Article published Nov 13, 2002
Amid concerns about a nationwide nursing shortage, a new study shows that the number of patients a nurse has to care for can be a matter of life or death.
In a study published in the Journal of the American Medical Association, University of Pennsylvania researchers reported that inadequate nursing levels lead to thousands of avoidable deaths each year.
Every time an extra surgical patient is added to a registered nurse's workload, they found that a patient's chances of dying within 30 days of admission rose by 7 percent. So did a patient's odds of not being saved from a complication, called "failure to rescue."
With an estimated 94,000 nursing positions open at U.S. hospitals at the end of 2001, what does the nursing shortage mean for you and your family? Should you hesitate before scheduling surgery in a local hospital?
Kathleen Long is dean of the University of Florida College of Nursing and current president of the American Association of Nursing Colleges. She is scheduled to speak this morning at a meeting of the Community Campus Council, and her message will be simple: It is past time for the public to become concerned about the quality of its nursing care.
"I'd like to see the public become the strongest advocate for quality nursing and nurses, because it is in everyone's best interest - we are all going to be patients some day in our acute-care hospitals," Long said.
"We need patients and the public to say, 'We understand that even if we have great physicians doing our surgery, without well-educated nurses, we may not survive.' We need to encourage the public to start asking hospitals for a report card on their nurse-patient staffing," she said.
One of the downsides of poorly staffed hospitals is that they result in overstressed registered nurses who leave, making the problem worse, Long said.
Long points out that as a hospital patient, in one 24-hour period, you will probably have eight to 10 minutes of physician care. The remainder of that time you are under nursing care.
"Let's make sure that part of the team is there," she added.
A well-educated nurse will notice the first signs of falling blood pressure, infection or respiratory problems, Long explained. In very sick patients, those problems can become life-threatening very quickly.
Long said that an increasing amount of data is showing what common sense suggests - that nursing care matters.
"Nurses or those they directly supervise provide 90 percent of the patient care for a person in the hospital. So when we cut the supply of registered nurses, it only makes sense that patient care is going to suffer," she said.
According to the latest Florida Hospital Association survey, the nursing shortage has eased slightly in Florida this year, with vacancies for registered nurses dropping from 15.6 percent to 12.5 percent. One in eight positions for registered nurses remain empty, however.
A spokesman for North Florida Regional Medical Center said its vacancy rate was currently below the state average.
Gail Avigne, nurse manager of the Shands at UF operating room and the Florida Surgical Center, reports that the overall vacancy rate at Shands is about 9 percent.
According to the Joint Commission on Accreditation of Healthcare Organizations, hospitals that are better able to keep their nurses fare better on quality measures. In hospitals with a lower turnover - vacancy rates under 12 percent - patients fared better.
In both Shands at UF and North Florida Regional Medical Center, the nurse-to-patient ratios differ by the activity area - ICU, medical/surgical or pediatric, for example - and will flex up and down.
Gale Danek is quality and regulatory coordinator for the department of nursing at Shands at UF. She explains that scheduling projects the staffing needed for each unit. A supplemental staff pool of registered nurses is assigned where most needed. That need can vary not just day to day, but shift to shift.
"We must consider not just the numbers but the care needs of the patients," Danek said. "You want the right nurses, with the right experience level, to take care of the patients you have.
"In general, Shands has a lot of intensive-care patients. We get a lot of very sick patients referred to us here, so our ICU ratio is generally one-to-one. Our fresh transplant patients will have two nurses assigned to one patient. A community hospital that doesn't do transplants or get that many trauma patients . . . won't have that type of ratio. Indeed their patients don't demand it," Danek said.
The registered nurse in the operating room acts as a patient advocate, Avigne explained. The RN is in the OR to protect the patient.
"It's all about safety," she said. "We need to make sure we operate on the correct site, and there are all kinds of checkpoints.
"We involve the patient or a family member in identifying the operating site. We look at proper positioning, maintaining skin integrity, and being sure the patient knows exactly what to expect before, during and after surgery."
Avigne said at Shands, as elsewhere, the staffing ratio is of concern to nurses, primarily because they want to do their jobs well. Other things are important, as well.
"We know you've got to pay right, but what keeps people on the job is the environment and culture of the workplace," she said.
When you ask nurses what that means, they will tell you they want to be respected, listened to and be part of the team, according to Avigne. "Don't we all want that?" she adds.
"Within nursing, we have our own quality forum, and we review lots of data to decide where to invest our time in improving things," Danek said. "We've had increased reporting of potential errors, and we feel that has decreased the risk to patients."
Patients and families should be part of the process, she added, reporting potential problems to the nursing staff so that they can be addressed.
Danek said in her opinion, the national attention the Pennsylvania study has brought has been good for nursing.
"It's like the airline industry, and all the areas that have been tightened because of security," she said. "The things that have happened have made it a safer environment."
Long adds, "We want the public to understand that what is important is patient care. An environment that is supportive of nurses and nursing work is the best environment for patients."
Diane Chun can be reached at 374-5041 or chund@gvillesun. com.