Hospital nurse staffing & patient mortality

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Jewish World Review
Oct. 25, 2002 / 19 Mar-Cheshvan, 5763

By Robert A. Wascher, M.D., F.A.C.S.

http://www.NewsAndOpinion.com | Almost every hospital in the United States is struggling to recruit new nurses. The nursing profession has seen its ranks decline substantially over the past 10 years due to ever decreasing numbers of nursing student applicants, as well as the increasing numbers of trained nurses who are fleeing the profession. Long shifts, low pay, and excessive patient loads all contribute to the very high burnout rate among hospital nurses these days. The impact of inadequate nurse staffing is evident to many physicians (and patients), including myself. The dispensing of important medications is often delayed, patients who require assistance often must wait a very long time before their nurses are available to respond to a call for help, and important cues relating to early complications are often missed by harried nurses who are simultaneously caring for more patients than they can safely handle.

A study in this week's Journal of the American Medical Association puts this problem into sobering perspective. The authors reviewed patient outcome at 168 hospitals in Pennsylvania, and studied more than 230,000 surgical patients and more than 10,000 nurses at these hospitals. The study determined that for each additional patient assigned to a hospital ward nurse, there was a corresponding 7 percent increase in the risk of death among patients assigned to the same nurse.

The risk that a nurse would fail to respond promptly when a patient signaled that a serious problem was occurring also increased by 7 percent for each patient added to his or her care. Doubling a nurse's patient caseload from 4 to 8 patients resulted in a a very significant 31 percent increase in the risk of patient death.

This study merely confirms what most health care professionals already know: inadequate staffing of hospitals with nurses seriously degrades patient care, and results in a higher risk of complications, including patient death. At the same time, overwhelming caseloads of seriously ill patients increase the likelihood that nurses will develop job-related burnout. As it stands now, there are not enough new graduating nurses from American nursing colleges to fill all of the empty nursing slots.

Therefore, hospitals are recruiting large numbers of nurses from other countries. (The Philippines is a particularly rich source of foreign-trained nurses for hospitals throughout the United States.) This study adds further evidence that the chronic shortage of trained nurses in the United States is having a deleterious effect on the health of hospital patients.

More needs to be done to transform Nursing into a better-paying and more highly respected profession. As anyone who has ever been a patient in the hospital knows, few things are more comforting in the middle of the night than a concerned and well-trained nurse who is readily available if the need arises. Now, according to this new study, it appears that One's recovery from surgery or a major illness hinges upon patient access to a nurse who is not constantly overwhelmed by an excessive number of patients under his or her charge.