Massachusetts Nurses Association
FROM: John Gorman, Chris Anderson, Opinion Dynamics
DATE: June 18, 2003
RE: Survey of Massachusetts Registered Nurses
survey of 600 Registered Nurses in Massachusetts finds a stressed
workforce that largely views the state’s hospitals as declining
in quality and understaffed to a degree that is harming and even
Registered Nurses in Massachusetts believe that the quality of health
care in the state’s hospitals is worse today than five years ago,
and they expect it to be even worse five years down the road. Over
two-thirds of Registered Nurses feel the problems with the state’s
health care system are so deep that it needs a major overhaul. When
RNs are asked what problem facing the nursing profession has the
biggest impact on patient care, understaffing of RNs is by far the
most frequently cited problem.
to the state’s Registered Nurses, understaffing in hospitals is
not a crisis of the future—it is a crisis of the moment. A majority
of RNs are aware of specific instances in which high patient loads
have led to medical complications and injury or harm to patients.
Nearly one-third of RNs know of patients who they believe have died
as a result of understaffing.
consequences of understaffing appear to be two-fold and self-compounding.
The direct effect is a decreased quality of patient care leading
to more medical complications, longer hospital stays and, in some
instances, mortality. The secondary effect is a stressed workforce
that is burning out and feeling that their own livelihood is increasingly
at risk due to possible legal liabilities resulting from mistakes
caused by high patient loads. The compounding effect is that the
stress and risk associated with high patient loads is further decreasing
the number of RNs willing to work in acute care situations, thus
leading to poorer care for patients.
Nurses see a solution to the problem of understaffing in the form
of RN-to-patient ratios. When asked what they believe are the best
solutions to addressing the nursing shortage, regulating RN-to-patient
ratios is identified as a top solution—above financial incentives
such as increasing salaries, sign-on bonuses and loan forgiveness.
In fact, it appears that many RNs would consider returning to acute
care from other settings if ratios are established—among RNs who
do not currently provide direct patient care, a majority would consider
returning to the bedside if legislation were passed to regulate
respondents were randomly selected from a complete file of nurses
registered with the Massachusetts Board of Registration in Nursing;
this file contains approximately 92,000 names. The survey results
can be assumed to be representative of these 92,000 individuals
to within ±4% at a 95% confidence interval. It should be
stressed that the opinions reflected in this survey are those of
all Registered Nurses, not RNs of any particular union or professional
of RNs agree that RNs working in hospital units have to care for
too many patients.
of RNs think understaffed acute care units is the most serious
problem facing the nursing profession, followed by 18% who think
fewer young people choosing nursing as a career is the most serious
of RNs are aware of incidents in Massachusetts hospitals in which
understaffing of RNs led to complications or other problems for
of RNs are aware of incidents in which understaffing led to injury
or harm to a patient.
are aware of incidents in which understaffing led to mortality
for a patient.
of RNs agree that burnout from high patient loads causes RNs to
leave the hospital setting.
of RNs agree that legal liabilities in case of errors are too
risky and are causing RNs to leave the hospital setting.
of RNs currently providing direct patient care at the bedside
have considered leaving the bedside.
of RNs favor legislation that would set nurse to patient ratios
in acute care units.
of RNs currently working in non-bedside positions would consider
returning to a job providing direct patient care in a hospital
if a law were passed regulating RN-to-patient ratios.
4% of RNs feel that their hospitals provide excellent patient
majority (55%) of RNs think the overall quality of health care
in Massachusetts hospitals has gotten worse in the past five years,
15% think it has stayed the same, and 16% think it has improved.
of RNs expect the overall quality of health care in Massachusetts
to be worse in five years.
of RNs think the health care system in Massachusetts has real
problems and is in need of a major overhaul; 23% think the health
care system could use some minor changes, but overall it is in
pretty good shape.