in Three Registered Nurses Report Patient Deaths that are Directly
Attributable to RN Understaffing
percent of RNs agree that burnout from high patient loads is causing
nurses to leave the hospital setting; Two-thirds of RNs who have
already left the bedside say they would consider returning if RN-to-patient
ratios were established
Summary] :: [Presentation of
Mass.—A study of registered nurses in Massachusetts
released on June 18th, 2003 established that poor RN-to-patient
ratios are resulting in significant harm and even death for patients.
According to the survey, 87 percent of nurses report having too
many patients to care for, and the results are devastating to patients:
Alarmingly, nearly one in three nurses (29 percent) report patient
deaths directly attributable to having too many patients to care
67 percent report an increase in medication errors due to understaffing;
64 percent report an increase in complications due to understaffing;
54 percent report readmission of patients due to understaffing;
52 percent report injury and harm to patients do to understaffing;
1 in 2 nurses report that poor staffing leads to longer stays
for patients, which cost more; and
Only 4 percent of registered nurses report that patient care in
their hospitals is excellent.
shocking conditions exist right here in Massachusetts, a state that
is known around the world as a medical mecca,” said Karen Higgins,
RN, president of the Massachusetts Nurses Association and one of
the spokespeople who released the survey results at a State House
press conference in June.
survey, the first in nine years to examine Massachusetts nurses’
views on the quality of patient care and nurse staffing in area
hospitals, follows three national studies that paint an equally
dismal picture of the quality and safety of patient care, spelling
out in detail the conditions in Massachusetts that endanger patients
and that have caused and continue to exacerbate the current nursing
was commissioned by the MNA and conducted between May 30 and June
8, 2003 by Opinion Dynamics Corporation, Inc., an independent research
firm headquartered in Cambridge. Survey respondents were randomly
selected from the complete file of the 92,000 nurses registered
with the Massachusetts Board of Registration in Nursing. Fully 68
percent of the respondents have no affiliation with MNA—the
state’s largest association of registered nurses, with 22,000 members.
According to the research firm,, the survey results can be assumed
to be representative of the 92,000 nurses to within ± 4 percent
at a 95 percent confidence interval.
release of the survey coincided with the Joint Committee on Health
Care’s public hearing on H.1282, a bill that would establish RN-to-patient
ratios in Massachusetts hospitals. More than 500 nurses joined leaders
from 59 health care and consumer advocacy groups that have endorsed
the legislation to show their support for the measure. This study
complements Opinion Dynamics’ findings earlier this year that 82
percent of registered voters support legislation to regulate RN-to-patient
ratios and that 75 percent are willing to pay more for their health
care in order to guarantee their safety as patients.
MNA has long advocated for safe RN-to-patient ratios. Research conducted
by the country’s most prestigious medical publications—the
Journal of the American Medical Association and The New England
Journal of Medicine—and by the Joint Commission on Hospital
Accreditation supports our position,” Higgins said. “The survey
results we are releasing are in line with these national studies.
They underscore that RNs in Massachusetts are forced to care for
too many patients at the same time and that the safety of all patients
is seriously compromised as a result.
findings should be a wake-up call to hospital administrators, a
warning to patients who seek care in our hospitals, and a call to
action for legislators, who have in their hands now the means to
protect the public from the serious risks posed by current hospital
conditions,” Higgins concluded.
addition to the dangers of inadequate RN staffing, the study found
that other vital aspects of patient care are also suffering. Nine
out of 10 nurses report not having enough time to comfort and assist
patients and their families, 86 percent report not having enough
time to educate patients, and 81 percent of nurses report that,
because they have too many patients to care for, their patients
have to wait for medications or treatments.
medication delay can result not only in unnecessary pain and suffering,
it can lead to a downturn in a patient’s condition that causes complications
or lengthens that patient’s stay,” noted Julie Pinkham, executive
director of the MNA. “When nurses—all of whom are educators
in our health care system—don’t have enough time to teach
diabetic patients how to manage their conditions, there is a greater
likelihood that those patients will end up being readmitted for
complications resulting from the fact that they were not taught
how to administer their insulin. Because we are all concerned with
costs, let me point out that poor patient outcomes like this cost
the health care system billions of dollars.”
survey found that 66 percent of RNs believe that hospital finances
are not properly spent on patient care; 55 percent believe that
the overall quality of health care in Massachusetts has gotten worse
over the last five years; and 61 percent believe that in the next
five years the overall quality of health care in the state will
become even more desperate.
survey not only underscores the danger posed by chronic understaffing
in hospitals, but also provides solid and compelling evidence that
poor staffing conditions created and continue to exacerbate the
shortage of nurses in the state.
national surveys of nurses show that one in five nurses plan to
leave the profession in the next five years, fully 55 percent of
nurses providing hospital care in Massachusetts have considered
leaving direct patient care at the bedside because of the poor staffing
to nurses who have already left the hospital bedside, the number
one reason given was that they had too many patients to care for.
However, 65 percent of those who have left the hospital bedside
say they would be likely or extremely likely to return if Safe Staffing
legislation was enacted.
the 600 nurses polled:
astounding 93 percent report being burned out by excessive patient
percent agree that working conditions in hospitals are “brutal”
percent report that their managers schedule too few nurses for
percent of nurses report being “floated” to assignments in other
areas of the hospital for which they lack the proper orientation
percent report that hospital administrators assign mandatory overtime
instead of staffing properly;
percent report that hospital managers assign nursing duties to
non-nurses instead of hiring registered nurses; and
overwhelming 86 percent support legislation to regulate RN-to-patient
ratios in hospitals
1282, An Act Ensuring Quality Patient Care and Safe RN Staffing,
would establish minimum RN-to-patient ratios in Massachusetts hospitals
as a condition of Department of Public Health licensure. The bill
was filed by Rep. Christine Canavan (D-Brockton) and the MNA, and
is co-sponsored by 101 out of 200 members of the Legislature, including
13 of the 17 members of the Joint Committee on Health Care.