nursing shortage/patient survival

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Report Links Nurse Staffing to Patient Survival

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c.2001 The Boston Globe

With the nation in the grip of a nursing shortage, a long-awaited

report says that differences in the number of nurses in a hospital

can strongly affect the chances of adverse outcomes such as

gastrointestinal bleeding, pneumonia and extra days in the hospital.

Given that some 30 million Americans are admitted to hospitals

every year, low nurse staffing could be a factor in thousands of

deaths annually, said the researchers.

``It says that we've put the nail in the coffin: It's going to

be awfully hard to say we don't need to be concerned about staffing

levels, or that these are just complaining nurses,'' said I.

Bueurhaus, a co-author of the report and an official at the

Vanderbilt University School of Nursing.

The project was directed by Jack Needleman, an assistant

professor at the Harvard School of Public Health, for the federal

Health Resources and Services Administration.

Commissioned several years ago, the study analyzed 1997 data

from more than 5 million patient discharges from 799 hospitals in 11

states.

``This study underscores why the Bush Administration budget

increases funding for nurse training programs,'' said Tommy G.

, secretary of health and human services. ``We have to take

action to address the emerging nurse shortage to protect the health

and well-being of all patients.''

In sifting the massive amount of data, the researchers looked

for medical outcomes that were better or worse as a result of a

higher or lower number of nurses - or a greater or lesser ratio of

registered nurses compared with less-skilled nurses. They found links

between these staffing variables and five adverse outcomes: urinary

tract infections, pneumonia, shock, upper gastrointestinal bleeding

and length of hospital stay in medical and major surgery patients.

Higher staffing was associated with a 3 to 12 percent reduction

in certain adverse outcomes.

Schildmeier, a spokesman for the Massachusetts Nurses

Association, said the study ``validates what we've been saying for

years - staffing does make a difference.''

The hospital industry, he said, has fought attempts in

Massachusetts to track staffing levels against patient outcomes.

On a typical medical or surgical floor, said Schildmeier, a

ratio of one nurse for every four or five patients is considered

appropriate. But these days in Massachusetts, the ratios are more

like one nurse to six or seven patients, ``and some days, nine or

10.''

The nurses union supports a bill that would require health care

facilities to maintain certain staffing levels, he said. California

passed such a bill in 1999.

But Buerhaus, the report's co-author, said, ``For lots of

reasons, mandating staffing levels is not a good idea. Not every

nurse is equal. I don't think (mandates) are a solution.''

(The Boston Globe Web site is at http://www.boston.com/globe/