Hospital Staff Shortages Harm Patients

In some ways, nurses are like cops: They all have stories to tell that make you simultaneously grateful you do not have their job and relieved that someone competent does.

A commentary earlier this month in the New York Times written by Theresa Brown, an oncology nurse, warned about overtaxed nurses who have “too many cases, too many procedures to keep track of until one critical step, just one, slips through our frenetic fingers and someone gets hurt.”

She recounted a harrowing hospital tale when she was in nursing school. A nurse administered a higher dose of pain medication to a patient in need. It did ease the pain, but the patient’s breathing slowed and her oxygen level dropped. Brown advised the nurse that the patient might need Narcan, which reverses the effects of opioids.

But the nurse was in charge of eight patients on a medical surgery floor, and managing their care and all their paperwork was a huge time suck. She couldn’t administer the Narcan at that moment. Half an hour later, the patient had to be revived by an emergency team. “I held her hand while an anesthesiologist stuck a tube down her throat,” Brown wrote. “She ended up in intensive care.

“It would be easy to blame the nurse. How could she be too busy? But she was a good nurse, smart and committed. She simply had too much to do, too many acute needs to address. And then one, just one, got out of control.”

Nurses can’t be attuned to both critical care needs and clerical efficiency if they have too many patients. In addition, as Brown noted, even basic patient care is more complex than it used to be, “And as hospitals face increasing financial pressure,” she said, “nurse staffing often takes a hit, because nurses make up the biggest portion of any hospital’s labor costs.”

She referred to research conducted by Linda H. Aiken, a professor of nursing and sociology at the University of Pennsylvania, that showed how each additional patient under a nurse’s care over the established nurse-patient ratio made it 7% more likely that one of his or her patients would die. Aiken concluded that 20,000 people died a year because they were in hospitals with overworked nurses.

Brown also wrote that when hospitals are staffed adequately with bedside nurses, the number of patients injured by falls declines, as does the number of hospital-acquired infections, which kill 100,000 patients every year.

In acknowledgment of the problem and its consequences, two congressional representatives introduced the Registered Nurse Safe-Staffing Act of 2013. (See our blog, “Proposed D.C. Law Demands More Nurses in Hospitals.”)

Among other provisions, it requires hospitals to include their nurse staffing levels on Medicare’s Hospital Compare website and post their staffing levels in a visible place in every hospital.

The typical argument of tight hospital budgets makes passage of the legislation an uphill fight. Brown acknowledged that cost-benefit analyses are tricky to compute thanks to the confusing nature of health-care accounting systems, but she also said data suggests adequate staffing reduces hospital costs.

For example, how Medicare reimburses hospitals is based in part on their record of readmissions, and sufficient nurse staffing reduces the chance that hospital patients will have to be readmitted within 30 days of their initial discharge. Another Medicare measure is patient satisfaction scores; generally the more nurses, the more satisfied are the patients. And when overworked nurses burn out and are absent or quit, it costs money to hire and train their replacements.

“What [the] discussion of finances misses, though, is that having enough nurses is not just about dollars and cents,” Brown wrote. “It’s about limiting the suffering of human beings. When hospitals have insufficient nursing staffs, patients who would have gotten better can get hurt, or worse.”

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