Nursing Notes

March 18, 2011

When Nurse Staffing Drops, Mortality Rates Rise: Study

Filed under: Nursing — Shirley @ 4:12 am
Tags: , , , ,

Here’s an article I found in my email this morning.  This article simply states what we nurses have always known.  If we don’t have time to see our patient due to staffing shortages, then we don’t have time to do nursing for our patients.

People today don’t come into the hospital for a “rest cure” like they did 50 years ago.  Today you need to really be sick or at death’s door figuratively (or literally for ER and ICU) to even be admitted to a hospital.  When you have critically ill patients to care for, there is a minimal amount of time involved to simply provide basic care and assessment; but when you have 7 or 8 critically ill patients how much time do you think you get to spend with each one during a standard 8 hour shift.  Let’s not even consider charting, answering the phones, talking to doctors and pharmacy, getting lab results, etc.  Let’s just consider time to look at and observe your patient; time to interact with the patient and the family to gather pertinent information about the patient’s condition prior to the current crisis.

Since I am a psychiatric nurse, you may think that this all does not apply.  However, today for a person to actually be admitted to a psychiatric facility, they MUST be in imminent danger to self or others.  In plain English, that means they actively want to kill themselves or plan to hurt/maim/kill someone else.  When you have 8 or 9 of these types of patients to observe and medicate as well as a milieu to manage to maintain everyone’s safety because all of these patients are up walking around in the day area,  there is very little time to actually spend working with your patients.

Here is the article I got this morning from the ANA.  The article is from the Health Day website.  Interesting, don’t you think?


Experts say finding shows clear link to patient safety

By Amanda Gardner
HealthDay Reporter

WEDNESDAY, March 16 (HealthDay News) — When nurse staffing levels fell below target levels in a large hospital, more patients died, a new study discovered.

The finding may provide guidance in an era of nursing shortages and cost-cutting, in that the focus should shift from cost to patient safety, said the authors of the research, appearing in the March 17 issue of the New England Journal of Medicine.

“Hospitals need to know what their nursing needs are for their patients, and they need to bring staffing into line,” said study senior author Jack Needleman, a professor of health services at the School of Public Health of the University of California Los Angeles.

“Patients are entitled to be safe in the hospital and to have care delivered reliably and to have nurses with enough time to make sure they aren’t developing avoidable complications with permanent consequences,” Needleman said.

Previous research has suggested that this might be the case, but many of those studies were dismissed in part because of methodology flaws.

“People had thought maybe [adverse consequences] were due to something else, maybe the quality of the nurses, quality of the doctors, technology, equipment or the hospital doesn’t have a commitment to quality,” Needleman explained.

For this study, the authors looked at almost 200,000 admissions and about 177,000 nursing shifts at 43 patient units at one hospital that generally had high staffing targets.

Presumably, different areas of the hospital had the same quality of nurses, doctors, technology and equipment, thus eliminating these factors as the source of problems.

Units were considered properly staffed if nursing staffing fell within eight hours of the target level.

When units were understaffed, patient mortality increased by 2 percent. On average, a patient stayed in the hospital for three shifts and when they were all understaffed, mortality rose by 6 percent.

And when nurses had to work harder because of high patient turnover on their unit, the mortality risk increased by 4 percent.

“A telling outcome is that they looked at a hospital that really had pretty good staffing levels and they still found that there was a difference,” said Sharon Wilkerson, dean of the Texas A&M Health Science Center College of Nursing in Bryan. “When I think about the number of hospitals that do not maintain good staffing levels, either because they can’t find the nurses or maybe they’re rural or they’re just aren’t as many people they can hire, that’s even more frightening.”

The authors believe the findings…[click here to read the rest]


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1 Comment »

  1. This is a great article, Shirley. I wonder what the statistics would be if we looked at not only mortality, but also adverse events and outcomes. Patients dying because of understaffing is, of course, the worst possible scenario. I suspect the numbers would be even higher if we included adverse events, hospital acquired infections, med errors, etc. that may not result in death, but can certainly impact recovery and quality of life.

    Comment by kitchrn — March 18, 2011 @ 4:25 am | Reply

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