By Leslie Miller, Associated Press, 06/19/01

BOSTON -- An acute shortage has left overworked and exhausted nurses fearful of losing their licenses and of being attacked by violent patients, according to a draft report of the Special Commission on Nursing and Nursing Practice obtained by The Associated Press.

The report is the result of hearings by a legislative commission investigating the nursing shortage and its effect on patient care, which result from cutbacks in Medicare and Medicaid, managed care, downsizing and restructuring.

"I am so close to being burnt out I am beginning to smolder," Shirley Webber, a registered nurse, told the commission.

The report said patients in health-care facilities with nursing shortages risk inadequate assessment of their conditions, increased infection, medication errors, skin problems, inadequate pain management and falls.

"It is the unanimous consensus of licensed nurses, health care personnel and administrators that the shortage of nursing care in the commonwealth is endangering the quality of care that our nurses can provide to the patient," the report's authors wrote.

Nurses fear violence, especially from psychiatric patients. The report cites a Centers for Disease Control statistic showing 73 percent of psychiatric nurses have been assaulted at least once.

One nurse recounted how she had been attacked by a patient: "My entire face was ground into the floor. Still blinded, I then felt a blow to the back of my head. ... I screamed as loudly as I could, but no one was around to help me," said the nurse, identified only as J.B.

Nurses fear they will lose their licenses because they make mistakes after they've been told to work overtime or take care of too many patients.

"Prospective nurses are aware that their entire career can be scrapped for a mistake made while deep into the fourteenth or fifteenth hour of their work day," the report said.

The shortage of nurses is expected to get worse between 2008 and 2010, the report said, citing testimony from the Massachusetts Hospital Association.

A smaller post-Baby Boom generation with more career options to choose from than older workers is the reason for the declining enrollment in nursing programs, according to testimony by Lorna R. Prince, president of the Massachusetts Organization of Nurse Executives.

The commission recommends finding ways to retain nurses and to recruit new ones through financial support and improved working conditions. It also recommends legislation to limit mandatory overtime and establish patient-to-staff ratios.

The Organization of Nurse Executives opposes legislated staffing ratios because it will not solve the problem of providing adequate care.

The commission said the state, which doesn't know how many nurses are licensed to practice, needs to keep better tabs on the number of nurses.

The Legislative Nursing Commission on Nursing and Nursing Practice is co-chaired by Sen. Robert Creedon, and Rep. Christine Canavan, a registered nurse. Both are Democrats from Brockton, where 435 Brockton Hospital nurses are entering the fourth week of a strike over the issues addressed in the report.