what more the hosp. could do if the legislature passed a staffing statute. (Not sure I want to know :)
nurses today are rushed and pushed through programs to be dumped into acute care hospitals. newly graduated rns are becoming the new face of specialty nursing units such as icus ers ors and the like. these new rns come out of school with a totally different attitude and demeanor than ever before. i have worked with some new nurses who have flat out refused to take anything home for review or study. i was even told by one new nurse that she had finished school and was done with studying and that if i had anything for her to read i would have to make time at work for her to do it. when i graduated nursing school and started my first job i was scared to death because it was then that i realized that i was so unprepared for the real world of nursing. i had many late nights before work reviewing material pertinent to the area i was working in. i requested information to take home so that i would be more prepared and able to care for the people who depended upon me.
i see new rns who have never done any real patient care except for clinical in school going to icus to care for critically ill patients with out basic bedside nursing experience. we train them to nurse the monitors and the bells and whistles and they don't even know there is a real live person attached to those monitors. we are so caught up in paper work that we nurse the chart instead of the patient. with techs giving baths, doing vs and answering pt call bells when is the nurse in the room. when does the nurse place her hands on the patient, observe their skin, interactions, eye contact and generally get o know them. i get patients from units with infiltrated and phlebotic ivs, swollen arms and the documentation reflects that the iv was fine or there is no documentation at all addressing the iv site. patients are sent to me for surgery or endoscopy covered in stool so bad that it is dried and caked onto their skin. they are sent down with their mouths dry caked with thick salvia the tongues to dry and cracked that they bleed. ivs may be documented to be in the same place for 7, 8 or 9 days with out any supporting documentation as to why.
reports have to be coaxed out of transferring units. sometimes all i get is that she is just really sick. i have to ask about age, medical hx, admitting diag, allergies, pertinent labs, p.o. intake, loc, vs, ect... then i am met with exasperation from the rn because she has to look the info up in the chart and she is just too busy to get that info for me... and.. no one else asks for report! i get patients that have documentation of med taken that were not taken and pts who received meds that just weren't charted. when i have to call for all this information before a procedure it slows the process and then everyone gets his or her panties in a wad. the problem and excuses i get is that everyone is to stressed, too busy, have too many patients ect... i believe that is all true. i know i am stressed everyday. i know that there are more and more days now after 21 years of nursing that i think of walking away from it all. i know that i am encouraged by my peers, my supervisors, the hospital administration, and the doctors to hurry hurry hurry and that i don't need to take time to do the things that i need to do to take proper care of the patients entrusted to my care. i also know that if i take short cuts and try and please the higher ups that when an incident occurs as it inevitable will then they will hide behind their policies and say they had no idea i was not following the written policy. we so often teach the short cut and so new rns never learn the right way to do things. they think the short cut is the way and we all know that short cuts get shorter when learned as the proper way to do something. too many of the new nurses are not given a solid and stable foundation of do it right take your time and always think of the patient first speed comes after a skill is mastered. we are taught to slap a band-aid on the artery and move on. we all are paying the price of this lack of proper training. msn rn, bsn rn, adn rn, lpn we all have a personal and professional responsibility to the people we serve. no matter how much education you have care and responsibility to the patient are the cornerstones of our professions. i have worked with msn rns who were worthless in the pt care area. i have worked with techs who have been better and more observant that the rn or lpn. it really isn't the level of education that brings about good patient care it is the personal dedication and drive to be the best, do the best for the patient and continue to grow and learn all through your career. we can argue about entry level of practice but that is a moot point as long as associate programs and lpn programs are out there and being promoted. msn, bsn and adn all take the same licensing exam to become an rn. all have to maintain the same number of ceus per licensing cycle. all are able to provide the same care. we need to change our way of thinking and demand of each other professional support and care. we need to make sure that all new rns get a good foundation and that those providing mentorship are truly mentors with the dedication to properly train new rns.
A factor that the article seemed to me to miss is how hospitals fail to retain experienced nurses at the bedside. It is true that a few enlightened facilities have implemented retention policies here and there. Unfortunately, 5 years into the shortage most of the emphasis remains on hiring as opposed to retention.
The other day I walked into this: 6 bed ICU, 6 vents, 3 critical/unstable, one with runs of vtach, the other just coded on the floor and transferred in and on verge of coding again. The staffing provided? Me and a scared shytless medsurg LPN 'who doesn't take vents.' This is one of these little hospitals that has no doc inhouse, no pharmacist after hours, no lab...we do it all ourselves.....and share 1 RT with the whole hospital. No ancillary help really. Nurses are pretty much on their own and dealing with docs over the phone...regarding patients who are critically ill and full codes. With NO standing orders no less...I couldn't believe that! We have to track down the docs for every little thing....
Patients code, we have to argue with the docs to come in and run things ourselves...
When is somebody going to hold facilities responsible for staffing their units appropriately and setting up decent policies and procedures??? I was told 'deal with it there is nobody else." Well I couldn't accept responsibility for this and told them so. Get me another critical care nurse or I can't do this, I said. They could only give me 1 medsurg nurse who was already in tears. Well, I had to say no in terms of safety, and I left. No wonder they can't get any decent help...the staff they hire don't stay long.
And I know this goes on elsewhere too...I read of it on these boards and hear my peers discussing it in breakrooms, so it seems rampant out there today.
I just don't think I can work for facilities anymore. Its back to the agency for me...shift by shift. And I will NOT be in charge...only responsible for my OWN work from now on!!.
Thanks for letting me vent. GRRRR!
This is one of my main gripes about Nursing schools.
Waaaay too much writing. I wrote Nursing Care Plans until I was blue in the face . The hands-on skills that I was taught were awful. I was taught things like making beds and ambulating patients. These are important skills if you are a CNA. I think I did IV/phlebotomy for a few days, but that was it!!. I had to learn all of my basic skills "on the job". I hated it! Nurses are coming out of school with excellent writing and communication skills, but ask them to start an IV, hang blood, etc., they are shaking in their clogs. I know because this is exactly what I endured. Nurses are not graduating with skills to give them the confidence (and thick-skin) that they need to survive. I feel that this is one reason many new nurses hate nursing!
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