All RN Ratios Save Lives…and
Slow The Exodus Of RN’S From Hospitals
Safe
staffing by registered nurses produces dramatic cuts in patient
mortality
and is a key element in stemming the flood
of RNs from our nation’s hospitals. Up to 20,000 patient
deaths each year may be linked to unsafe RN staffing levels,
according to the Journal of the America Medical Association.
A
study by one of the nation’s most prominent researchers
provides the most definitive link yet between safe RN-to-patient
rations and patient mortality.
For each additional patient assigned to an RN, there is a
7 percent increase in the likelihood of death within 30 days
from a complication not present upon admission to the hospital-
as recorded by Linda Aiken, RN, Ph.D. and colleagues, in the
October 23/30 issues of the Journal of the American Medical
Association.
“Our results document sizable and significant efforts
of registered nurse staffing on preventable deaths,” Aiken
wrote.
Examining patient discharge records and existing RN staffing
rations in Pennsylvania hospitals over 18 months, the JAMA
study found a 31% increase in mortality rates between general
medical units where RNs had 8 patients compared to units where
they had 4 patients.
For
each additional patient the study also found a 23 percent
increase
in RN burnout and a 15 percent increase in job dissatisfaction – major
causes of the hospital RN shortage.
Why All-RN Ratios?
Safer Care
Research over three decades documents the therapeutic effect
of RNs on patient outcomes. A wave of new studies directly
links safe RN staffing to reduced rates of patient deaths,
post-operative complications, including respiratory failure,
urinary tract infections, pneumonia, shock, upper gastrointestinal
bleeding and hospital lengths of stay.
The
new studies coincide with the market-driven cuts in services,
decline in patient care standards, reports of growing numbers
of avoidable hospital patient deaths, and the hospital nursing
shortage. As John Hoyt, MD, director of the ICU at Mercy Hospital
in Pittsburgh and a leading expert on reducing medical errors,
said in January, 2002, “the greatest impact on patient
outcome in ICU staffing.” Hoyt recommended that patients
and families always ask, what is the RN-to-patient ratio?
Sicker Patients
Today’s
patients are more ill than ever. They require more intense
and complex care, and they need the analytical
skills, knowledge and expertise of a registered nurse. Patients
who just a few years ago were in intensive care can now be
found on virtually every floor of a hospital today.
Stemming the Shortage
Headlines trumpet the worst hospital nursing shortage in decades.
The origins of the current crisis are a decade of the failed
policies that drove scores of RNs out the hospital door. RNs
will not stay in hospitals that compromise care and threatened
their patients, their licensure, and their own well being.
Turnover rates for RNs continue to skyrocket.
But RNs will come back to the hospital bedside, frustrated
RNs will stay on the job, and new graduates will choose hospital
nursing with the implementation of all-RN ratios coupled with
effective retention and recruitment programs.
The best evidence comes from Victoria, Australia, where ratios
were enacted in 2001. By February 2002, the full-time RN workforce
had increased by 16.5 percent.
Where Will We Find The RNs?
Safe RN staffing ratios are an essential component of the
cure for the hospital nursing shortage, along with effective
programs to persuade experienced RNs to remain at the bedside,
convince RNs who have left the hospital setting to return,
and restore the image of nursing as an attractive and fulfilling
career.
Today’s
shortage is the direct product of 10 years of the failed
policies of market-driven medical care that included
reckless downsizing and displacement of RNs with unlicensed
staff. In 1995-1996 alone, hospitals laid of 40,000 RNs across
the US and replaced them with 100,000 other staff, according
to a Vanderbilt University study.
Other frustrated RNs simply voted with their feet, unwilling
to work in hospitals they felt endangered their patients and
their own well-being.
Stop the hemorrhaging of RNs
Despite a variety of gimmicks to attract nurses, from huge
sign-on bonuses to lawn care service, RN turnover rates are
at their highest mark in decades. Nurses will not remain in
unsafe hospitals.
The
percentage of RNs who work in hospitals is declining steadily,
from
68% in 1988 to about 59% now. One-third of nurses under
30 plan to leave their job within a year due to poor conditions,
according to a National Institutes of Health-funded study last.
But numerous reports affirm that RNs will remain in hospitals –or
return- if they can practice their profession safely.
Ratios Are Cost-Effective For Public and
Private Hospitals
Despite the doom-and-gloom predictions of the hospital industry,
safe RN ratios will produce cost savings for hospitals in reduced
spending on temporary RNs and overtime costs, lower RN turnover
and improved patient outcomes.
Shorter patient lengths of stay
A 2001 Harvard School of Public Heath study cites a 3% to
6% shorter length of stay for patients in hospitals with a
high percentage of RNs (Nurse Staffing and Patent Outcomes
in Hospitals, bhpr.hrsa.gov/dn/staffstudy).
Similarly, Johns Hopkins University researchers found that
hospitals with fewer RNs in intensive care units at night incurred
a whopping 14% increase in costs (American Journal of Critical
Care, November 2001).
Huge savings on temporary RN staff
Hospitals across the US spent $7.2 billion in 2001 and were
projected to spend $10.6 billion nationally for temporary employees
in 2002 (New York Times, July 17, 2001). Fletcher Allen Health
care spent over $7 million on travelling nurses in Fiscal Year
2001.
Hospitals say they pay registry-recruited RNs about $10 more
per hour than permanent employees, and registries typically
seek to raise rates every six months (East Bay Business Times,
August 21, 2000).
Travel nurse companies charge hospitals $40 to %40 an hour,
and more in high cost cities- sometimes double the average
pay rate for staff RNs (Albany, NY, Times Union, August 4,
2001).
Cutting RN turnover costs
With frustrated RNs leaving the hospital setting due to short
staffing and eroding patient care standards, hospital RN turnover
is at a record, and very costly level.
Hospitals spend about $42,000 to replace each general medical
and surgical unit RN, and $64, 000 to replace each specialty
RN (Journal of the American Medical Association, October 23/30,
2002).
