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Nurse Shortage Linked to Patient Deaths

Study Shows 7% Boost in Death for Each Additional Patient in Nurses' Workload

WebMD Health News

Oct. 22, 2002 -- You may have heard about the nation's epidemic nurse shortage, which a new government report says now affects 30 states and will likely quadruple by next decade. Now there's evidence on how these staffing issues may affect you, as a patient -- increasing the risk of death or complications following surgery.

For each additional patient a nurse has, the researchers found that patients face a 7% greater chance of dying within 30 days. This means the difference between a nurse caring for four or six patients at the same time results in a 14% boost in likely death for those patients; simultaneously tending to eight patients translates to a 31% greater likelihood of dying.

More patients per nurse was also linked to a greater risk of complications after surgery and to higher rates of job dissatisfaction by nurses.

The study, by researchers at the University of Pennsylvania's Center for Health Outcomes and Policy Research, is based on data that measured the outcome of more than 230,000 patients undergoing various forms of surgery at 168 hospitals in Pennsylvania. It appears in the Oct. 23/30 issue of TheJournal of the American Medical Association.

"We looked at several factors, including three of the most important and commonly measured characteristics of hospitals -- whether it was a teaching hospital, its size, and the how technology-intensive it was, such as whether or not they performed procedures such as open-heart surgery," study researcher Sean Clarke, PhD, RN, tells WebMD.

His team also surveyed more than 10,000 nurses from those hospitals and tracked 133 characteristics of the recovering patients -- factors such as age, surgical procedure, and the types of chronic diseases they had.

"What we found was that those hospitals and other characteristics didn't really affect the patient outcomes as much as the level of nursing staffing," says Clarke, associate director of the center. "It comes down to how heavy the workload is for nurses."

And that workload has increased. A report by the Department of Health and Human Services released just three months ago shows that America's hospitals need at least 110,000 additional nurses -- a 6% shortage that is expected to grow. "If not addressed and if current trends continue," the reports says, "the shortage is projected to grow to 29% by 2020."

To help retain nurses and reduce their workload, the nation's first law to mandate patient-to-nurse ratios takes effect next year in California. By July, hospitals there must have at least one licensed nurse for every six patients.

Although Clarke's is one of the first to quantify how nurse staffing and workload affect patient outcome, its finding wasn't a surprise to the nation's largest group representing practicing nurses.

"This new study reaffirms what nurses have been saying forever: There is a very direct link between the level of staffing and the safety and quality of care that's delivered," says Katherine Kany, RN, spokeswoman for the American Nursing Association.

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