Study Finds ICU Nurse Staffing and Working Conditions Linked
to Increase in Infections and Deaths Among Elderly Patients
Bolsters Case for Increasing RN Staffing in Hospitals
Mass.—A new study to be published in the
June issue of the journal Medical Care finds that hospitals
that have better staffing and less overtime for registered
nurses are safer for elderly intensive care unit (ICU) patients.
The study is yet another piece of scientific evidence that
bolsters the case for increasing RN staffing in hospitals,
prohibiting mandatory overtime and limiting the number of
patients assigned to a nurse, as proposed in the Patient
Safety Act (H.2059), legislation currently before the Massachusetts
legislature. To receive a copy of the study, contact David
Schildmeier at 781.249.0430.
report, which was led by Columbia University School of Nursing
researchers, measured rates of hospital-associated infections;
the sixth-highest cause of death in the United States (CDC,
March 2007). Findings suggest that nurses, as the largest
workforce in the nation's hospitals, are in a unique position
to positively affect the safety of ICUs if systematic improvements
to their working conditions are made.
review of outcomes data for more than 15,000 patients in
51 U.S. hospital ICUs showed that those with higher nurse
staffing levels had a lower incidence of infections such
as central-line associated bloodstream infections (CLSBI),
a common cause of mortality in intensive-care settings.
The study found that patients cared for in hospitals with
higher staffing levels are 68 percent less likely to acquire
such an infection.
measures such as ventilator-associated pneumonia and skin
ulcers, which are common among hospitalized patients who
cannot move regularly, were also reduced in units with high
staffing levels. Patients were also less likely to die within
30 days in these higher-staffed units. Higher levels of
overtime hours were associated with increased rates of infection,
including catheter-associated urinary tract infections as
well as skin ulcers. On average, the ICU nurses worked overtime
5.6 percent of the time.
are the hospitals' safety officers," said Patricia W. Stone,
Ph.D., M.P.H., RN, assistant professor of nursing at Columbia
University Medical Center and the study's first author.
"However, nursing units that are understaffed and that have
overworked nurses are shown to have poor patient outcomes.
Improvements in nurse working conditions are necessary for
the safety of our nation's sickest patients."
is yet another in a long line of published studies that
clearly demonstrate that improving RN staffing ratios has
enormous benefits in terms of lives saved and reduced complications,
while also being highly cost effective," said Karen Higgins,
RN, an ICU nurse 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 that only nurses can provide if they
are allowed to care for a safe number of patients at any
study on ICU staffing comes on the heels of a study published
in the May issue of the same publication. That study reported
that a 10 percent increase in the number of patients assigned
to a nurse leads to a 28 percent increase in adverse events
such as infections, medication errors, and other injuries.
A 2003 report by the prestigious Institute of Medicine (IOM)
regarding the impact on patient safety of nurses' working
conditions found that poor RN staffing and excessive overtime
increase the likelihood of preventable patient injuries
and deaths. The IOM report recommended that a strict limit
of no more than two patients per nurse in ICUs be established
and that overtime for nurses be limited.
nurses 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
case in point is Lawrence General Hospital where the nurses
are locked in a protracted struggle to improve unsafe staffing
conditions, and where the administration has recently informed
its ICU nurses that they will be assigned up to three patients
at a time, a practice that is patently dangerous and unacceptable
by any standard of nursing practice.
and countless other studies confirm that the case for better
RN staffing has been made and the time has come to act to
ensure that a safe limit is put on the number of patients
a nurse is assigned," said Beth Piknick, RN, president of
the Massachusetts Nurses Association. "Patients are suffering
and dying routinely because hospitals continue to understaff,
while they reap mounting profits year after year. The hospital
industry has proved that it will not staff safely until
it is required by law to do so. Hospitals must be held accountable
for investing in a safe standard of care."
Patient 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.