Nurses Surveyed on HMO Health Plans
Nurses Say Managed Care Has Decreased the Quality of Care

A recently released report entiled,  “A View From Bed-Side:  A Survey of Doctors and Nurses on Their Patients’ Experiences With Health Plans,” found that both groups of professionals found managed care has decrease the quality of care in America’s health care system. 

American Nurses Association President Beverly A. Malone, who spoke at a press conference announcing the results of the report, stated, “Nearly four out of vice nurses say that managed care has decreased the quality of care to patients who are sick.  Almost half the nurses surveyed said that health plans have made specific decisions that have resulted in a decline in patient’s health.  Of these nurses, almost two-thirds said these adverse decisions happen as often as once a week to once a month.  This is far too often for the ‘system’ to decide against America’s ill and vulnerable.”

While fifty-eight percent of physicians cite increased administration time as a great concern, 69% of nurses point to inadequate staffing concerns at their greatest concern. 

Survey Adds to Growing Body of Evidence

According to data on United States community hospitals released in the American Hospital Association's latest [1999] edition of Hospital Statistics, revenues are up, admissions are up, and outpatient surgeries are all up, while lengths of stay continue to decline. Yet, despite this well-documented churn of acutely ill patients through hospitals, RN staffing has not kept pace from 1993 to 1997. Furthermore, the picture is incomplete because it does not include outcomes measurements or patient satisfaction reports. 

Health plans are not directly responsible for nurse understaffing, of course. But the indirect link is clear. Patients are not admitted to the hospital until they are sicker than ever before. They are discharged sooner than ever before. 

Over 900 New York registered nurses responded to a March 1999 survey conducted by the New York State Nurses Association. Nearly half of these nurses reported that they could not provide the level of nursing care their patients needed. Nearly 80 percent of hospital nurses and 76 percent of all nurses surveyed said that acuity - the seriousness of patients' conditions -- has increased over the past two years. One of the major issues in recent disputes between nurses and hospital management has been over the need to establish safe staffing levels based on both patient census and acuity. 

According to the American Journal of Nursing Patient Care Survey (1996), 9 out of 10 nurses polled indicated serious concerns that the safety and quality of patient care was being diminished by RN cutbacks and increased use of unlicensed personnel. In 1997, the AJN Patient Care Survey was revisited. The updated survey showed that nurses who rated their institutions' quality of care as "poor" or "very poor" reported significant increases from 1996 to 1997 in the following quality of care indicators: patient and family complaints, injuries to patients, medication errors, pressure ulcers and skin breakdown, and complications secondary to admitting diagnosis. Nurses working in poorly rated hospitals were four times likely to report an increase in pressure ulcers and almost all of them (91%) stated that the quality of care does not meet their professional standards. 

A new study by researchers at the U.S. Agency for Health Care Policy and Research (AHCPR) found that patients who have surgery done in hospitals with fewer registered nurses per patient than other hospitals run a higher risk of developing avoidable complications following their operations. Among the adverse patient events the study found associated with lower RN-to-patient staffing were increased urinary tract infections, pneumonia, thrombosis -- formation of blood clots -- pulmonary congestion, and other lung-related problems following major surgery.

What You Can Do To Improve The System

Nurses in Massachusetts interested in workting to effect change to improve the quality of care in the health care system can do so by participating the MNA’s Statewide Campaign for Safe Care.  The campaign is an effort to generate public awareness and to create public policy to improve staffing in health care facilities as well as to educate the public and policy makers to the need to increase access to appropriate nursing care. To view specific legislative initiatives created by the campaign, or for a listing of specific things you can do to support the campaign, call the MNA at 781.821.4625 x728.