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Boston Herald and New York Times—Coverage of New England
Journal of Medicine Study on Nurse Staffing and Patient Safety—"Fewer
RNs Can Deter Good Health"
Here is some the press generated by the New England
Journal of Medicine Study and Report published this week (5/29/02)
concerning
the impact RN staffing has on patient care. In a related
TV Channel 5 report, Jack Needleman, one of the authors of the
study, stated that hundreds and even thousands of patients could
die every year due to insufficient RN staffing. These studies
and this media coverage underscore the need to pass HB 1186, Quality
Patient Care/Safe Staffing legislation that would regulate nurse
to patient ratios in Massachusetts health care facilities. Undoubtedly, this
bill is key to ending the nursing shortage, but as this and other
studies have shown, the most important benefit of this bill is
its ability to improve the quality of health care, and yes, to
save many lives! For more information about this legislation,
visit the Safe Staffing page
of our web site.
Fewer RNs can deter good health, study says
by Jon Chesto , Friday, May 31, 2002
Patients in hospitals with fewer nurses often take longer to recover
and develop more complications than those who get a higher level
of nursing care.
That's what a Harvard School of Public Health professor and other
researchers describe in a study published in yesterday's New England
Journal of Medicine.
"The problem of low staffing is very serious at many hospitals," said Harvard
professor Jack Needleman, lead author of the federally funded report. "The consequences
for patients can be really severe."
The study - which is based on data from 799 hospitals in 11 states
- shows connections between registered nurse staffing and negative
health complications.
For example, Needleman said the number of patients who develop
pneumonia at hospitals with low staffing levels would likely drop
by 6.4 percent if those hospitals increased their staffing to match
those with higher staffing levels.
The report found that reductions would also occur in urinary tract
infections, hospital stays, gastrointestinal bleeding and instances
of shock or cardiac arrest.
But other negative results, such as overall patient mortality,
weren't connected to staffing levels. The report also didn't find
a connection between patient health and the number of licensed
practical nurses - nurses with less training than registered nurses
- or nursing aides.
The Massachusetts Nurses Association plans to use the report to
lobby state legislators to pass a bill that would lead to
minimum nurse-patient ratios at hospitals. The bill, which is opposed
by the hospital industry, has been stuck in a legislative committee.
"This is another piece of evidence that shows patients suffer when you don't
have enough nurses," MN spokesman David Schildmeier said.
Sen. Richard Moore, co-chairman of the health care committee, said
he hopes it will release the bill next month. He expects to make
some changes, such as adding a provision to reduce nurses' overtime
hours.
There's not much time left to pass the bill this year. The Legislature
will finish its formal sessions at the end of July.
The nurses' union says many registered nurses would return to the
profession if patient-nurse ratios improve. But Massachusetts Hospital
Association spokesman David Young said his group doesn't believe
there are enough nurses to meet the demand that would be caused
by the bill.
Shortage of Nurses Hurts Patient Care, Study Finds
By DENISE GRADY, New York Times, May 30, 2002
In hospitals with low numbers of registered nurses, patients are
more likely to suffer complications like urinary infections and
pneumonia, to stay in the hospital longer and to die from treatable
conditions like shock or gastrointestinal bleeding, researchers
report today.
"I estimate that hundreds or, perhaps, thousands of deaths each year are due
to low staffing," said Dr. Jack Needleman, an economist at the Harvard School
of Public Health and the lead author of a study on staffing published today in
The New England Journal of Medicine.
The nation has a serious nursing shortage, with 126,000 jobs unfilled,
12 percent of capacity, says the American Hospital Association.
The shortage is a result of hospital mergers, layoffs and heavy
workloads. Many hospital nurses shifted to other work. The average
salary, $46,000 a year, has not increased much in a decade. Even
though hospitals are trying to hire again, nurses are no longer
available.
The new study, paid mostly by the government, is one of the largest
to look at care in relation to staffing. The findings were based
on a computer analysis of the discharge records of more than six
million patients at 799 hospitals in 11 states in 1997. Five million
had medical problems. One million had surgery.
The research sought to find out whether there was a correlation
between how patients fared and the levels of registered nurses
and two other types of workers with less training, licensed practical
nurses and aides.
Registered nurses receive several years of training and usually
hold associate's or bachelor's degrees. Practical nurses usually
have high school diplomas and a year of training. Aides have less
training.
The researchers found that for certain aspects of care just nurses
made a difference. In hospitals with higher nurse staffing, stays
were 3 to 5 percent shorter, and complication rates 2 to 9 percent
lower than in hospitals with lower staffing. No relation was found
between patients' well-being or length of stay and the levels of
aides or practical nurses.
Registered nurses, Dr. Needleman said, are "the eyes and ears of
the hospital" for judging whether a patient is recovering normally.
"If something is going wrong," he said, "they can catch the signs early, before
the problem gets worse."
But problems cannot be spotted early, he added, if nurses do not
have time to observe their patients.
The president of the American Nurses Association, Mary E. Foley,
said, "We're very pleased that another large set of research data
has validated what the American Nurses Association has been saying
since the mid-90's, that there is a direct effect on the outcome
of patient care when you have enough nurses."
As an example, Ms. Foley said, pneumonia and blood clots in hospitalized
patients often result from immobility, and nurses help prevent
such complications by turning and repositioning bedridden patients,
encouraging them to exercise and cough and helping others to get
up and walk around. Even if nurses themselves do not do those things
for patients, they have the training and experience to know when
such help is needed and to ensure it is provided.
A senior vice president for policy at the American Hospital Association,
Carmela Coyle, said: "The stud suggests that registered nurses
are key and critical to insuring good patient care. This is something
that hospitals and patients have known for some time."
Ms. Coyle said she feared that the study would lead some people
to assume that health care problems could be solved by laws that
require specific staffing ratios, a move that hospital trade groups
have long resisted. She called such a reaction overly simplistic.
"What you really need to look at," Ms. Coyle said, "is much more than the number
of nurses and the number of patients. How many of the nurses have 20 years of
experience or more, and how many are right out of school? What technology is
there to support them? How sick are the patients?"
Dr. Needleman said his group made its study because the government
sought to fill a large research gap on the connection between nurse
staffing and quality of care. In the early 1990's, nurses testified
to Congress that patients in some hospitals were endangered by
managed-care companies that were trying to save money by replacing
registered nurses with less skilled and lower paid workers. Congress
asked the Institute of Medicine to study the issue. In a report
in 1996, the institute said there was not enough data to draw conclusions
and called on the government to finance studies.
Dr. Needleman's is one of those. It measured staffing two ways,
by the proportion of nursing hours provided by each type of worker
and by the number of hours a day the types of workers devoted to
each patient.
For registered nurses, the average number of hours a day per patient
worked out to eight. The hours included not only time spent at
the bedside, but also time spent preparing medication, writing
chart reports and consulting colleagues or family members.
The averages include intensive care units, with one nurse for every
one or two patients around the clock.
"There were some hospitals, that if I were going to them as a patient, I would
be very concerned," Dr. Needleman said. "The hospitals at the very low end of
our sample had as little as two hours, and some at the high end had 16 hours."
When the study compared the hospitals in the top quarter with those
in the bottom quarter on the proportion of nursing time from registered
nurses, it found that the medical patients, as opposed to surgical
patients, in the bottom quarter had stays 3.5 percent longer, 9
percent more urinary infections, 5.1 percent more gastrointestinal
bleeding, 6.4 percent more pneumonia and 9.4 percent more shock
or cardiac arrest.
In addition, the death rate was 2.5 percent higher for "failure
to rescue," meaning that the patients died from conditions that
might have been reversed if they had been treated in time. Those
conditions include pneumonia, shock or cardiac arrest, upper gastrointestinal
bleeding, sepsis or a blood clot.
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