Nurse understaffing harms patients
ONCE AGAIN, it's National Nurses Week -- the annual event that simultaneously manages to celebrate and compartmentalize the importance of nursing. While RNs certainly deserve recognition, Nurses Week sends a mixed message at best.
During this one brief period, nurses are heaped with praise for being devoted, self-sacrificing ''angels of mercy" whose role is essential to quality patient care. Then, during the rest of the year, those admirable qualities are endlessly exploited by healthcare administrators. Nurses are asked to work longer hours, caring for more patients, who are being assembly-lined through hospitals under cost-cutting conditions that many RNs regard as unconscionable and unsafe.
The result is more older nurses leaving their profession due to burnout and disgust and fewer younger people embracing it as a career choice.
The 23,000-member Massachusetts Nurses Association is seeking relief from understaffing through legislation it believes would also increase nurse recruitment and retention. The bill would limit the number of patients that hospitals can assign to any one nurse. Nurses on medical surgical floors would not be ordered to care for more than four patients. If the condition of particular patients required a greater amount of nursing care, managers would, of course, be free to improve the nurse-patient ratio.
Unfortunately, the Massachusetts Hospital Association opposes state-mandated staffing ratios of any kind. Many industry officials agree that nurses are overworked. But, according to Karen Moore, president of the Massachusetts Organization of Nurse Executives, ratios are a cure that's too ''radical and extreme."
Those two organizations say there is insufficient research available for the Legislature to determine appropriate nurse-to-patient staffing formulas in the many varied settings of local hospitals. At the same time -- to avoid government regulation -- the Hospital Association calls for voluntary establishment of nurse staffing plans in each hospital and urges them to disclose to ''patients, their families, and the public how clinical leaders determine the right nurse staffing levels to meet the medical needs of individual patients in every unit."
Greater information sharing is also the favored approach of Senator Richard Moore, who proposed his own alternative legislation requiring hospitals to ''post a nurse staffing plan that addresses patient nursing needs by identifying the appropriate number and mix of staff for each hospital, specific to each shift in the hospital inpatient units." Both Moore and the Hospital Association also want more hospitals to apply for what's called ''magnet status" -- a credential awarded to those institutions that offer RNs better working conditions and more of a voice in patient care decisions.
These ratio opponents are operating on the assumption that legislative mandates aren't necessary because market and/or magnetic forces will, by themselves, solve the problem of too few nurses caring for too many patients.
If ''magnet status" is achieved by some hospitals, the theory is that nurses will leave their jobs elsewhere and make a bee-line to better employers, solving the problem of the nursing shortage, at least in a few places. Meanwhile, consumer sovereignty will be restored everywhere. As Massachusetts Hospital Association President Ron Hollander explains, if each of his members publicizes its staffing figures, then patients themselves will be able to identify which hospitals provide better RN coverage and shop around accordingly. This in spite of the fact that employer-imposed ''managed care" networks restrict hospital choice in most group plans and that patients can hardly protect themselves from poor nurse staffing in mid-hospital stay.
Most puzzling of all is that the voluntary staffing levels Moore and the hospital association agree should be publicized to facilitate patient choice require somebody to make a private calculation, in each hospital, that ratio foes insist cannot be made accurately by the state.
Massachusetts nurses and the many consumer groups who support this bill have learned that voluntary compliance isn't sufficient as an industry-wide solution to the nursing crisis. The bill requiring mandatory minimum staffing levels has been introduced and reintroduced for the past 10 years. Meanwhile, the problems it could help alleviate have steadily gotten worse. If elected officials want to celebrate Nurses Week, they should finally pass the bill that would improve conditions for nurses and their patients.
Suzanne Gordon's new book is ''Nursing Against the Odds: How Health Care Cost-Cutting, Media Stereotypes, and Medical Hubris Undermine Nurses and Patient Care."
