Nurses are often overworked, undertrained and distracted by paperwork, a situation that contributes to medical errors that cause preventable deaths and injuries, a government advisory panel reported yesterday.
The report from an Institute of Medicine committee, which called for an overhaul of working conditions for nurses, recommended that nursing homes have at least one registered nurse on duty at all times and said staffing levels should increase as the number of patients increases.
The current federal standard is for an R.N. to be there at least eight consecutive hours every day.
The report also pressed state regulators to limit nursing shifts to 12 hours in any 24-hour period and no more than 60 hours in a seven-day stretch. That requirement is in a House bill backed by the American Nurses Association.
"All the health professions contribute to errors occurring, but nursing plays a very special role," committee Chairman Donald M. Steinwachs said, noting that nurses are positioned to catch others' mistakes. "It's the profession by the bedside."
The 18 recommendations came nearly four years after another Institute of Medicine panel focused national attention on patient safety by estimating that medical errors kill up to 98,000 hospital patients a year.
Yesterday's report offered no such revelations, but experts said it's still likely to focus attention on crises in a profession that, when nursing assistants are included, accounts for 54 percent of all health-care workers.
"It provides legitimacy to this whole arena of working conditions being so important" to patient safety, said Linda H. Aiken, director of the University of Pennsylvania Center for Health Outcomes and Policy Research, which has studied the link between patient safety and nurses' workloads, education and overtime hours.
The 327-page report, titled Keeping Patients Safe: Transforming the Work Environment of Nurses, comes amid a shortage that has left Maryland, a state with about 60,000 registered nurses, about 2,000 short, according to the Maryland Nurses Association.
Nationwide, hospitals are filling shifts with temporary workers, hiring foreign nurses and, all too often, asking nurses to work so much overtime that fatigue alone causes them to make mistakes. The conditions have created a vicious cycle, encouraging some registered nurses, many of whom are nearing retirement, to leave the profession, studies have shown.
