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Lack of Nurses Blamed for More Deaths

Mortality* A major study shows concrete effects of the shortage: a higher casualty rate among patients and more health complications.


The nursing shortage afflicting the nation's hospitals has resulted in increased deaths and illnesses of patients from heart attacks, infection, shock and internal bleeding, according to a new study.

The article in last week's New England Journal of Medicine by Harvard researcher Jack Needleman is the first major study to document, on a national scale, the damage to patient health caused by inadequate nursing staff levels.

"The problem of low nurse staffing is serious at many hospitals, and its consequences for patients can be severe," said Needleman, an assistant professor at the Harvard School of Public Health, who worked with four colleagues.

The decreasing popularity of the nursing profession has resulted in an estimated 126,000 vacancies at U.S. hospitals, about 13% of the average medical center's nursing staff.

The federally funded study by Needleman and colleagues shows the concrete impact on patient health, said Deborah Dang, director of nursing at Johns Hopkins Hospital.

"This study speaks to the real contribution of nurses in acute-care settings," said Dang. "Nurses make a real difference in how patients fare." Dang said nurses work as an "early warning system" to detect health problems that arise in patients during their hospitalization. If there aren't enough nurses around to recognize the early signs of infection, shock or heart attack, for example, doctors might not be able to prevent death.

In their study, Needleman and colleagues analyzed data from 799 hospitals in 11 states nationally. They concluded:

* Patients suffer cardiac arrest and shock 9.4% less often in hospitals with high staff levels (one nurse for every 2.5 patients per day) than low staff levels (one nurse for every four patients).

* People cared for in hospitals with high nursing staff levels also suffer 9% fewer urinary tract infections, 5% fewer episodes of bleeding in their stomachs or intestines and 6.4% less hospital-acquired pneumonia.

* Surgical patients in hospitals with high nursing staff levels are 6% less likely to die from complications of surgery.

* Patients in medical centers with high nursing staff levels recover more quickly, spending an average of four hours less in the hospital.

Over the last two decades, the shift to managed care and cost containment have reduced the nursing staffs of hospitals and fuelled burnout among employees, experts say. Mandatory overtime and relatively static pay have also made the job less appealing.

At the same time, more women are discovering higher-paid alternatives to this traditionally female occupation, experts say.

Dr. Robert Steinbrook, a deputy editor at the New England Journal of Medicine, wrote in an article accompanying Needleman's study that one barrier to recruiting more nurses is that physicians often fail to treat them with enough respect.

"The perception is that physicians and hospital administrators often treat registered nurses as workers, not as clinicians and peers, and when possible seek to replace them with less skilled and cheaper personnel," Steinbrook wrote.

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