New England Journal of Medicine Highlights Publishes Study Demonstrating RN Staffing Levels Directly Impact Patient Health and Survival

Low RN Staffing Levels Put Patients at Risk for Life-Threatening Infections, Shock and Bleeding

MNA Applauds Journal For Demonstrating Positive Impact Nurses Have on Patient Care and the Need for Policies to Increase RN Staffing and Regulate Nurse to Patient Ratios

The number and mix of registered nurses in a hospital have a direct impact on the outcome of patient health, according to a study and policy statement published in the May 30th edition of the New England Journal of Medicine. For nurses in Massachusetts, the Journal's findings provide a strong scientific underpinning for legislation pending on Beacon Hill that would mandate improvements in nurse staffing levels in Massachusetts health care facilities.

The study, Nurse Staffing and Patient Outcomes in Hospitals, is the most comprehensive to date on the topic and was led by Jack Needleman of the Harvard School of Public Health in Boston and Peter Buerhaus of Vanderbilt University School of Nursing in Nashville, Tennessee.

The study included hospital discharge data for more than 6 million patients, financial reports and hospital staffing surveys from 799 hospitals in eleven states including: California, New York, Maryland, Virginia, West Virginia, Arizona, Massachusetts, Missouri, Nevada, South Carolina, and Wisconsin. These data were analyzed to determine staffing levels of registered nurses (RN), licensed practicing/vocational nurses (LPN/LVN), and aides, and to measure the frequency of a wide range of complications and that patients developed during their hospital stay.

Of the hospital inpatient nursing personnel studied, the study found that registered nurse staffing makes the biggest impact on patient outcomes. The researchers found relationships between nurse staffing and six adverse patient outcomes—urinary tract infections, pneumonia, shock and cardiac arrest, upper gastrointestinal bleeding, failure to rescue, and length of hospital stay—in medical and major surgery patients treated in hospitals. They found higher RN staffing was associated with a 3 to 12 percent reduction in these adverse outcomes and higher staffing at all levels of nursing was associated with a 2 to 25 percent reduction in these adverse outcomes.

"The problem of low nurse staffing is serious at many hospitals, and its consequences for patients can be severe. Patient outcomes like hospital-acquired pneumonia, shock and cardiac arrest, and gastrointestinal bleeding have a substantial risk of death associated with them, and hospital-acquired urinary tract infections are far too common," said Jack Needleman, assistant professor at the Harvard School of Public Health and project director for the study. "The goal should be to reduce them to zero, if possible. Our study underscores that nurse staffing is an important element in improving patient safety."

The study shows that nurse staffing matters considerably to the well being of hospital patients, said Peter Buerhaus, co-project director for the study and senior associate Dean for research at Vanderbilt University School of Nursing. "Policy makers must make sure hospitals and nurses have the resources that will allow nurse staffing at levels that protect patient safety and reduce adverse outcomes. Nurses are the glue that holds the health care system together, and it is time that we invest more resources in the nursing profession."

In addition to the study, the New England Journal of Medicine also featured an in-depth health care policy report entitled, "Nursing in the Crossfire," by Robert Steinbrook, MD. The report reviews the background of the current crisis in nursing, including a survey of recent research concerning the growing dissatisfaction of nurses, the growing shortage of nurses, minimal nurse staffing ratios, the use of mandatory overtime as a staffing tool, as well as a review of potential solutions, including extensive coverage of the recent passage of groundbreaking legislation in California that regulated nurse to patient ratios in hospitals and legislation filed in a number of states to ban mandatory overtime. Legislation to regulate nurse-to-patient ratios is now pending in the Massachusetts legislature.

"This study and report validate what the Massachusetts Nurses Association and thousands of nurses across the Commonwealth have been saying for more than seven years - nurses are the key to quality care in our hospitals and chronic understaffing conditions are harming patients and driving thousands of nurses away from the hospital bedside," said Karen Higgins, President of the MNA, the Canton-based professional association and the state's largest union of registered nurses.

For years, the MNA has been raising concerns about the negative impact of dramatic cutbacks in nurse staffing levels at Massachusetts health care facilities. Nurses have claimed these staffing reductions have resulted in a rapid deterioration in nurses' working conditions, contributed to a dramatic shortage of nurses, and placed patients in jeopardy. In the last decade, nurses' patient assignments have doubled and sometimes tripled. When nurses should be caring for no more than 4 or 5 patients, today they are often expected to care for 7, 8, 9 or even 12 patients.

"When nurses have too many patients, they have less time to spend with patients, they are rushed through their duties, they become fatigued and they loose their ability to adequately monitor and evaluate their patient's condition. When nurses have too many patients, mistakes become more likely and the quality of care slips, as the Journal's study confirms," Higgins explained.

In response, the MNA has already provided the industry and policymakers with the mechanism to improve care for Massachusetts Hospitals, and reap the benefits identified in the New England Journal's study and report, with its filing of HB 1186, Quality Patient Care/Safe Staffing Legislation. Sponsored by State Rep. Christine Canavan and State Sen. Robert Creedon, both Democrats from Brockton, this legislation would put in place a process that would result in minimum registered nurse-to-patient ratios for all health care providers based on the needs of the patients.

In describing the rationale for legislation passed in California and proposed in Massachusetts, Dr. Steinbrook quoted Linda Aiken, a renowned nurse researcher from the University of Pennsylvania School of Nursing, who said, "unless a floor for staffing is established, we are not going to be able to stop the flight of nurses from hospitals."

Higgins agrees. "What policymakers need to understand is that we don't have a shortage of nurses in Massachusetts. In fact, Massachusetts has the highest per capita population of nurses in the nation. What we have is a shortage of nurses willing to practice with the current staffing ratios. If we give nurses a safe number of patients to care for, nurses will stay, and more importantly, more nurses will come back to the bedside.