Shots by Marvin Ackerman, MD –  Doctors aren’t the only ones in trouble.

So are hospitals and nurses. It’s been going on for about twelve years now and there doesn’t appear to be any let up.

As a case in point, it was so bad in California that a law was passed in 1999 mandating that starting in July of 2003 hospitals must have at least one licensed nurse for every six surgical and medical patients. This was in response to the growing shortage of nurses caused by an inability to retain them. They are simply quitting due to burdensome workloads, burnout, and dissatisfaction with their jobs. It’s not just happening in California. All over the country reports are coming in from both doctors and nurses that there are not enough nurses available to provide safe and effective care: The end result inability to provide high-quality hospital care. The following quote comes from the introduction to an article called “Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction” published in the October 23/30, 2002 JAMA by Aiken et al:

“Forty percent of hospital nurses have burnout levels that exceed the norms for health care workers. Job dissatisfaction among hospital nurses is 4 times greater than the average for all US workers, and 1 in 5 hospital nurses report that they intend to leave their current jobs within a year.”

It was statistics such as these that prompted Aiken’s group to try to determine what affect this shortage was having on patients. During a period lasting for 19 months from April 1, 1998 to November 30, 1999, they gathered linked data on 10,184 staff nurses, and 232,342 patients from 168 hospitals in Pennsylvania. This cross-sectional analysis was performed on patients undergoing general, orthopedic, or vascular surgery. The items chosen for study were mortality adjusted for risk, failure-to-rescue (mortality following complications) within 30 days of admission, job dissatisfaction as reported by the nurses themselves, and job-related burnout. The dissatisfaction and job-related burnout factors were measured on specified scales by the 52% of nurses who agreed to do so.

The results were pretty much as might be expected when any individual is subjected to an excessive workload. For each additional patient added to a nurse’s routine there was an astounding 7% increase in the likelihood of one of the patients dying within 30 days after being admitted. The same percentage increase was found for the odds of failure-to-rescue. As for the nurses, that additional patient caused a 23% increase in the odds of burnout and a 15% increase in the odds of job dissatisfaction.

These are unbelievably high increases, if true. After going over the approach to the study and the statistical evidence, I am afraid that these results are probably correct and typical at least with regard to the three forms of surgery. If this were true of nurses, it would seem to imply that it might be even truer for the surgeons. Are we in effect actually killing 14 more patients out of 100 operated upon because 23 out of 100 nurses are unable to function properly in our overloaded hospitals?

Obviously, it’s not just deaths due to lack of nurses involved here. Unhappy, overworked nurses are prone to become surly, inefficient nurses as well. Elizabeth E. Hand, a nurse from the Oklahoma Heart Institute, also pointed out in a letter to the editor “burnout seeps into hospital nursing in the form of aggressive behaviors of leaders toward staff nurses, charge nurses, and others involved in providing nursing services.”

The findings in this study are open to discussion since we are dealing with a limited category; surgery in hospitals, and the study limits itself to only those nurses who responded, creating a skewing of the percentages. Christine Kovner of New York University pointed this out,  but concludes that the problem exists and must be dealt with.

My advice to my readers is to be real nice to your nurses when you are in the hospital, and don’t expect too much from them without appropriate reward. The squeaky wheel may get the oil, but the gentle, kindly, and giving soul gets the loving attention often necessary for survival in a potentially hostile environment.

 

If I ring this bell, the nurse should come,
“Cause I really have to go,
But I’ve rung it five or six times now,
When, oh when is she going to show?

I know I’m not her only patient,
But surely, I would win,
If she’d only realize how hard it can be,
To try’n hold it in.

Ah there she is, at last she’s here,
Without a doubt she ran,
Oh no, my God, what’s in her hands?
She’s got a catheter, and a bedpan

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About Marvin Ackerman, MD

Dr. Ackerman provides helpful insights and answers to the important medical issues that affect you. He is also recognized as a prolific lecturer, researcher and inventor, and an author of numerous medical articles for journals, magazines, and the Internet. More about Dr. Ackerman.

Cartoons and Poems following each article are created and copyrighted by Dr. Ackerman and cannot be copied or reproduced without his permission. Copyright © 2009 by Marvin Ackerman, M.D.

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