More Than 1-in-3 Registered Nurses Report Patient Deaths & Nearly 80% Report Increase in Medical Errors Due to RN Understaffing
New survey finds 90% of state's RNs believe patients are suffering due to poor staffing ratios; 80% support a law to regulate ratios and, by a two-to-one margin, prefer a ratio law over a hospital industry bill calling for no limit on nurses' patient assignments
BOSTON, Mass.—A new study of registered nurses in Massachusetts establishes that poor RN-to-patient ratios continue to cause significant harm and even death for patients. According to the survey, which will be released today at a State House rally and public hearing on legislation to regulate RN-to-patient ratios, fully 90% of RNs say patient care is suffering due to understaffing, with devastating results for patients:
- Alarmingly, more than 1-in-3 nurses (34%) report patient deaths directly attributable to having too many patients to care for (an increase over the 29% reported by nurses in 2003);
- 77% report an increase in medication errors due to understaffing (a 10% increase since 2003);
- 68% report complications or other problems for a patient (a 4% increase);
- 59% report readmission of patients due to understaffing (a 5% increase);
- 53% report injury or harm to patients; and
- 50% report that poor staffing leads to longer stays for patients.
"These results represent an indictment of the hospital industry and demonstrate without a doubt that hospital administrators are not putting patients first – they are putting them in harm's way," said Karen Higgins, RN, president of the Massachusetts Nurses Association (MNA). "This study shows patient care continues to deteriorate and will only get worse unless and until we pass legislation regulating ratios."
As a solution to the problem, 80% of nurses surveyed support legislation to set minimum RN-to-patient ratios, while less than half (48%) support a competing measure sponsored by the hospital industry, which calls for no limit on the number of patients a nurse can be assigned. When given a choice between the two measures, front-line nurses prefer the ratio law by more than two-to-one (68% - 25%).
The study, "The State of Nursing and Patient in Massachusetts," duplicates an earlier survey in 2003, conducted by Opinion Dynamics Corporation, Inc. (ODC), an independent research firm headquartered in Cambridge. The 2005 survey of 400 Registered Nurses was conducted by telephone between the dates of June 29 - 30, and July 5 - 6, 2005. Survey respondents were randomly selected from a complete file of the approximately 85,000 nurses registered with the Massachusetts Board of Registration in Nursing who are currently living in the state. According to the research firm, the results can be assumed to be representative these 85,000 individuals to within ± 4.9% at a 95% confidence interval. Fully 67% of the respondents have no affiliation with MNA, which is important given that the hospital industry has attempted to claim that legislation to establish ratios is only being driven by unionized nurses.
Survey Shows Understaffing Driving Exodus of Nurses From Bedside—Ratios Bring Them Back
The researchers point to the understaffing of nurses in Massachusetts hospitals as a leading cause of an exodus of nurses from the hospital bedside. According to Chris Anderson, who directed the project, "The same circular dynamic we found in our 2003 survey is still in full effect – patient care is suffering because of understaffing, and more nurses are leaving the beside because of understaffing. The RN survey found that 89% of RNs agree that nurses are leaving the profession because they are burned out from high patient loads. Among nurses who stopped working in an acute care setting, short staffing is the number one reason cited for leaving the bedside."
As did the survey of 2003, the 2005 results contain a silver lining, in that nearly two-thirds (64%) of RNs not working at the bedside would consider returning to acute care settings if the ratio law was passed – a pool of more than 25,000 nurses.
According to Anderson, "This suggests that not only would establishing ratios immediately improve the quality of patient care, but ratios would also increase the pool of nurses willing to work in acute settings."
RN Survey Results Echo Findings of Recent Surveys of Past Patients and Physicians
The RN survey follows two earlier surveys this year by ODC—one of recent patients in Massachusetts hospitals released in March and another of physicians who regularly admit patients to hospitals released in April. These studies paint an equally dismal picture of the quality and safety of patient care in the state's acute care hospitals.
The survey of past patients in the state's hospitals over the last two years found that one-quarter reported their safety was compromised because their nurse had too many patients to take care of and one-third reported the quality of their care suffered. The survey of the state's physicians found that 8 in ten believe staffing levels in Massachusetts hospitals are too low and a greater percentage believe the quality of care in hospitals is suffering as a result. More than 60% report an increase in mediation errors, 54% report an increase in complications for patients, and 1-in-5 physicians report patient deaths directly attributable to poor ratios. Both surveys found strong support for the nurses' bill to establish minimum RN-to-patient ratios, with 82% of past patients and 75% of physicians supporting the bill.
The nurses' bill, H. 2663, An Act Ensuring Patient Safety, is sponsored by Rep. Christine Canavan, RN (D-Brockton) and Sen. Mark Pacheco (D-Taunton). It has 106 co-sponsors with a majority in both branches. It was filed by the Massachusetts Nurses Association, one of the leaders of the Coalition to Protect Massachusetts Patients. The Coalition is an alliance of 93 leading health and consumer groups that support H. 2663.
The bill sets minimum standards for RN-to-patient ratios that would be adjusted to reflect the types of hospitals units and the severity of patient conditions. It would also ban the use of mandatory overtime for nurses, prohibit requirements for nurses to practice in areas of the hospital for which they are not appropriately prepared and prohibits the replacement of registered nurses with lesser qualified, unlicensed personnel—all of which are common practices in the hospital industry that contribute to the deterioration in patient care identified in recent years.
"Today's survey results, along with surveys of patients and physicians, show what the most important experts and stakeholders in this debate know from their first-hand experience in the health care system: patients are suffering and suffering greatly under the current staffing practices in hospitals," Higgins said. "All three groups believe a law regulating RN-to-patient ratios is the most important solution to this crisis, and all three prefer this approach to the toothless bill being proposed by the hospital industry. The time has come to pass the nurses' bill and end the suffering of our patients."