<<REPORT: September 2002
Research Supports Warnings from Nurses
by Anne Schott
New York State Nurses Association
For decades, both hospital management and the general public too often dismissed nurses' complaints about workplace conditions
. Nurses said inadequate staffing put patients at risk. They said workplace conditions were contributing to stress, injuries, and staff turnover. Skeptics asked, "Where is the evidence to support those claims?"
But for decades, that question was difficult to answer. No one was doing the extensive and often expensive research that could show the nurses were right.
Fortunately, that has now begun to change. Recent studies have shown the connection between adequate RN staffing and better patient outcomes, and new studies are under way. "This new research focus on workforce issues will provide the answers we need to make our case at the bargaining table," said Cindy Gurney, director of NYSNA's Research and Planning Program, "and will strengthen our lobbying efforts at the New York State Legislature."
JCAHO Study Links Poor RN Staffing to Patient Deaths
The news in headlines across the nation that a shortage of RNs adversely affects patients is certainly not news to nurses. But data supporting that warning, which came from a study released in August by the Joint Commission on Accreditation of Healthcare Organizations, underscored the seriousness of the problem. JACHO found that 24% of unanticipated patient deaths and permanent loss of function were related to inadequate numbers of nurses.
The commission based its findings on its own sentinel event reporting system, which requires hospitals to provide detailed information on unexpected patient deaths and injuries. The sentinel event database analyzed by the commission contained 1,609 hospital reports made since 1996.
RN Shortage Deepening
The commission also warned that the RN shortage was growing more serious. There are an estimated 126,000 vacant nursing positions in the US today-a vacancy rate of 12%-and the nurse workforce is aging. Unless something is done, it is anticipated there will be 400,000 fewer nurses than needed by the year 2020.
Recommendations for Change
Calling for "definitive steps" to address the problem, the commission made three broad recommendations. The first is to create a culture that supports nurse retention by adopting the characteristics of the "Magnet" hospitals.
Second, the commission called for changes in nursing's educational infrastructure, including increased funding for nursing education, a standardized post-graduate nursing residency program, more support for continuing education in hospitals, and nursing career ladders.
The final recommendation called for new federal funds to be invested in nursing services.
Health care organizations receiving those funds would have to show achievement of "quantifiable, evidence based, nursing sensitive goals." The commission also suggested that both private payer and federal reimbursement incentives reward effective nurse staffing.
How Do Working Conditions Affect Nurses and Their Patients?
New Study to Examine Use of Overtime and Temporary Workers
Ask nurses what their number one concern is these days and the answer is usually poor working conditions - by which they mean short-staffed units and mandatory overtime. Those conditions, they say, jeopardize patients and their own health and safety. But very little is known about how various workplace conditions affect patient outcomes or how they relate to RN stress, burnout, or staff turnover.
An ambitious new study by a team from Harvard University School of Public Health is now beginning to examine these questions. Led by Jack Needleman, the research team includes three RNs, NYSNA member Chris Kovner of NYU, Eileen McNeely of Harvard, and Ann Minnick of Rush-Presbyterian in Chicago.
The two-year study is unusual in that it will proceed on both a broad scale, analyzing staffing data from hospitals across the country, and on a small scale, examining staffing on the RN to patient level. To obtain information on the RN to patient level, researchers will mail surveys to 15,000 individual RNs at 100 different hospitals.
"Research that's based only on large databases raises questions about how it is connected to the actual workplace," McNeely said. "Research on individual units is often dismissed as being too narrow. We are collecting data on both levels and putting it together."
A Close Look at Staffing
Much of the research on RN staffing ignores the use of contract nurses, who are not regular employees of the institution, but fill holes in the schedule. "Nurses frequently complain about staffing when there are lots of agency nurses," McNeely said, "but we really don't know what affect they have. We are going to examine not just the number of nurses on the unit, but how many are part of the professional staff and how many are 'core' staff, as opposed to those working overtime or coming in from agencies."
NYSNA Supports Study
To help further this project, NYSNA is obtaining the OSHA logs from all its represented facilities for the years 1996 to 2001. This information will help the researchers establish the relationship between staffing patterns and the risk of on-the-job injury and illness.
NYSNA has also arranged for 150 members from each of 19 NYSNA-represented hospitals to receive a survey, asking for information about conditions on the nurse's unit. Questions relate to work demands, job autonomy, supervisor and coworker support, how nursing work is organized, and the use of overtime and staffing by agency or other contract nurses. Members will receive these surveys some time between September and November.
"If you receive a survey, I urge you to complete it," Gurney said. "This is a major research project that will help answer significant questions about the nurse workforce. Surveys are going to only a small number of NYSNA's 34,000 members, chosen at random from our membership database, so it's important that every survey be completed." Data from research studies such as these are important and necessary to support and strengthen our lobbying efforts and advance the RN agenda in the state Legislature.