Better Staffing Ratio's for RN's can save lives
Working as a Registered Nurse in a busy hospital, I have noticed the importance of staffing levels. Too many patients and not enough nurses can lead to increased complications and even death. Higher RN to patient ratios should equal better care. What if your RN has 7 other patients? Sometimes RN's are discharging a patient, getting a fresh postoperative patient, and supervising nurse's aides all at the same time. Patients admitted to the hospital are much sicker than they have ever been. It is common knowledge among nurses that patients on a typical medical/surgical unit would have been in the ICU (intensive care unit) 10 years ago. Patients in the ICU today would have died 10 years ago. Patients on a medical/surgical unit back then would be sent home today.
RN's are responsible for all of the nursing care a patient receives. Teaching about medications, how to prevent complications, discharge instructions, intervening during a crisis, these are just a few of the most important things. The general public probably does not fully understand all in which the RN is responsible. We are guided by the nursing process which has 5 major steps: 1. Assess the patient's condition. 2. Analysis of what was assessed. 3. Make a plan. 4. Implement that plan. 5. Evaluate that plan and if it isn't working, start over. We also need to hold the hand of someone who is scared or answer the same questions many times to help alleviate anxiety. While the nurse is doing all of these things, the phone is ringing, call lights are going off, patients are coming and going, pumps are beeping, crises are happening. Ill people and their families can become very egocentric and not realize how busy their nurse is working. They don't realize that we can't get their mother a fresh pitcher of ice water right away because we are dealing with someone who is going into respiratory failure or some other major emergency. Asking for something simple like more ice water should not be a problem, but nurses always have to prioritize.
There have been a lot of studies done recently about nurse to patient ratios. The state of California is currently undergoing issues with this and the governor of that state is fighting it, citing a nursing shortage. 1. A recent study by Linda Aiken, RN, PhD, and others, found that for each additional patient over four in a nurse's workload, the risk of death increases by 7% for surgical patients. Patients in hospitals with the lowest nurse-to-patient ratio (eight patients per nurse) have a 31% greater risk of dying than those in hospitals with four patients per nurse. On a national scale, staffing differences of this magnitude may result in as many as 20,000 unnecessary deaths each year. To me that is very much a sobering statistical analysis.
When the impossible is expected out of a person, that person can "burn out". Nurse burn out is a large contributor to the shortage of nurses. Not many professions go to work and get little or even no lunch breaks. Doctors and visitors can be very demanding and even rude. There's even a new term called "ward rage". Nurses can be threatened on a daily basis, sometimes even by doctors. This abuse can be verbal but it is sometimes physical. The only other profession that seems similar is being a police officer.
A shortage of nurses is a factor in about one-fourth of patient injuries or deaths in hospitals, according to the Joint Commission on Accreditation of Healthcare Organizations' 2002 report. The Institute of Medicine says long work hours and fatigue contribute to errors. They suggest that nurses not work more than 12 hours a day. A 2002 study by Harvard and Vanderbilt university researchers, examining millions of 1997 hospital cases, found preventable deaths and patient complication rates were up to nine times higher in hospitals where the most care was given by licensed practical nurses and aides, not better-trained RN's. Again, these are sobering statistics.
One RN for four patients is better than having one RN for seven patients or more. Why? If you have fewer patients, you are able to spend much more time with them. Your assessments can be much more thorough allowing you to catch changes that could result in serious complications. Nurses have more time to check lab work and catch potential life-threatening conditions. It's possible to not catch a change in condition fast enough than can even result in death. This is "failure to rescue," or a patient who has a major change in condition. Usually it's because the nurse who has this patient has other unstable patients. There have been deaths and lawsuits from this. The hospital is usually the one found guilty for not providing enough staff. An example of a "failure to rescue" would be someone who develops a pulmonary emboli, or blood clots to the lungs. The mortality rate is high if not caught soon enough.
It is interesting to note that when staffing ratios are increased, nurses who have "dropped out" of the profession come back to work. It is possible that the nursing shortage is not as severe as believed. There are plenty of nurses; they just do not want to work under such horrible conditions. Nurses work under a professional "license" that is governed by the state and are accountable for every action they perform within the scope of their duties. Is it no wonder nurse's fear losing this license because of a mistake? At hospitals with better RN-to-patient ratios job satisfaction is much better. There is less of a turnover rate, which is much better for continuity of care. It costs institutions a lot of money and time to "orient" or "train" new nurses. This adds to the overall cost of health care. It is vitally important to do what we can as a society to keep down these costs.
It will be interesting to see the developments that occur in nursing over the coming years. Everyday I get an email from Google email alerts telling me of all the steps various states are taking to help improve the coming severe nursing shortage. When addressing this shortage, my hope is that it will also apply to the actual ratio of RN's-to-patients. When this ratio is "proper" for the acuity of the patients, there is a belief that the nursing shortage will be more easily fixed.
I don't know why this didn't copy over very good. No paragraphs or anything. Sorry, but thanks for reading.
1. Aiken, Linda, Journal of the American Medical Association, October 22, 2002.