"Shortage of nurses can be deadly"

March 28, 2004 -- Today the Deseret News (Utah) and other U.S. papers ran a long, generally good AP piece by Linda Johnson about the tragic effects of nurse short-staffing and recent efforts to address the problem, along with a useful AP companion item listing "some of the tasks nurses say regularly get skipped or delayed."

Johnson builds her discussion of the effects of short staffing and a survey of recent efforts to address it around the stories of two patients apparently injured by inadequate nurse staffing in Kansas hospitals. One patient was a 61-year-old woman who was misdiagnosed in the emergency department, then crashed on a floor with just two registered nurses for 42 patients, ending up living four more years "depressed, paralyzed except for one arm and unable to talk because a stroke during the ordeal had caused brain damage." The woman's daughter, at first "furious" with the nurses, has now "joined their cause, speaking out about the need for more nurses at the bedside." The other patient was a young mother who ended up paralyzed from the neck down after being admitted to a different hospital for a torn artery lining, which allegedly caused mini-strokes that nurses did not notice because they did not perform standard neurological checks.

The article backs up these stories by citing a 2002 Joint Commission on Accreditation of Healthcare Organizations report finding that a shortage of nurses was a factor in about one quarter of hospital injuries or deaths; the massive November 2003 Institute of Medicine report noting that long hours and fatigue contribute to errors; a large 2002 Needleman and Buerhaus study finding that preventable deaths and patient complication rates were "up to nine times higher in hospitals where most of the care was given by licensed practical nurses and aides, not better-trained RNs;" and the well-known 2002 study by Penn's Linda Aiken finding that post-surgical mortality rose seven per cent for each additional patient a nurse was assigned over four patients.

The story goes on to explore the reasons for the short-staffing and recent efforts to address it around the U.S. It reports that hospitals cite as reasons for short-staffing the shortage itself and financial pressures such as technology costs and cuts in reimbursements, noting that most hospitals oppose mandatory staffing ratios. Then--without quite making the point that many nurses say short-staffing is itself a principal reason for the shortage--the piece goes into a lengthy survey of the efforts of nurses to force hospitals to improve staffing, focusing on union struggles at particular hospitals and state legislative measures, especially California's new mandatory staffing law. The article reports that the California Nurses Association says the law has improved staffing, and that Kaiser Permanente has hired more than 3,000 new nurses in its 28 California hospitals to comply with the law, as well as giving nurses more input on policy and better training, which has reportedly reduced turnover. The piece describes efforts to recruit and train foreign nurses, as well as Johnson & Johnson's funding of an extensive nursing image campaign and fellowships to train more nursing faculty, who are also in short supply. The story ends on a hopeful note, reporting that the various efforts, along with the weak economy, are helping to entice non-practicing nurses back and recruit new ones, and that applications to nursing schools have risen "so much that students are turned away for lack of space or teachers." Though the piece could have provided more context as to reasons for the shortage--including hospital staffing cuts in the 1990's and continuing problems with the image of nursing--it is still a serious effort to describe the state of the shortage.

An AP item accompanying the article lists 10 tasks that nurses say are often delayed or skipped as a result of short-staffing. These include "[m]aking sure patients have adequate pain relief," "[d]oing thorough evaluations and follow-up checks on all patients, especially listening to critical lung and heart sounds," "[c]omforting distraught, lonely patients," and "[t]eaching patients and their famil[ies] how to deal with an illness when they go home." This item is a good primer on some of the important things nurses do (or should be able to do), and is especially helpful since a lack of public understanding of nursing is itself a critical factor in the current state of the profession.

See Linda A. Johnson's article "Shortage of nurses can be deadly: Hospitals are pressured to set limits on patient loads" in the March 28, 2004 edition of Salt Lake City's Deseret News. The article also appeared in Florida Today, the Suburban Chicago News, Chicago's Daily Herald, New York Newsday, Ft. Worth's Star-Telegram and others.