You’ll have heard about it: Hospitals around the country are grappling with a shortage of qualified, experienced nurses. One way they are dealing with this problem is by spreading the nurses they have too thin, assigning more patients to each nurse and imposing longer work hours on nurses.
The problem: nurse understaffing costs lives
From a business perspective, that might seem only logical. But health care is no ordinary business, and cutting corners literally costs lives. That may sound overwrought, but multiple studies have demonstrated that nurse understaffing increases patient mortality. One recent study, based on an exceptionally large data sample, showed that the average patient is exposed to three understaffed shifts, and with each of those shifts their mortality risk grew by 2%. That’s 6% in total, for an average patient. The cumulative risk rises further for patients who have to stay in hospital longer.
There have been other studies too. They have suggested that, beyond four patients per nurse, each extra patient causes a 6% increase in the patient’s risk of death. That a workload of more than four patients per nurse significantly increases the likelihood that a hospitalized child will have to come back to the hospital for more treatment within a month. That nurse understaffing leads to more deaths, more failures to rescue patients, more infections, and longer hospital stays. That a higher patient-to-nurse ratio increases the amount of urinary tract and surgical site infections. And that’s without even talking about the nurses themselves, who are more likely to suffer burnout and sleep problems.
The solution: legislation to impose minimum nurse-to-patient ratios?
For the second year in a row, a group of nurses is marching in Washington DC today to demand action. They call themselves #NursesTakeDC, and they want Congress to pass a bill, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act.
Right now, federal law only requires hospitals to “have adequate numbers” of nurses “to provide nursing care to all patients as needed,” which is pretty vague. But California passed a law in 2004 that imposed minimum nurse-to-patient ratios on hospitals, and #NursesTakeDC want Congress to do the same across the US. They point to a study that showed the California law led to fewer patient deaths, and that it also persuaded nurses to stay on the job longer.
The debate: flexibility vs minimum standards. Where do you stand?
The National Nurses United union agrees, but others, like the American Nurses Association, have not been on board. They prefer more flexible solutions, arguing that hospitals and individual units are too different from each other, with a different mix of more and less experienced nurses, and different kinds of patients with more or less severe problems, for a standard solution like this.
Instead, they have promoted other kinds of strategies. They support efforts that have translated into new laws in at least half a dozen states to oblige hospitals to use special hospital committees to create safe staffing plans. They advocate for giving nurses a greater say within hospitals, increasing their representation on hospital committees.
The #NursesTakeDC activists are insisting this has not been helping enough. Looking at the bills they want Congress to pass, it does seem that those already address some of the concerns about flexibility. The minimum number of nurses would depend on the kind of unit and the kind of patients. The nurse-to-patient ratio would just be a bare minimum, and beyond that hospitals would be free to use nurses and other staff as needed based on “patient acuity”, i.e. how severe the patients’ health problems are.
I’ve found the arguments of NursesTakeDC pretty convincing, as you could probably tell. :) But it’s also clear that there’s smart and experienced people in nursing who disagree. What do you think? If you are a nurse yourself, or you work in a hospital, where do you stand?
0 nhận xét:
Đăng nhận xét