Nursing Notes

March 18, 2011

When Nurse Staffing Drops, Mortality Rates Rise: Study

Filed under: Nursing — Shirley @ 4:12 am
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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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December 16, 2010

Medical Care in Pennsylvania: Nurse to Patient Ratios

The Great Seal of the State of New Jersey.
Image via Wikipedia

This is a short article I found on the Pennsylvania Law Monitor published by Stark and Stark Attorneys at Law.  I read it, twice.  I find that a 10 to 13% reduction in mortality rates is not something to be ignored.

Today, I watched the news about the side-drop baby crib problem where it was stated that the design of these beds had led to several (less than 100) deaths and now these beds are forbidden to be sold.  But a reduction of 10-13% mortality in hospitals is not okay?  Where is the sense of this?  Where is the public outcry. I understand that my example may be weak–after all we are talking about baby safety–but what about all the senseless deaths that are occurring daily because nurses cannot do the jobs they were trained to do.

When did it become okay for nurses to be the janitors, the transporters, the phlebotimists, the nurse’s aide, and the legal department?  Most nurses just want to be able to nurse patients.

Let me know what you think, won’t you?  This article was found here.


Pennsylvania Law Monitor

Posted at 8:06 AM on December 10, 2010 by Mary M. Labaree

In The Works
In Pennsylvania, House Bill 147 was introduced in January 2009 and remains “in committee.”  A similar version was sponsored in the PA Senate.  Among other provisions, they establish RN – to -patient ratios in the Commonwealth. Specifically, the legislation would establish the following minimums:

  • 1 nurse:1 patient – PR and trauma emergency units;
  • 1 nurse: 2 patients – Critical care, including emergency critical care and all ICUs, labor and delivery units, and post-anethesia units;
  • 1 nurse: 3 patients – Ante partum, emergency room, pediatrics, step-down and telemetry;
  • 1 nurse: 4 patients – intermediate care nursery and medical/surgical and acute care psychiatric units;
  • 1 nurse: 5 patients – rehab units;
  • 1 nurse: 6 patients – postpartum and well-baby nursing units

Why Should You Care?
Nurse-patient ratios can have a significant impact on patient outcome. A research study published in 2010 in the journal Heath Services Research, entitled “Implications of the California Staffing Mandate for Other States” by Linda Aiken, and others, compared 2006 data from three states, including Pennsylvania, New Jersey and California in terms of patient mortality and failure-to-rescue based on the nurse:patient variable.  California has long required a minimum ratio of nurses to patients. Pennsylvania’s bill  is still “in the works”.

The research found that nurses in California were assigned, on average, about one fewer patient each when compared to Pennsylvania and New Jersey.  This may not appear significant on the surface but, in fact, the ratio of nurses to patients correlated negatively with patient mortality.  In other words, the higher the ratio of nurses to patients, the lower patient mortality.  Even more disturbingly, in the med-surg areas, the difference in number of patients cared for was even greater for both Pennsylvania and New Jersey.

The researchers extrapolated the findings to ascertain whether changes in staffing for the two states, Pennsylvania and New Jersey, would materially impact mortality rates.  They predicted a reduction in mortality rates by 10.6 and 13.9 percent in Pennsylvania and New Jersey respectively.

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