By Molly M. Ginty
Tuesday, November 23, 2004
Medical experts warn that a national nursing staff shortage is putting Americans' health at risk.
(WOMENSENEWS)--In Denver, 78-year-old Mary Heidenreich died when a nurse who had flunked a medication competency test accidentally gave her a fatal dose of intravenous drugs.
In Wichita, Kan., 38-year-old Deedra Tolson bled to death after an emergency hysterectomy when her nurse, busy caring for 12 other patients, failed to hear her feeble cries for help.
In Alliance, Ohio, 30-year-old Lisa Vitale was waiting to give birth when she felt searing pain rip through her abdomen. An overworked nurse misread Vitale's fetal monitoring strip and failed to notice that her baby was in serious distress. Born hours after an emergency cesarean section could have saved his health, Vitale's son suffered severe brain damage that left him unable to drink from a bottle and required round-the-clock medical care.
All three of these tragedies struck within the past decade--and all three have been attributed to problems with nursing, a field where 94 percent of the nation's 2.7 million workers are female.
Some 126,000 nursing positions in the United States are unfilled and the lack of staff is putting patients' health in grave danger, according to a 2004 report by the Joint Commission on Accreditation of Healthcare Organizations, a nonprofit health care monitoring group based in Oakbrook Terrace, Ill. The report found that nursing shortages are responsible for 19 percent of medical errors resulting in death or serious injury, and that more than 90 percent of nursing homes lack a sufficient number of health care workers to provide even the most basic care.
"Unless we address the nursing shortage now, we face a future in which patient safety and health care quality will be significantly compromised," says Dr. Dennis S. O'Leary, the commission's president.
Health care experts blame the nursing shortage on pervasive changes to the medical industry that haven taken place over the past decade. Since the 1990s, there have been dramatic technological improvements in health care. There are more diagnostic tests to run, more medications to administer and more machines to monitor. Care is becoming more specialized, requiring a greater number of nurses and nurses with more comprehensive training. Nursing has consequently become one of the five the fastest-growing professions in the United States, according to the Washington, D.C.-based Department of Labor
Even though the need for nurses is growing, many hospitals are making staffing cuts. In 1997, the Balanced Budget Act slashed the amount of money that Medicare, a government-funded health insurance program, reimburses to hospitals.
Throughout the 1990s, health maintenance organizations, known as HMOs, gained prominence and started pressuring hospitals to cut corners.
"In response to reduced hospital stays mandated by HMOs, hospitals thought they could reduce the number of nurses they employed," says Dr. Linda Aiken, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing in Philadelphia. "They started cutting their nursing staffs just when they needed to increase them."
To save money, hospitals not only let nurses go, but began replacing registered nurses with less-qualified, lower-paid licensed practical nurses and nursing aides. The remaining registered nurses had to cope with heavier workloads, mandatory overtime, and inflexible schedules--problems that turned would-be nurses away from the profession.
From 1995 to 2003, reports the Chicago-based National Council of State Boards of Nursing, Inc. the number of nursing school graduates taking the national licensing exam for registered nurses plummeted 20 percent. Established nurses began working as home health care aides or taking other jobs where they could continue earning $45,000 to $80,000 per year but suffer far less stress.
Now, 83 percent of nurses who have remained in the profession have experienced a recent spike in the number of patients under their care, according to a 2001 study by the University of Pennsylvania. "Some nurses are looking after 20 patients at once," says Aiken. "They're beginning to think their jobs are impossible because they simply can't provide quality care."
The challenge has taken a physical toll, causing nurses to develop chronic back pain and repetitive stress injuries. It's taken a psychological toll, making them feel harried and overwhelmed. The study says 41 percent of nurses are dissatisfied with their jobs and 43 percent suffer from burnout. In addition, 75 percent of nurses believe the quality of care at their hospitals is declining, and 40 percent would not feel comfortable having a family member cared for at their facility, according to a 2001 survey by the Washington, D.C.-based American Nurses Association.
On the national level, health care advocates are working to address the nursing shortage with sweeping policy changes. The Joint Commission on the Accreditation of Healthcare Organizations is recommending that the federal government provide hospitals with funding for more nurses. The American Nurses Association is lobbying Congress to pass the Safe Nursing and Patient Care Act, which would severely limit mandatory overtime. The nurses' association is also urging hospitals to apply for its magnet recognition program
--a form of volunteer accreditation for excellence in nursing that keeps industry standards high.
On the state level, legislators are also doing their part. California recently mandated a ratio of no more than six patients to every nurse. Ten states have limited overtime for nurses and 20 more states are considering similar measures.
On the local level, individual health care organizations are drumming up their own solutions. At San Antonio Community Hospital in Upland, Calif., a special errand service helps nurses working 12-hour shifts do their dry cleaning, film developing and laundry. At Columbia-Presbyterian Medical Center in New York City, a one-armed robot hands instruments to doctors during surgery, freeing up nurses who normally perform this function to spend more time with patients.
At Our Lady of Lourdes Medical Center in Camden, N.J., nurses "bid" for extra shifts that go to those who offer the lowest wages for their work. "The bidding system guarantees that patients have enough nurses to care for them," says Miriam Ziegler, a critical care nurse at Lourdes who is working 48 hours per week under the new system instead of her usual 36. "It helps nurses earn up to double their usual salary. And it helps the hospital because there's no need to pay $50 an hour to hire an outside nurse from a staffing agency."
Though these solutions may be promising, health advocates warn that far more must be done. The American Hospital Association says 13 percent of nursing positions nationwide are vacant today and 20 percent are likely to be vacant by 2015. Nursing is about to face a new health crisis as 78 million aging Baby Boomers place unprecedented demands on our health care system.
"Hospitals have a history of being inflexible when it comes to the nursing staff shortage," says Aiken. "But our health should not have to suffer from a lack of innovation."
Molly M. Ginty is a freelance writer based in New York City.
University of Pennsylvania--Center for Health Outcomes and Policy Research: