What happens to patients when nurses are short-staffed or work with a high nurse-to-patient ratio?
The Truth About Nursing answers: “When nurses are forced to work with high nurse-to-patient ratios, patients die, get infections, get injured, or get sent home too soon without adequate education about how to take care of their illness or injury. So they return right back to the hospital, often sicker than before.”
What about the nurses? They get burnout from the physical and emotional exhaustion and drop out from the practice, further exacerbating the now global nursing shortage problem.
Here are the Facts
“Safe Staffing: The Registered Nurse Safe Staffing Act,” a 2012 study published by the American Nurses Association (ANA), says: “Massive reductions in nursing budgets, combined with the challenges presented by a growing nursing shortage have resulted in fewer nurses working longer hours and caring for sicker patients. This situation compromises care and contributes to the nursing shorting by creating an environment that drives nurses from the bedside.”
It found that high nurse-to-patient ratios have been associated with an increase both in terms of medical errors and in length of patient stay, as well as in the incidents of bedsores, cardiac arrests, accidental deaths, pneumonia and patient infections, including Methicillin-resistant Staphylococcus aureus (MRSA) infections. It also found that for each additional patient beyond four assigned to a registered nurse, the risk of death increases by 7% for all patients.
Numerous other studies have been cited to support the increasing clamor for more legislated state-mandated safe-staffing based on some minimum nurse-to-patient ratios, much like what California did back in 2004, including:
“Hospitals With Higher Nurse Staffing Had Lower Odds Of Readmissions Penalties Than Hospitals With Lower Staffing” by Matthew D. McHugh, Julie Berez and Dylan S. Small which found that “each additional nurse hour per adjusted patient day was associated with a 10% decrease in the odds of being penalized [[under The Affordable Care Act’] CMS Hospital Readmissions Reduction Program].”
“Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia” published by Lippincott Williams & Wilkins which found that “each additional patient per nurse was associated with the risk of within 30 days of readmission for heart failure (7%), myocardial infarction (9%), and pneumonia (6%).”
“Implications of the California Nurse Staffing Mandate for Other States” by Linda Aiken et al found that California nurses felt 15% and 20% fewer burnout symptoms when compared to nurses in New Jersey and Pennsylvania, respectively.
“Nurse Working Conditions and Patient Safety Outcomes” by Patricia W. Stone et al found that patients in hospitals with higher staffing levels were 68% less likely to acquire an infection, less likely to get ventilator-associated pneumonia and skin ulcers, and less likely to die within 30 days.
The 2012 “Survey of Registered Nurses: Job Satisfaction and Career Plans” by AMN Healthcare found that 31% of the nurses surveyed said they planned to make career changes in the next one to three years, with one-third of those surveyed considering careers outside of nursing altogether.
The fact is, there’s enough evidence to prove that inadequate staffing not only puts patients’ health at risk, it drives the nurses as well away from the practice of their profession.
Now more than ever, as baby boomers age and add to the demand for healthcare services, the concern for safe-staffing in hospitals has turned into a matter of even greater urgency.
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