Deaths from nurse shortage documented

Nationwide study finds hospital patients do better where more RNs work

May 30, 2002|By Tom Pelton | Tom Pelton,SUN STAFF

The nursing shortage afflicting the nation's hospitals has resulted in increased deaths and illnesses of patients from heart attacks, infection, shock and internal bleeding, according to a new study.

The article in today's New England Journal of Medicine by Harvard researcher Jack Needleman is the first major study to document, on a national scale, the damage to patient health caused by inadequate nursing staff levels.

"The problem of low nurse staffing is serious at many hospitals, and its consequences for patients can be severe," said Needleman, an assistant professor at the Harvard School of Public Health, who worked with four colleagues.

The decreasing popularity of the nursing profession has resulted in an estimated 126,000 vacancies at U.S. hospitals, about 13 percent of the average medical center's nursing staff.

The federally funded study by Needleman and colleagues shows the concrete impact on patient health, said Deborah Dang, director of nursing at Johns Hopkins Hospital.

"This study speaks to the real contribution of nurses in acute care settings," said Dang. "Nurses make a real difference in how patients fare."

Dang said nurses work as an "early warning system" to detect health problems that arise in patients during their hospitalization. If there aren't enough nurses around to quickly recognize the early signs of infection, shock or heart attack, for example, doctors might not be able to prevent death.

In their study, Needleman and colleagues analyzed data from 799 hospitals in 11 states nationally, including Maryland. They concluded:

Patients suffer cardiac arrest and shock 9.4 percent less often in hospitals with high staff levels (one nurse for every 2.5 patients per day) than low staff levels (one nurse for every four patients per day).

People cared for in hospitals with high nursing staff levels also suffer 9 percent fewer urinary tract infections, 5 percent fewer episodes of bleeding in their stomachs or intestines, and 6.4 percent less hospital-acquired pneumonia.

Surgical patients in hospitals with high nursing staff levels are 6 percent less likely to die from complications of surgery such as shock or sepsis.

Patients in medical centers with high nursing staff levels recover more quickly, spending an average of four hours less in the hospital.

Over the past two decades, the shift to managed care and cost containment have reduced the nursing staffs of hospitals and fuelled burnout among employees, experts say. Mandatory overtime and relatively static pay have also made the job less appealing.

At the same time, more women are discovering higher-paid alternatives to this traditionally female occupation, experts say.

Dr. Robert Steinbrook, a deputy editor at The New England Journal of Medicine, wrote in an article accompanying Needleman's study that one barrier to recruiting more nurses is that physicians often fail to treat them with enough respect.

"The perception is that physicians and hospital administrators often treat registered nurses as workers, not as clinicians and peers, and when possible seek to replace them with less skilled and cheaper personnel," Steinbrook wrote.

As nursing becomes less attractive as a career, however, the aging of the baby boom generation means that the demand for nurses will continue to rise. Hospitals all over the country are paying bonuses and recruiting overseas.

"Hospitals are in a bidding war with each other for nurses," said Barbara R. Heller, dean of the University of Maryland school of nursing, one of the largest in the country. "Nurses are the backbone of our medical care system, and it's clear we need to do much more to bring more people into the field."

About 11 percent of the University of Maryland Medical Center's 1,200 full-time nursing positions are open, said Kathy McCullough, senior vice president of patient care services.

The need for qualified nurses is so great that hospital administrators recently traveled to the Philippines to recruit and import 60 nurses with bachelor's degrees, McCullough said.

In an attempt to attract nurses locally, the medical center is offering up to $10,000 a year in college tuition payments for the children of nurses, McCullough said. The hospital is also handing out $5,000 cash bonuses to any employees able to persuade a friend to work as a nurse at the medical center.

In the emergency room yesterday, nurse Erin Ruark, a 14-year veteran, inserted an intravenous tube into the arm of a 38-year-old Baltimore woman, Lejune Rogers, who came in complaining of stomach pain.

"Certainly you are overworked. There are less hands to do the usual work," Ruark said of the general state of the nursing profession. "It does affect the patients, because they don't get the care they should get."

Administrators at Johns Hopkins Hospital and Sinai Hospital in Baltimore wouldn't reveal their nursing vacancies, but said they were close to the 15 percent average for hospitals in the state.

Sinai, like many other hospitals, relies on overtime and temporary nursing agencies to fill in gaps in its nursing staff, said Diane Johnson, vice president of patient care services.

Rather than risk inferior care, Hopkins chooses to close hospital beds during the staffing crises that arise a few times a year.

"We've made a decision to close beds to keep nurse staffing levels at appropriate levels for our patients," said Dang.

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