A recently published New England Journal of Medicine article found that the nation’s nursing shortage is likely leaving patients open to a greater risk of complications.
Researchers evaluated medical records from 799 U.S. hospitals in 1997 – accounting for about one-fourth of all discharged patients that year – and found that care from registered nurses is crucial in preventing eight of 25 negative patient outcomes, including urinary tract infections and extended hospital stays.
"We found consistent evidence of an association between higher levels of staffing by registered nurses and lower rates of adverse outcomes," said Jack Needleman, the lead researcher for the Harvard School of Public Health team that conducted the study.
In Rhode Island, the General Assembly took up the issue in 2000, mandating that the Rhode Island Department of Health Department identify specific patient outcomes that are significantly swayed by nursing care.
The department released its findings this past February, concluding that adverse patient outcomes – most notably bedsores, urinary tract infections and pneumonia – can be linked to low nurse-staffing levels. Also, a patient’s length of stay in the hospital can hinge on the amount of nursing care he or she receives, the report said.
The report did not, however, call for the creation of nurse-staffing benchmarks or improvements in patient-to-nurse ratios.
"There is no definitive agreement on those outcomes believed to be nursing sensitive that is quantitatively supported across multi-institutional investigations," the report reads, concluding that a wider agreement among the nursing and medical community was needed before performance measurements be put in place.
But to many nurses, further studies aren’t needed: The link between nursing care and patient outcomes is obvious.
"Registered nurses are on the front lines of patient care; they are the key ingredient to improving patient safety," said Linda McDonald, president of the United Nurses & Allied Professionals, a union that represents 4,000 RNs and other health care professionals in Rhode Island.
But increasingly nurses’ hands are tied when it comes to providing quality care, McDonald said, because they’re taking care of more – and sicker – patients as the nursing shortage worsens. The latest survey by the Hospital Association of Rhode Island shows roughly 500 vacant, budgeted RN positions at hospitals throughout the state.
"It’s scary when you leave work wondering ‘Did I give all those meds? Were they the right doses? Did I start that IV?’" said McDonald, who has worked as an RN at Rhode Island Hospital for 21 years, mostly in the surgical intensive-care unit. "If you have too many patients, it leads to fatigue and frustration, and you can easily miss something."
It is that harried environment that is making it difficult for the health-care industry to attract young people into the nursing profession – and it is increasingly driving nurses out of the field. McDonald said that until working conditions improve and wages increase, the shortage will continue. But therein lies a big part of the problem: Nurses will continue to be run ragged until more people enter the field.
"It’s a Catch-22," McDonald said.
For the time being, hospitals in Rhode Island are trying to plug the holes in the system through a combination of mandatory and voluntary overtime, use of temporary or traveling nurses and creative incentives to get nurses to work hard-to-cover shifts or when patient census is high – all of which drive up labor costs.
"We’re staffing to meet the needs of the patients we have," said Cathy E. Boni, vice president of the hospital association. "I wouldn’t want to leave the impression that because we have 500 vacancies across the state that we’re not covered with safe staffing."
As evidence of the link between patient safety and nurse staffing builds, a small handful of states have sought to correct the staffing problem by regulating maximum patient-to-nurse ratios. Those efforts have been met with staunch resistance by the hospital industry, which fears spiking labor costs and yet another regulatory burden to adhere to.
Boni said there is no way to quantify an average patient-to-nurse ratio in Rhode Island because the adequate staffing levels vary based on the acuity level of patients at a particular facility or on a certain unit.
The clinical responsibilities of nurses at a given hospital also make calculating ratios difficult. For instance, nurses at some hospitals are responsible for drawing blood, whereas that duty may fall to a separate IV team at other hospitals, Boni said.
According to an article published May 30 in the Wall Street Journal, Rhode Island’s patient-to-nurse ratio is between 4 and 4.99, a range that 19 other states also fall into. About 10 states have worse average ratios – above 5 patients for every nurse – while roughly 20 states have better ratios, of 3.99 or lower.
The data from the Wall Street Journal article was taken from research done by the University of California, San Francisco.
