Saturday, 2 February 2008

Nurse/ Patient Ratios: The Facts



http://query.nytimes.com/gst/fullpage.html?res=9405E6DD1530F93AA25752C1A9649C8B63

In the journal article, University of Pennsylvania researchers analyze why nursing care means more to hospitalized patients than pillow plumping and good cheer.

They culled data from more than 200,000 patients and 10,000 nurses to calculate that for every additional patient a nurse is assigned to care for, the odds of a patient's dying within a month of hospital admission rises 7 percent. In other words, when your nurse cares for seven other patients on a shift, your chances of dying from whatever ails you are about 30 percent higher than it would have been if your nurse had only three others.


Nurses in the UK average about anywhere from 1-10 to 1-20. It can be anything the managers want it to be and believe me, they want to divert as much money away from decent staffing as they can. When patients complain about waiting for a call bell to be answered, the managers forbid the nurses from talking about and explaining staffing levels because they "will not admit liability". They lay the blame with the nurses and nurses get a bad reputation. This is a fact.

http://www.nursingadvocacy.org/news/2002may30_nejm.html

May 30, 2002 -- In today's issue of the New England Journal of Medicine (NEJM), researchers Jack Needleman of the Harvard School of Public Health in Boston and Peter Buerhaus of Vanderbilt University’s School of Nursing in Nashville, Tennessee found that nurse short-staffing leads to deadly consequences for patients.

The study analyzed discharge data from 6 million patients and financial data and staffing surveys from 800 hospitals in 11 US states. When nurses were short-staffed, patients suffered up to 25% more life-threatening complications including infections, bleeding, pneumonia, shock, cardiac arrest, and "failure to rescue," all of which contributed to an increased length of hospital stay





http://www.massnurses.org/safe_care/Safe_Staffing/news/2005/PhysSurv.htm

78% of MDs believe RN staffing levels are too low, 82% believe quality is suffering, an alarming 1-in-5 doctors report patient deaths due to nurses caring for too many patients

(this article comes from the USA, where general ward nurses have 1-8 as opposed to the 1-10,20 etc that we have in the UK.)

http://www.crnbc.ca/downloads/402.pdf

AS RN to patient ratios decrease from 1:4 to 1:10, the number of post op surgical patient deaths climbs dramatically. (aiken, Clarke, Sloan,Solkalski and Silber 2002).

UK nurses average anywhere from 1:10 to 1:20 on general medical and surgical wards.


http://allnurses.com/forums/f300/don-t-blame-nurse-fix-system-266262.html

The Allnurses.com discussion forum cites numerous first-hand stories of how nurses have blamed themselves, or have been blamed by hospital administrators, for dangerous and sometimes fatal medical errors. In most cases, these incidents reflect far more on deficiencies in the systems in which nurses must work.

At least four out of five medical errors are probably due not to negligence or carelessness, but to deficiencies in the system in which doctors and nurses must work. The ISO 9001:2000 standard and its health care specific modification, IWA‑1, recognize that people work in a system, and that a deficient system cannot deliver good quality no matter how skilled or careful the workers might be.

It is a general rule in industry that only 15 to 20 percent of trouble comes from negligence, carelessness, and incompetence. The rest is due to deficient organizational systems that make trouble almost unavoidable. W. Edwards Deming's 85/15 rule says that 85 percent of all defects and errors are the fault of the system in which people must work, while 15 percent results from carelessness and negligence. Frank Gryna cites an 80:20 ratio, with 80 percent of errors and mistakes being "management-controllable" and only 20 being "worker-controllable." [1]


(i.e.organizational problems such as a NHS managers who have no clinical experience, a bad attitudes towards nurses and ignorance regarding nurse patient ratios. Total hospital wide system failures that cause the nurse to have to spend time away from patients i.e. chasing pharmacy up to do their jobs)



http://www.hbs.edu/research/facpubs/workingpapers/papers2/0203/03-059.pdf

Recently conducted large scale research found that:

In a given unit the optimal workload for a nurse was four patients. Increasing the workload to 6 resulted in patients being 14% more likely to die within 30 days of admission. A workload of 8 patients versus 4 was associated with a 31% increase in mortality. Higher nurse staffing levels resulted in reduced numbers of urinary tract infections, pneumonia, upper gastrointestinal bleeding and shock in medical patients and lower rates of "failure to rescue" and urinary track infections in major surgery patients


(What have I said regarding the ratios we are working with at my hospital? According to this research even 1:8 is bad on a general ward...let alone the 1:20 that happens on mine).

This paper from Harvard is an excellent explanation as to why working conditions and piss poor management causes nursing care to be so bad.

http://www.hbs.edu/research/facpubs/workingpapers/papers2/0203/03-059.pdf

108 comments:

blogger6420 said...

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MedTEAM said...

I worked in US Medical facilities and was fired as a Whistleblower for reporting Deliberate Negligent Understaffing in the OR at "America's Best Hospital." I will have to retrain from scratch to work in the NHS and I am not happy about what I am hearing regarding UK staffing practices. What lies ahead?

I hear that the NHS is eager to start privatizing our care and import many of the worst flaws in US "For Profit" Healthcare system. It does not need to be this way if we just stop hemorrhaging funds on obscenely top heavy or incompetent Management and costly consultants. We must eliminate the toxic work environment that is forcing so many qualified Nurses to quit.

In the US most Nurses who leave regular jobs, join Nursing Agencies, but we do not need to squander the HR budget on Agency commission fees to obtain the services of former employees. At least the majority still retain their license and they can be lured back. We do not have a "Nursing Crisis;" we created a "Nursing Exodus" driven by greed.

I will post a link to your site on my Blog. It deals mostly with US Healthcare issues, but my post on "The Golden Hour in Transit" is on UK A&E closures. Please e-mail me and try to visit the MedTEAM Blog at WordPress - Transparency for Equal Accountability in Medicine a site dedicated to ending the Deliberate Negligent Understaffing of clinical units with the C.U.T! Campaign to Control Understaffing Today. Read about the 21 C.U.T! Campaign goals at: http://medteam.wordpress.com

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They should also pay nurses a bit more as well...might help with retention.
When I get out of med school at the end of next year I will be paid more than most nurses and than my mother, who is an EXCELLENT teacher with 30 years experience. The discrepancy there seems more than a bit wrong to me.

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