Nursing Notes

October 1, 2009

Too much expected of too few nurses (2007)

Here is an article written in 2007 by Kevin T. Kavanagh, MD. It appears that staffing ratios have long been an issue and actually may be contributing to the current nursing shortage. Please go on to read the entire article because he talks in specifics about how increased patient load adversely affects nurses’ ability to protect their patients. He also talks about the law in Kentucky for reporting suspected cases of abuse, neglect or exploitation of adults or children to the Department of Community Based Services. He explains why this is not always done in the best interest of the nurse, doctor or social worker due to the ability for retaliation against them.

If this situation has been known and allowed to continue since before 2007, that really does say something about the power and clout the hospital lobbyists must carry.

Health Watch USA
Promoting Healthcare Quality, Access & Affordability
No one should ever underestimate the importance of registered nurses. With-out them, there could be no hospitals or nursing homes. The existence of these facilities is solely to provide nursing care. Home health agencies, surgery centers, imaging centers and urgent treatment centers can do the rest.
“How well we are cared for by nurses affects our health, and sometimes can be a matter of life and death,” said an Institute of Medicine report which estimated in 2002 as many as 98,000 patients die each year from medical errors. The National Consumer League reported (2004) that almost half of patients or patient families believed patient care was compromised to some extent by hospital staffing with too few nurses. Twelve percent believed the care was very or ex-tremely compromised.

Aiken reported in the Journal of the American Medical Association found that as a nurse’s patient load doubled from four to eight, the chance of patient death increased 31 percent, and Leape (JAMA, 1995) also reported that nurses were responsible for 86 percent of all interceptions of medical errors.
I would bet errors are more likely caught by a nurse responsible for four to six patients than one trying desperately to take care of eight to 10 patients.

In 2002, low nurse staffing levels were a factor in 24% of all sentinel events which resulted in death, injury or permanent loss of function, according to the Joint Commission (JCAHO), the largest agency which accredits hospitals and guards patient safety . Care the Joint Commission said, “is literally being left undone.” Despite the Joint Commission’s landmark study on the importance of adequate nurse staffing to insure patient safety, the Commission’s ability to assure a high standard of care in hospitals is now questioned.

On June 15, 2006, the American Nursing Association filed suit against the US Department of Health and Human Services for the failure to assure adequate nursing staffing in hospitals. The suit alleges that the Joint Commission’s “nursing standards are totally devoid of standards and requirements concerning the immediate availability of a registered nurse to render bedside care to the patients.” Because of the breakdown of the medical quality assurance, California became the first state to mandate minimum nurse to patient staffing ratios. General medical and surgical floors must have a ratio of 1 to 5 or greater and intensive care units a ratio of 1 to 2 or greater.

With the advent of adequate nurse staffing, the California Nurses Association reported that the California nursing shortage disappeared with a 60% increase in registered nurse licensure applications and a 20% increase in actively licensed registered nurses.>>read more here


1 Comment »

  1. Nice! I wrote a blog on “A Nurse’s Life is No Bed of Roses,” focusing more on the interferences nurses experience while caring for people, & in more detail.

    Regulatory agencies need to look into a new trend – that of closing open nursing positions (via closing them when someone quits, putting the new hire into an open position, continue until you’re “fully staffed” but have fewer positions – & fewer nurses – than ever). Without ratios, I don’t believe it will be possible for regulatory agencies to have an objective measure of whether or not a facility’s staffing is adequate. Certainly, if all they look at is how many open positions are filled, they won’t have a sense of how safe the care actually is. I wish we could get them on board; that we could get them to see that ratios would help them keep their jobs & justify their existence, because regulatory agencies can close hospitals if they don’t comply – so they get what they want. How they can be so blind, I’ve no idea – but I have seen this & heard of it occurring. It’s just kept a huge secret, & telling on them gets you fired.

    I also believe the judicious use of disabled nurses – i.e., ones who can’t take long hours standing/walking but could do things like admissions, patient education, etc. – will have to occur; disabled nurses can still give value & can ease the burden. Right now, the idea of “allowing” an injured or disabled nurse to “do something easy” while other nurses are running up & down long halls & lifting heavy patients, grates on them. We have to find some way to collaborate. Plus, it’d be really nice if there was some way to break hospitals of the long-hallway habit when they build or add on to a facility.

    I also believe firmly that nursing ratios will bring healthy nurses back to the bedside. No one wants to lose everything because they were taking care of 10 patients on days and 2 crashed at the same time, at opposite ends of the hallway, while the other nurses were taking care of people trying to prevent them from crashing. It’s not only possible, it’s likely happened. And if I’m right, I’d bet the nurse was likely fired, possibly even faced BON investigation or action against their license, so we don’t hear about a defective system, we hear about a “bad nurse.”

    I hate unions, but at this point, I believe we won’t be able to achieve ratios any other way. It was hard enough in CA with the unions working at it, & they still have to fight from what I am seeing. The only other way to prove the need is to allow us to bill for our services instead of having our care bundled with room & board. We’re professionals. And hospitals would get far better reimbursement if we could bill for what we do.

    Comment by nerdse — October 5, 2009 @ 11:10 am | Reply

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