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One in Three Registered Nurses Report Patient Deaths that are Directly Attributable to RN Understaffing

93 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

[Executive Summary] :: [Presentation of Key Findings]

CANTON, 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 for;
  • 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.

“These 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.

The 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 shortage.

It 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.

The 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.

“The 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.

“These 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.

In 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.

“A 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.”

The 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.

The 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.

While 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 conditions.

According 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.

Of the 600 nurses polled:

  • An astounding 93 percent report being burned out by excessive patient loads;
  • 65 percent agree that working conditions in hospitals are “brutal” for nurses;
  • 75 percent report that their managers schedule too few nurses for their shifts;
  • 70 percent of nurses report being “floated” to assignments in other areas of the hospital for which they lack the proper orientation or training;
  • 60 percent report that hospital administrators assign mandatory overtime instead of staffing properly;
  • 58 percent report that hospital managers assign nursing duties to non-nurses instead of hiring registered nurses; and
  • An overwhelming 86 percent support legislation to regulate RN-to-patient ratios in hospitals

H. 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.

P.O. Box 309 Canton Massachusetts 02021 617.522.3461