• MNA Applauds Study For Demonstrating Positive Impact Nurses Have on Patient Care

• Study Underscores Need for Legislation Pending to Mandate Safe Staffing Levels

The number and mix of nurses in a hospital make a difference in the quality of care patients receive, according to a Department of Health and Human Services study released on Friday, April 20, 2001. For nurses in Massachusetts, the study'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.

"This study validates 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 efforts to decreases nurses' staffing levels are harming patients," said Denise Garlick, President of the MNA, the canton-based professional association and the state's largest union of registered nurses.

The study, Nurse Staffing and Patient Outcomes in Hospitals, is based on 1997 data from more than 5 million patient discharges from 799 hospitals in 11 states (including Massachusetts). It found a strong and consistent relationship between nurse staffing and five outcomes in medical patients -- urinary tract infection, pneumonia, shock, upper gastrointestinal bleeding, and length-of-stay. A higher number of registered nurses was associated with a 3 percent to 12 percent reduction in the rates of adverse outcomes, while higher staffing levels for all types of nurses was associated with a decrease in adverse outcomes from 2 percent to 25 percent.

According to the study, the costs associated with patient complications can be substantial. Reductions in the rates of adverse outcomes reduce hospital costs as well as significant financial and psychological costs to patients and their families.

"The study findings show that nurse staffing matters considerably to the well being of the hospital patients," said Peter Buerhaus, co-project director for the study. "Perhaps the study results will move health policy forward, making it possible to provide hospitals and nurses with the resources that will enrich staffing levels to the point where the adverse patient outcomes we found can be reduced."

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 response, the MNA has already provided the industry and policymakers with the mechanism to improve care for Massachusetts Hospitals, and reap the cost benefits identified in the HHS study, with its filing of HB 1186, An Act Relative to Sufficient Nurse Staffing to Ensure Safe Patient Care. 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 mandated staffing standards for all health care providers based on the needs of the patients. A similar bill was passed by the California legislature in 1999.

In addition to this study, recent nursing research, as well as a number of media exposes, have made a clear link between all of these issues and decreases in nursing staffing levels and unsafe nurse-to-patient ratios. It is not uncommon for medical/surgical nurses at a Massachusetts hospital to be assigned between 9 – 12 patients on a shift, or nurses working in long term care to be assigned 30 – 40 patients. Home care nurses, who a few years ago were seeing 5-6 patients in a day, are now being asked to see between 7-9 patients. And in all of these settings, patients are more acutely ill and in need of more nursing care. None of these ratios are considered safe, and all contribute to the types of outcomes identified by this study, according to the MNA.

HHS funded this study as a result of a series of activities stemming from a 1993 congressional hearing that focused national attention on the delivery of nursing care in hospitals and its effect on patient care. Subsequently, the Institute of Medicine examined the same issues and concluded that more research was needed on the relationship between quality of patient care in hospitals and the level and mix of nurse staffing. Four HHS agencies—the Health Resources and Services Administration, Health Care Financing Administration, Agency for Healthcare Research and Quality, and the National Institute of Nursing Research of the National Institutes of Health – sponsored the study. It was conducted by the Harvard University School of Public Health.

Copies of the study are available on HRSA's web site at http://bhpr.hrsa.gov/dn/staffstudy.htm