Casting the issue as literally a matter of life and death, a study released Wednesday said that a shortage of nurses contributed to nearly a quarter of unexpected patient deaths and injuries in hospitals over the past five years, and called for immediate steps to fix the problem.
The study by the Joint Commission on Accreditation of Healthcare Organizations outlined what it calls a "nursing crisis," with 126,000 unfilled positions, and called on hospitals to better support nurses, to allow them more independence and to increase staffing levels. The study also pushes for more federal funding for nurse education and nursing services. If such measures are not taken, even more people will die, the study said.
In its most compelling finding, the study reported that inadequate nurse staffing has been a factor in 24 percent of the 1,609 cases involving death, injury or permanent loss of function reported since 1997 to the commission, which evaluates and accredits hospitals and health care networks.
"In the end, nurses are the primary source of care and support for patients at the most vulnerable points in their lives," the report states. "The need for solutions to this problem is particularly urgent."
The report helps illustrate the impact of an acute nursing shortage that, in California, is made all the more desperate by a forthcoming state law improving nurse-to-patient ratios. Bay Area hospitals are scrambling to attract and retain more nurses, agreeing to signing bonuses of as much as $5,000 and raises above 20 percent, to meet the ratio targets by July 2003.
Nationwide, 41 percent of nurses are not happy with their jobs, according to statistics cited in the report, with 22 percent planning to leave by the end of the year, primarily due to workplace stress. Amid the medical cost-cutting of the past decade, the report says, nurses lost much of their authority and have in many cases been replaced with less skilled workers.
Job dissatisfaction has been particularly acute among younger nurses, making it tough to ensure a future generation of skilled caregivers. The nursing shortage is all the more troubling, the group said, because it comes as 78 million baby boomers age.
The California Nurses Association, which recently threatened strikes at several Bay Area hospitals before winning pay increases and better pensions, said the call to action was long overdue.
"We are not surprised," said Jill Furillo, the association's director of government relations. "We go back on this issue to 1995. -- They are a little late."
In 1995, the nurses union compiled testimony for the National Institute of Medicine from more than 2,000 bedside nurses who said that patient care was threatened by hospital restructuring and the nursing shortage. Furillo said many of the hospitals that help run the joint commission have spent years ignoring nurses' concerns, only to now wake up and realize there will not be enough nurses if working conditions are poor.
"Thank God we had a Legislature that was listening to us and said, 'We believe the nurses,'" she said, referring to the nurse-to-patient ratios, which were voted into law in 1999.
Now, Furillo said, California has a lead in the national race to retain nurses and protect patients amid the nursing shortage. In fact, Furillo is disappointed that the report does not specifically call for mandatory nurse-to-patient ratios.
But the commission said that although the California plan has been endorsed by nurses' unions and has inspired consideration of similar laws in other states, it could do more harm than good.
"Mandated ratios may lead to greater numbers of bedside nurses, but this could be at the cost of fewer ancillary support staff," the report states. "In such a scenario, nurses, with more to do beyond the scope of nursing care, could still be thinly spread and even less satisfied with what they are being asked to do."
Ryan Tate is a general assignment business reporter. Reach him at 925-977-8568. The Associated Press contributed to this story.
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