Study Links RN Nurse Staffing To An Increase in Patient Infections
and Hospital Costs
Bolsters Case for Increasing RN Staffing in Hospitals
study published in the July issue of the open access journal
Critical Care finds that understaffing of registered nurses in hospital
intensive care units increases the risk of serious infections for
patients; specifically pneumonia, a preventable and potential deadly
complication that can add thousands of dollars to the cost of care
for hospital patients. Click
here for the study.
study is the second in three months to link poor ICU staffing
to hospital infections, and the fourth this year to link poor RN-to-patient
ratios to poor patient outcomes for hospitalized patients. The new
research bolsters the case for increasing RN staffing in hospitals
and limiting the number of patients assigned to a nurse as has been
proposed in pending legislation, the Patient Safety Act (H.2059),
currently before the Massachusetts legislature.
Hugonnet and colleagues from the University of Geneva Hospitals,
Switzerland, investigated the number of patients admitted to the
ICU who developed ventilator-associated pneumonia (VAP), over a
four-year period. They then compared this to the number of nurses
on duty for each patient in the preceding days. VAP affected over
a fifth of the 936 patients who received mechanical ventilation
study. The team found that when there were lower numbers of
nurses, patients were more likely to catch pneumonia six days or
more after being placed on a ventilator. This could be due to short-staffed
nurses having less time to follow hand hygiene recommendations and
proper isolation procedures or being unable to provide adequate
care to the ventilated patient. The nurses’ training level
had no effect on infection rates.
study shows that a low nurse-to-patient ratio increases the
risk of late-onset VAP,” said Hugonnet. “It also adds
to the growing body of evidence demonstrating that adequate staffing
is a key determinant and a prerequisite for adequate care and patient
safety.” VAP is caused by bacteria entering the lungs as a
consequence of the ventilator tubing and is one of the most common
preventable problems affecting critically ill hospital patients.
It can cause a stay of about an average of 10 extra days in the
hospital at a cost of of $10,000 to $40,000.
is yet another in a long line of recently published studies that
clearly demonstrate that improving RN staffing ratios has enormous
societal benefits in terms of lives saved and reduced complications,
while also being highly cost effective,” said Karen Higgins,
RN, an ICU nurses at Boston Medical Center and co-chair of the Coalition
to Protect Massachusetts Patients, an alliance of 107 leading health
care, civic and consumer groups promoting passage of The Patient
Safety Act. “There is no longer any rationale for allowing
hospitals to deprive patients of the lifesaving care nurses are
capable of providing if and when nurses have a safe number of patients
to care for at one time.”
A 2003 report
by the prestigious Institute of Medicine on the impact of nurses’
working conditions on patient safety found that poor RN staffing
and excessive overtime increased the likelihood of preventable patient
injuries and deaths. One of the recommendations of the IOM report
was for a strict limit of no more than two patients for nurses in
ICUs as well as to provide limits on overtime for nurses.
Nurses in Massachusetts
hospitals, including those working in ICUs are regularly forced
to accept unsafe patient assignments as identified in the new study.
A study of actual RN staffing levels in the state’s hospitals
conducted by the Massachusetts Nurses Association and Andover Economic
Evaluation in 2006 found that in a shocking 36 percent of observations
hospitals failed to meet the accepted minimum standard of no more
than two patients per nurse in the intensive care unit.
Safety Act (H. 2059) would dramatically improve care by setting
a safe limit on the number of patients assigned to a nurse. The
measure, which is co-sponsored by State Rep. Christine Canavan (D-Brockton)
and Senator Marc Pacheco (D-Taunton), calls upon the Department
of Public Health to set a safe limit on the number of patients a
nurse is assigned at one time. In addition, the bill calls for staffing
ratios to be adjusted based on patient needs. It also bans mandatory
overtime, and includes initiatives to increase nursing faculty and
nurse recruitment. During the last legislative session, the Massachusetts
House of Representatives passed a similar bill by a vote of 133-20.
A hearing on the bill has been scheduled before the Joint Committee
on Public Health on Oct. 24, 2007.