6.18.03

Survey of Registered Nurses in Massachusetts
Presentation of Key Findings
June 18, 2003

Julie Pinkham, RN, Executive Director
Massachusetts Nurses Association

There’s an old adage in medicine that says: if you don’t listen to nurses you will not hear the patients. The results of the survey I will share this morning tell us what nurses, those on the front lines, are thinking and experiencing. If we listen to what they are saying, we will hear the sound of patients who are suffering. Worse, we will hear the deafening silence of patients who can no longer speak because they are no longer alive to tell their stories.

These findings are at the core of a telephone survey of 600 registered nurses in Massachusetts completed by Opinion Dynamics, an independent research firm located in Cambridge. The 600 nurses interviewed were randomly selected from a file of all Massachusetts RNs. Survey respondents were interviewed at home, between May 30 and June 8, 2003.

Karen just reviewed for you what we have learned from research on the national level. This data is the first in many years to focus on what nurses in Massachusetts are experiencing as a result of staffing conditions in hospitals. I want to underscore that 70 percent of those surveyed were not members of our organization. Today’s results paint a true picture of the experiences of front-line nurses in our state.

The picture they paint is shocking. Let me give you the most alarming statistic in the survey of nurses in the Commonwealth: nearly one in three Massachusetts nurses surveyed report they are aware of patients who have died because nurses had too many patients to care for.

Let’s look at the current staffing conditions that lead directly to this sobering statistic:

• 87 percent of Massachusetts nurses surveyed report that they have too many patients to care for;
• 75 percent of Massachusetts nurses report that their managers schedule too few nurses for their shifts;
• 70 percent of Massachusetts nurses report that they are being floated to other areas of the hospital without proper orientation or training;
• 60 percent of bedside nurses in Massachusetts report that hospital administrators impose mandatory overtime instead of staffing properly;
• 58 percent of Massachusetts nurses report that hospital managers assign nursing duties to non-nurses rather than hiring qualified registered nurses;
• An astounding 93 percent of all Massachusetts nurses surveyed report being burned out by excessive patient loads; and
• 65 percent of Massachusetts nurses agree with the statement that working conditions in Massachusetts hospitals are “brutal” for nurses.

Now let’s look at the results of these dangerous staffing practices.

• When asked what the most important problem they face while doing their jobs, the number one answer Massachusetts nurses give is that they are being asked to care for too many patients;
• 67 percent of Massachusetts nurses reported an increase in medication errors due to poor ratios;
• 64 percent of the nurses in Massachusetts report an increase in medical complications because of high patient loads;
• 54 percent of Massachusetts nurses report that patients are being readmitted because nurses are caring for too many patients;
• One in two Massachusetts nurses report that poor staffing leads to longer stays for patients;
• 52 percent of Massachusetts nurses--one in two--report that their patients were injured and harmed because of high patient loads;
• And again, most alarming of all, nearly one in three Massachusetts nurses report that they are aware of patient deaths because of nurses having too many patients to care for.

When it comes to other vitally important aspects of nursing practice:

• 88 percent of nurses report not having enough time to comfort and assist patients and their families;
• 86 percent of nurses report not having enough time to educate patients; and
• 81 percent of nurses report that their patients have to wait for their medications and treatments because the nurses have too many patients to care for.

These last statistics should not be overshadowed by the more alarming results that speak to the harm and complications for patients, since lack of time to comfort patients, educate patients and deliver medications on time represent the causes of many of the negative patient outcomes I just cited. A medication delay can result not only in unnecessary pain and suffering, but it can lead to a downturn in a patient’s condition that causes harm or lengthens that patient’s stay. When nurses, who are the educators in the system, don’t have enough time to teach a patient, such as a diabetic how to manage their condition, there is a greater likelihood that this patient will end up being readmitted for complications resulting from the fact that they were not taught how to manage their insulin. And because we are all concerned with costs, let me note that all of these poor patient outcomes cost the system billions of dollars.

The popular claim, the one in which we all take comfort regularly, is that Massachusetts is a medical Mecca. Unfortunately, the results of the nurses’ survey are more negative in their scope than those found in a number of national surveys of nurses conducted in recent years. Let’s look at what nurses think of the overall quality of health care being provided by Massachusetts hospitals:

Only 4 percent of nurses rate the care at their hospitals as excellent;

66 percent of Massachusetts nurses believe hospital finances are not being properly spent on patient care;

55 percent of nurses report that the care at their hospital has deteriorated in the last five years; and

61 percent report that they expect the care to become worse in the future.

This survey not only underscores the danger posed to patients by chronic understaffing in our hospitals, it also provides solid and compelling evidence that these conditions created and continue to exacerbate the shortage of nurses in our state.

While national surveys of nurses show that one in five nurses plan to leave the profession in the next five years, 93 percent of Massachusetts RNs agree that burnout from high patient loads causes RNs to leave the hospital bedside, and 55 percent have considered leaving the hospital bedside as a result of having too many patients to care for. The number one reason given by nurses in Massachusetts who have already left hospital bedsides is that they had too many patients to care for.

Fortunately, the dark cloud of data in this survey does contain a silver lining: 86 percent of all Massachusetts nurses surveyed support legislation to regulate RN-to-patient ratios in hospitals. More importantly, 65 percent of those who have left the bedside say they would be likely to return if this legislation passed, with 42 percent saying they would be much more likely to consider returning if safe staffing ratios are established.

These results make abundantly clear that the cause of the shortage of nurses we now face is understaffing of nurses. Unsafe staffing ratios and staffing practices such as mandatory overtime implemented by the hospital industry to save money have driven thousands of nurses away from the hospital bedside. Understaffing, the mandatory overtime, and the brutal working conditions that nurses in Massachusetts find so dangerous to patients have been the norm for more than a decade.

Their creation was a conscious choice by the hospital industry to roll the dice with the quality of patient care in an attempt to provide care at a lower cost by forcing fewer nurses to care for more patients and work longer hours. All this was done before there was a shortage of nurses, and, in fact, was precipitated by massive layoffs of nurses across the Commonwealth.

Our message is simple, if the legislature joins us in building safe staffing ratios, the nurses will most certainly come. If nothing is done, this situation will only get worse.

The sobering message this research conveys cannot and should not be ignored. We implore the legislature to listen to what nurses and, through them, patients in Massachusetts are saying. With the release of this survey, we are all pushing the call button and we are waiting for the legislature to respond with the only remedy that makes sense – safe staffing legislation that will restore safe, quality hospital care to Massachusetts.