Forensic Psychiatry & Medicine

Managed Health
Care & Malpractice

Patient Deaths Tied to Lack of Nurses



August 8, 2002
By SHERYL GAY STOLBERG
New York Times

WASHINGTON, Aug. 7 - Calling a shortage of nurses "a prescription for danger," the national organization that accredits hospitals reported today that the lack contributed to nearly a quarter of the unanticipated problems that result in death or injury to hospital patients.

The shortages have been a perennial problem, and hospitals have taken the position that the lack of staff members does not harm patients. But experts said today's report, by the Joint Commission on Accreditation of Healthcare Organizations, added to a growing body of evidence that links the shortage to ill health.

"Nursing staffing is low in many institutions, and patients are being hurt by it," said Dr. Jack Needleman, an economist at the Harvard School of Public Health who was not involved in the commission's report. "Now we need to move from arguing over whether that is the case to discussing how we can fix it."

The commission's finding utilized its "sentinel event" reporting system, a computer database that includes 1,609 reports of patient deaths and injuries since 1996.

Those reports include detailed explanations from hospitals, and when commission officials analyzed them, they found low levels of nursing staff were cited as a contributing factor in 24 percent of the cases.

"This data was so compelling," said Dr. Dennis S. O'Leary, the commission president. "We knew that some unanticipated deaths and permanent loss of function were related to inadequate numbers of nurses, but 24 percent surprised everybody."

More than 126,000 nursing positions - about 12 percent of the total - are vacant today, and the commission warned that the situation might worsen. As a group, nurses are aging - only 12 percent of registered nurses are younger than 30, the report said - and many more people are leaving the profession than entering it.

At the same time, today's hospital patients are sicker than those in previous years, so the demands on nurses are rising, said Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania.

A recent report in Pennsylvania found 50 percent less nursing care available to patients today than in 1980, Ms. Aiken said.

Several factors contribute to the nursing shortage. Hospital mergers, and the ensuing cost-cutting and heavy workloads have prompted many nurses to leave the profession. The American Hospital Association recently called on its members to make recruiting and retaining nurses a priority.

"I don't agree that patients' lives are in danger," said James Bentley, a senior vice president of the hospital association.

Still, Mr. Bentley said, hospitals ought to be concerned about "the number of nurses who feel overstressed, overworked, worried that they're not able to spend enough time with the patient."

The shortage has drawn attention in Washington. Last month, Congress passed the Nurse Reinvestment Act, which authorizes financial aid programs for nursing students; President Bush signed the bill into law last week. Congressional aides estimate that the assistance will cost more than $30 million from 2003 to 2007.

But Dr. O'Leary said the new law did not go far enough. "I sure hope Congress doesn't think it's done with this issue," he said. "We need substantially greater investment."

The commission called for improvements to the nursing education system, and for the federal government, which reimburses hospitals through Medicaid and Medicare, to tie the payments to a hospital's performance in improving nursing care.

It also said hospitals must improve the work environment for nurses, a recommendation that Mary Foley, a past president of the American Nurses Association, applauded, saying: "What I hear from nurses on a regular basis is that they are struggling to do the best that they can. They talk about the long hours of work, particularly mandatory overtime practices."

The report cited surveys showing that nurses were unable to keep up with the demands placed on them.

In one survey of nurses describing their last shifts, 31 percent said their patients did not receive necessary skin care, 20 percent said patients did not receive oral care, and 28 percent were not able to provide patients and their families with necessary education and instruction.

"Care is literally being left undone," the report said.

Courtesy of The New York Times

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