Closer link made between nursing shortage, safety: comprehensive study, JCAHO panel say lives may be in danger

HealthCare Benchmarks and Quality Improvement, Oct, 2002

Sally Sample, RN, termed the current situation "untenable." As moderator of JCAHO's national nursing shortage roundtable, which also compiled the report, Sample cited a recent poll indicating that 40% of nurses are dissatisfied with their jobs. "And many are planning to leave nursing within the next year."

Nurses, she noted, are being described as the "canaries in the coal mine," this particular coal mine being the hospital workplace, "which needs immediate improvement." Cost-cutting, lack of adequate training, and a variety of workplace stresses are adding up to create high levels of job dissatisfaction among nurses, she said. As a result, nurses are not encouraging others to follow in their footsteps.

"What I hear from nurses, on a regular basis, is that they are struggling to do the best that they can, and some of the situations in which they are working are presenting barriers to them feeling satisfied in their ability to give good nursing care," observed Mary Foley, RN, immediate past president of the American Nurses Association, Washington, DC. She said nurses "don't feel valued" and they "don't want to work in an unsatisfactory environment," often featuring excessive levels of mandatory overtime hours.

O'Leary elaborated: "When nurses who work in hospital settings feel stressed, overworked, [and] undervalued, and they go home and tell their children and they tell their friends and neighbors--that's discouraging people from going into nursing as a career." And he noted the impact of increased competition for women professionals from other job sectors.

Nurses save money

Solving the problem will be much more difficult than identifying it, Needleman concedes. "Fixing that problem is going to require bringing more nurses into the hospital. There may be ways to restructure work, but efforts in the '90s [to do that] do not seem to have been very successful."

To some degree, he says, the idea that using fewer nurses will save hospitals money can be misleading. "There is some reason to believe that the cost of bringing in more nurses will be associated with savings, in terms of shorter lengths of stay, a reduction in the need to treat complications, and so forth," he notes. "I can't tell you whether there will be a full offset, but to the extent it isn't, in this climate it seems to me that the patient may not be prepared to play roulette with his health. Given that, patients will be willing to pay some of the increased costs through higher premiums and Medicare."

O'Leary in particular underlined the link between additional funding and patient safety. "We need to put new federal money into nurse staffing, and that should be driven off of the patient safety platform," he said, noting that in the past 25 years, public policy-makers have been subtracting resources from hospitals "and it's starting to have its effect."

But he said that any money put back into hospital health care should be done in a targeted fashion, "so that hospitals are [incentivized] to achieve quantifiable goals that are very much along the lines of patient safety, which is very closely related to nurse staffing."