03.30.05

Massachusetts Patients Say Nurse Understaffing Harms Patient Safety, Undermines Quality Care

Statewide survey finds approximately 235,000 (1-in-4) patients per year feel their safety has been compromised in Bay State Hospitals

[Executive Summary (Word Doc)] :: [Findings (PowerPoint)]

BOSTON—More then one-quarter of Massachusetts hospital patients and their families say their safety was compromised during recent hospitalizations by nurse understaffing, and nearly one-third thought the quality of care was compromised, according to a statewide survey conducted by Opinion Dynamics Corporation (ODC) of Cambridge, Massachusetts. The new data is being released today at the Federal Reserve Bank in Boston at a forum on pending legislation to regulate RN-to-patient ratios in Massachusetts hospitals.

The poll revealed that 28% of those who spent one or more nights in the hospital say that their safety—or their family member's safety—was compromised. More than 1-in-10 (12%) say patient safety was extremely or very compromised. Based on the total number of hospital stays in the Commonwealth, this translates to approximately 235,000 Massachusetts patients annually who feel their safety is compromised by a lack of available nurses.

Nearly one-third (31%) of past patients and their families also report that the quality of patient care was at least somewhat compromised by a lack of available nurses. They said that important elements of routine care were not delivered in a timely fashion—this includes assistance when complications arose, delivery of medications, and information when patients had questions about their illness.

Behind the numbers are stories of patients who suffered pain or indignities unnecessarily:

• A Merrimack Valley man with heart problems who has been in and out of hospitals for five years because of heart attacks and heart operations. His wife says she has seen the quality of his nursing care decline with each admission, with nurse understaffing more and more apparent. She also told researchers that while emergency room and ICU nursing care for her husband was excellent, there is a noticeable deterioration in staffing when he is moved into standard units.
• A two-week old infant, being treated in a teaching hospital for bronchitis, nearly did not receive his treatment because the respiratory therapist was sent to the wrong crib. He was never bathed during the course of his stay, leading his mom to say she was "appalled" by the lack of adequate nursing care.
• A 76-year old woman from a suburb southwest of Boston who was hospitalized for four weeks because of a spinal fracture and who was left in pain on a bed pan for more than thirty-five
  minutes because nurses could not tend to her due to other patients' needs.
• A 40-year-old woman undergoing bypass surgery at a Boston teaching hospital had her throat injured when a harried nurse removed the patient's ventilator tube. It took several days, her mother said, before the damage was discovered and treated. The mother blames the working conditions—too many patients—the nurses had to care for.
• Almost universal acknowledgement from patients—even from those with no complaints about their treatment—that bedside nurses are overworked and overstressed.

"These findings paint an alarming picture," said John Gorman, ODC's president. "A significant number of patients and their families lack confidence about Massachusetts hospitals—and this in a state that prides itself on being at the forefront of medical care."

"I don't know how many times we need to share information like this before the message sinks in with legislators: patients are suffering because of RN understaffing," said Massachusetts Nurses Association (MNA) President Karen Higgins, RN. "Nursing is the key to quality hospital care. An RN cannot be in two places at once, much less six or more. Yet because of chronic understaffing, that is the prevailing situation in the state's acute care hospitals."

Moreover, the patients want something done about the situation—80% of those surveyed support the Safe Patient Care Act now pending in the Massachusetts Legislature that would set minimum patient-to-nurse ratios in the state's hospitals. By a 20-point margin they preferred that approach to the hospital industry's plan to provide minimal disclosure of existing staffing levels instead of genuine safe staffing standards.

The belief that the safety or quality of care was compromised appears to stem from important elements of care not being delivered expediently.

More than one-third (38%) of past patients and their immediate family members report nurses did not always arrive promptly when they asked for assistance.

One-third (33%) report medicine was not always provided in a timely fashion.

29% report nurses did not always arrive promptly if complications arose. One-in-twenty (5%) past patients and family members say nurses rarely or never arrived promptly when complications arose.

Many past patients also report that nurses didn't have enough time to provide information about their illness.

One-third (33%) say nurses didn't always have time to answer their questions about their illness.

35% report nurses didn't always have time to provide adequate information to the patients or family members on the care the patients would need once released from the hospital.

The survey of 200 healthcare consumers who were hospitalized, or who had family members hospitalized, in the last two years was commissioned by the Massachusetts Nurses Association, one of the leaders of the Coalition to Protect Massachusetts Patients. The Coalition is an alliance of 86 health and consumer groups that support the Safe Patient Care Act.

The bill, which has 106 co-sponsors, sets minimum standards for patient-to-nurse ratios that would be adjusted to reflect the types of hospital units and the severity of patient conditions. The measure is designed to put an end to the major disparities in care levels that now exist among the state's hospitals.

[Executive Summary (Word Doc)] :: [Findings (PowerPoint)]