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TO: Massachusetts Nurses Association
FROM: John Gorman, Chris Anderson, Opinion Dynamics Corporation
DATE: June 18, 2003
RE: Survey of Massachusetts Registered Nurses

Executive Summary

Our 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 killing patients.

Most 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.

According 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.

The 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.

Registered 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 RN-to-patient ratios.


Survey 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 affiliation.

Key Findings

  • 87% of RNs agree that RNs working in hospital units have to care for too many patients.
  • 50% 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 problem.
  • 64% of RNs are aware of incidents in Massachusetts hospitals in which understaffing of RNs led to complications or other problems for a patient.
  • 52% of RNs are aware of incidents in which understaffing led to injury or harm to a patient.
  • 29% are aware of incidents in which understaffing led to mortality for a patient.
  • 93% of RNs agree that burnout from high patient loads causes RNs to leave the hospital setting.
  • 76% of RNs agree that legal liabilities in case of errors are too risky and are causing RNs to leave the hospital setting.
  • 55% of RNs currently providing direct patient care at the bedside have considered leaving the bedside.
  • 86% of RNs favor legislation that would set nurse to patient ratios in acute care units.
  • 65% 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.
  • Only 4% of RNs feel that their hospitals provide excellent patient care.
  • A 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.
  • 61% of RNs expect the overall quality of health care in Massachusetts to be worse in five years.
  • 71% 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.

P.O. Box 309 Canton Massachusetts 02021 617.522.3461