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Impact of the Nursing Shortage on Patient Care

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Recent Reports

  • Hospital Nurse Practice Environments and Outcomes for Surgical Oncology Patients
    In an article published in Health Services Research in August 2008, Dr. Christopher Friese and colleagues found that nursing education level was significantly associated with patient outcomes. Nurses prepared at the baccalaureate-level were linked with lower mortality and failure-to-rescue rates. The authors conclude that "moving to a nurse workforce in which a higher proportion of staff nurses have at least a baccalaureate-level education would result in substantially fewer adverse outcomes for patients."

  • Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes
    In a study published May 2008 in the Journal of Nursing Administration, Dr. Linda Aiken and colleagues confirmed the findings from her landmark 2003 study (see below) which show a strong link between RN education level and patient outcomes. Titled "Effects of Hospital Care Environment on Patient Mortality and Nurse Outcomes," these leading nurse researchers found that every 10% increase in the proportion of BSN nurses on the hospital staff was associated with a 4% decrease in the risk of death.

  • Impact of Hospital Nursing Care on 30-day Mortality for Acute Medical Patients
    In the January 2007 issue of the Journal of Advanced Nursing, a new study validates the findings of Dr. Linda Aiken and others that baccalaureate-prepared nurses have a positive impact on lowering mortality rates. A research team led by Dr. Ann E. Tourangeau from the University of Toronto and the Institute for Clinical Evaluative Sciences in Ontario, Canada, studied 46,993 patients admitted to hospital with heart attacks, stroke, pneumonia and blood poisoning. The authors found that: "Hospitals with higher proportions of baccalaureate-prepared nurses tended to have lower 30-day mortality rates. Our findings indicated that a 10% increase in the proportion of baccalaureate prepared nurses was associated with 9 fewer deaths for every 1,000 discharged patients."

  • Is the Shortage of Hospital Registered Nurses Getting Better of Worse?
    In the March-April 2005 issue of Nursing Economic$, Dr. Peter Buerhaus and colleagues found that more than 75% of RNs believe the nursing shortage presents a major problem for the quality of their work life, the quality of patient care, and the amount of time nurses can spend with patients. Looking forward, almost all surveyed nurses see the shortage in the future as a catalyst for increasing stress on nurses (98%), lowering patient care quality (93%) and causing nurses to leave the profession (93%).

  • National Survey on Consumers' Experiences with Patient Safety and Quality Information
    In November 2004, results from this national survey found that 40% of Americans think the quality of health care has worsened in the last five years. Consumers reported that the most important issues affecting medical error rates are workload, stress or fatigue among health professionals (74%); too little time spent with patients (70%); and too few nurses (69%). This survey was sponsored by the Kaiser Family Foundation, the Agency for Healthcare Research and Quality and the Harvard School of Public Health.

  • Research in Action: Hospital Nurse Staffing and Availability of Care
    In March 2004, the Agency for Healthcare Research and Quality (AHRQ) issued a synthesis of nursing research studies that details the impact that staffing levels, staff mix, and education levels have on patient outcomes. The report cites studies showing that hospitals with lower nurse staffing levels and fewer registered nurses compared with licensed practical nurses or nurses' aides tend to have higher rates of poor patient outcomes.

  • Keeping Patients Safe: Transforming the Work Environment
    Publishing in November 2003, this Institute of Medicine calls for substantial changes in the work environment of nurses in order to protect patients, including changes in how nurse staffing levels are established and mandatory limits on nurses' work hours. Despite the growing body of evidence that better nurse staff levels result in safer patient care, nurses in some health care facilities may be overburdened with up to 12 patients to care for per shift. Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, diminishes attention to detail, and contributes to errors.

  • Educational Levels of Hospital Nurses and Surgical Patient Mortality
    New research indicates that a shortage of registered nurses prepared at the baccalaureate and higher degree level is endangering patients. In an article in the September 24, 2003 issue of the Journal of the American Medical Association, Dr. Linda Aiken and her colleagues at the University of Pennsylvania found that patients experience significantly lower mortality and failure to rescue rates in hospitals where more baccalaureate-prepared nurses provide direct patient care. At least 1,700 preventable deaths could have been realized in Pennsylvania hospitals alone if baccalaureate-prepared nurses had comprised 60% of the nursing staff and the nurse-to-patient ratios had been set at 1 to 4. Unfortunately, only 11% of PA hospitals have more than 50% of the nursing staff prepared at the baccalaureate level.

  • Views of Practicing Physicians and the Public on Medical Errors
    A survey reported in the December 12, 2002 issue of the New England Journal of Medicine found that 53% of physicians and 65% of the public cited the shortage of nurses as a leading cause of medical errors. Overall, 42% of the public and more than a third of U.S. doctors reported that they or their family members have experienced medical errors in the course of receiving medical care. The survey was conducted by the Harvard School of Public Health and the Henry J. Kaiser Family Foundation.

  • Hospital Nurse Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction
    According to a study published in the October 23/30, 2002 issue of the Journal of the American Medical Association, more nurses at the bedside could save thousands of patient lives each year. Nurse researchers at the University of Pennsylvania determined that patients who have common surgeries in hospitals with low nurse-to-patient ratios have an up to 31% increased chance of dying. Funded by the National Institute for Nursing Research, the study found that every additional patient in an average hospital nurse's workload increased the risk of death in surgical patients by 7%. Having too few nurses may actually cost more money given the high costs of replacing burnt-out nurses and caring for patients with poor outcomes.

  • Health Care at the Crossroads: Strategies for Addressing the Evolving Nursing Crisis
    Released in August 2002 by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the authors found that a shortage of nurses in America's hospitals is putting patient lives in danger. JCAHO examined 1,609 hospital reports of patient deaths and injuries since 1996 and found that low nursing staff levels were a contributing factor in 24% of the cases.

  • Nurse Staffing Levels and the Quality of Care in Hospitals
    According to a study published in the New England Journal of Medicine in May 2002, a higher proportion of nursing care provided by RNs and a greater number of hours of care by RNs per day are associated with better outcomes for hospitalized patients. This extensive study was conducted by Drs. Jack Needleman and Peter Buerhaus.