Nursing Shortage National Concern

Aug. 7, 2002 — -- Tens of thousands of hospital deaths every year can be blamed on a nationwide nursing shortage, according to a report released today by the Joint Commission on Accreditation of Healthcare Organizations.

The private commission, which inspects and accredits hospitals, believes that a lack of nurses is to blame for thousands of deaths caused by problems such as medication errors, patient falls, and hospital infections.

Of the 1,609 "adverse" events, or unexpected problems, that hospital officials reported between January 1996 and March 2002, 24 percent took place in part because hospitals had an insufficient number of registered nurses on the job, the report says. Findings were based on each hospital's assessment of unexpected deaths and serious physical or psychological harm patients suffered during their hospital stay.

Nurse staffing levels were found to contribute to 50 percent of ventilator-related incidents, 42 percent of surgery-related incidents, 25 percent of transfusion incidents, delays in treatment, and infant abductions, 19 percent of medication errors, 14 percent of in-patient suicides, and 14 percent of patient falls.

"When nurses care for more patients than they can handle, patients that are sicker than nurses used to care for five years ago, or they may be asked to do extra shifts, sooner or later, you get stressed, you get tired, you get more vulnerable to making mistakes," said Dr. Dennis O'Leary, president of the Joint Commission on Accreditation Health Care Organization. "I think there's been knowledge of the growing seriousness of the nursing shortage. Our data really underscores the urgency of trying to turn this problem around. And I do think there is an opportunity to turn it around."

Judith Andre, professor of ethics at the Center for Ethics and Humanities at Michigan State University, agrees that the shortage was predictable, but believes the report will finally force hospitals to pay attention.

"The fact that the problem is phrased in terms of patient deaths should make an impression on the general public. The problem is deep-rooted and has been growing for years. Some causes of the problem are also causes of its being ignored. Up until now, nursing was 'women's work,' unnoticed except in its absence, and generally underrated," she said.

However, after reviewing the data, one doctor is critical of the commission's report.

"It's ironic that the JCAHO folks are leading the parade of concern since their ever-growing regulations keep forcing hospitals to divert more and more nurse time from patient care to paper shuffling and documentation upon documentation," said Dr. John Sbarbaro, professor of preventive medicine at the University of Colorado Health Sciences Center. "All of which, in addition to reducing patient care, drives the cost of a hospital day up, and when payers won't cover the indirect overhead, the direct care nursing staff gets reduced."

Karen Stefaniak, chief nursing officer at the University of Kentucky in Lexington, says the conclusions appear valid, but also questions the reporting system that led to the findings.

"The JCAHO reporting system is a voluntary reporting system and does not represent all adverse occurrences nor the analysis of these occurrences," she said.

Stefaniak points out that while there are many variables that go into poor patient outcomes, including poor communication, failure to follow established policies and procedures, and other health care staffing shortages, many hospital problems do stem from the nursing shortage.

"Nursing is involved with nearly all patient care activities in some fashion, directly or indirectly. Therefore, of course, the shortage of these vital people is key to patient outcomes as recent research has clearly demonstrated," she said.

The report says there are 126,000 nursing positions unfilled in hospitals nationwide. Ninety percent of long-term care organizations lack sufficient nurses "to provide even the most basic care" and some home-health care agencies are being forced to refuse new patients.

With the aging of the nation's baby boomers and nurses themselves, it has been estimated that by 2020 "there will be at least 400,000 fewer nurses available to provide care than will be needed," the report says.