Nursing Shortage Is Killing Pts

Published Aug 7, 2002

161 Posts

But the suits will want a gazillion more "studies" before they will ever admit it

... they figure they have smoked n mirrored so much it takes a rocket scientist to realize that fewer caregivers = less care = bad outcomes :rolleyes:

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http://www.boston.com/dailyglobe2/219/nation/Casualties_tied_to_gaps_in_nursing+.shtml

8/7/2002, by Anne Barnard, Globe Staff

Casualties tied to gaps in nursing

Hospital data cited in report on injury, death

Inadequate nurse staffing contributes to nearly a quarter of hospital incidents that kill or injure patients, the national group that accredits hospitals says in a report being released today. The group called on the federal government and the health-care industry to act more aggressively on the growing shortage of registered nurses.

The report suggests that the shortage of nurses is a factor in tens of thousands of deaths annually from causes ranging from medication errors to patient falls and hospital-acquired infections. Nationally, 98,000 deaths a year have been blamed on medical errors, and one in 10 nursing jobs is currently empty.

''There's a problem out there,'' said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation of Healthcare Organizations. ''We knew other people were going to gulp and say, `That's really high.'''

The commission is a private group that inspects and accredits hospitals. Nurses unions and patient groups have sometimes called it too friendly to hospital administrations.

The commission based its findings on the hospitals' assessments of unexpected adverse outcomes that either killed patients or caused them serious physical or psychological harm. Of the 1,609 adverse events that hospital officials voluntarily reported to the commission between January 1996 and March 2002, 24 percent took place in part because hospitals had an insufficient number of registered nurses on the job, according to hospital officials.

THE NURSING SHORTAGE

Nurse staffing levels were deemed a contributing factor in...

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50%Ê of ventilator-related incidents.

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42%Ê of surgery-related incidents.

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25%Ê of transfusion incidents.

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25%Ê of delays in treatment.

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25%Ê of infant abductions.

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19%Ê of medication errors.

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14%Ê of inpatient suicides.

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14%Ê of patient falls.

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Sources: Joint Commission on Accrediting Healthcare Organizations analysis of 1,609 incidents from 1996 through March 2002.

PROJECTED NURSE SHORTAGE

in Massachusetts

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Sources: US Health Resources and Services Administration, Bureau of Health Professions

Despite increasing public attention to both medical errors and the nursing shortage, neither hospitals nor the government have reacted strongly enough, said O'Leary.

He called for more federal spending to train and support nurses and to encourage hospitals to increase staffing with incentives such as tying extra Medicare and Medicaid payments to improved nurse staffing and better patient outcomes.

''There seems to be a tacit belief that where we are now is OK,'' he said. ''We're saying somebody ought to be really bothered about this right now, and it's probably going to get worse if we don't wake up.''

There are now 126,000 unfilled nursing positions in the United States. Nursing specialist Peter Buerhaus, who helped write the commission's report, has predicted a shortage of 500,000 registered nurses by 2020; a federal report issued last month put the number at 800,000. A study published in Health Affairs magazine said that only 34 percent of registered nurses believe their hospitals have adequate nursing staff and that 83 percent said the number of patients in their care had increased.

The shortage of nurses is particularly worrisome because research increasingly shows a link between the staffing shortage and patient recovery. For instance, recent studies showed that increased nurse staffing is associated with fewer urinary tract infections and cases of pneumonia, as well as lower mortality. In another study, patients who had abdominal aortic surgery in hospitals with fewer intensive-care nurses had longer hospital stays and more complications.

The report by the Joint Commission on Accreditation was produced by a panel of academics, nurse executives, and a union representative. It recommends a range of initiatives, from more federal scholarships for nurses to establishing training regimens akin to doctors' residencies. And it argues that the cost of such changes will be offset by reducing the amount hospitals must spend to replace nurses who quit over adverse working conditions.

O'Leary, an internist, said he believes that the reports hospitals voluntarily submit to the commission are representative of all medical errors and that a quarter of the 98,000 deaths attributed to medical errors each year could be caused by staffing issues.

Hospital executives did not dispute the data. ''Now we have data to really demonstrate that this ... affects patient care,'' said Jeanette Clough, a registered nurse and president of Mount Auburn Hospital, which temporarily closed two of its 10 intensive-care beds last year because of inadequate staffing.

The commission's figures may understate the effect of the nursing shortage on adverse medical events, O'Leary said, because medication errors are often underreported and because hospitals may blame some of them on miscommunication or insufficient training that could also be related to staffing levels.

In proposing solutions, the commission is wading into a longstanding debate over levels of staffing. Hospitals say they have fallen victim to workplace trends that have pulled people away from nursing, and they want more subsidies for nursing education and recruitment, like those in a $30 million bill that President Bush signed last week.

But some nurses' groups say that hospitals created the shortage by laying off so many nurses in the mid-1990s that workloads became intolerable and nurses shied away from hospital employment, fearing they would make a fatal mistake. Those groups are calling for laws specifying nurse-to-patient ratios, such as a law and regulations that took effect this year in California. A similar bill was filed in Massachusetts last fall but has languished in committee.

The Massachusetts Nurses Association, the state's largest nurses union, welcomed some of the suggestions in the commission's report, but said it did not go far enough, because it stopped short of endorsing ratios.

''JCAHO was accrediting all these organizations for the last 15 years that purposely implemented staffing cutbacks and replaced nurses with less skilled people to save money,'' said Julie Pinkham, the union's executive director.

The commission accredits 80 percent of the nation's hospitals through site visits that hospitals usually know about in advance, with details kept private.

But the commission has recently vowed to get more aggressive. Last month, it introduced regulations that require hospitals to track staffing issues such as overtime and clinical outcomes that are affected by staffing, such as infections and patient falls.

The commission also plans to take public-policy stances on problems such as hospitals' emergency preparedness and overcrowding of emergency rooms.

It addressed the nursing shortage first, O'Leary said, because that was the issue ''that really curled our hair.''

Anne Barnard can be reached at [email protected]

This story ran on page A1 of the Boston Globe on 8/7/2002.