News & Events

Coverage of New England Jounral of Medicine Study on Nurse Staffing: 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.

  • Channel 5 coverage (available on their web site for a limited time)
  • Boston Herald coverage
  • New York Times Coverage

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.