Inpatient Mortality Linked to Nurse Understaffing

 Inpatient mortality goes up significantly when a hospital has greater patient turnover and when it fails to meet its own nurse staffing targets by at least eight hours, says a reportpublishedin the New England Journal of Medicine.

3 comments on "Inpatient Mortality Linked to Nurse Understaffing"
Mark Stambovsky (3/18/2011 at 4:17 PM)

Re comments from Phyllis Kritek, RN, PhD "Why do we automatically assume that somehow patient/nurse ratios are the preferred solution?" Since when do repeated studies concluding a similar result become an "automatic assumption?" I believe we would better characterize that as statement of fact. All things being equal, it is a matter of eyeballs on patients. The more eyeball time, the better the chances mistakes and/or patient deterioration will be spotted and reported. Ignoring or questioning repeating results in favor of yet further studies smacks of the kind of corporate behavior that serves no one except those who maintain that the bottom line trumps all other promises. I am also surprised and a little sickened, that in 2011 we are still asking, "Who benefits from this world view?" Let's see, how about starting with patients. We can then turn to the nurses who'll feel less like task monkeys and more able to spend actual face time with patients. Hospital nursing, at its core, is highly unpredictable involving fluid variables. Attempts at "nuanced" approaches, or those which hope micromanage what nurses do have always resulted in failure. The old mantra goes something like; "if we could just turn nursing into more of an assembly line, predictable practice we could then precisely staff for exactly what we know will happen." While most Hospital mission statement proclaim safety as job one, too many of them will delay, deny or discredit attempts at improving safety when it means hiring more nurses. After all, their responsibilities can't be all that complex, can they?
Rhonda S. Bell, DBA (3/17/2011 at 12:54 PM)

I respect Phyllis' comments regarding nurse/patient ratio not being the answer in all cases. However, what are some solutions to the nurse staffing challenges that are very real in most hospitals. The IOM reported in 2001, that there are 98,000 deaths due to preventable medical errors, and the 2011 preliminary reports do not show much improvement. This new report on staffing shortages does give merit to why some of these deaths are occurring. Intentional collaboration and communication between administration and nursing staff are essential to identify solutions for reducing preventable deaths. Why does that seem so difficult? True compassionate care does need to go beyond the bedside. Rhonda S. Bell, DBA
Phyllis Kritek, RN, PhD (3/17/2011 at 9:35 AM)

Thank you for posting this information. Two observations, coupled with suggestions: 1. Needleman, Buerhaus, Aiken, and others have amply documented what this study again demonstrates. It would be interesting to see an investigation about the push back their research evokes. It would appear that many want their outcomes to be untrue. What motivates those who challenge these outcomes? 2. When these studies emerge, there seems to be an automatic assumption that their outcomes point to patient/nurse ratios as a solution. Many highly creative nurse executive teams have [INVALID]d [INVALID]native models that provide more nuanced solutions. Patient-nurse ratios are a bit like using a chain saw for surgery. Ratios are an over-simplified solution to a very complex problem. It would be interesting to see investigation of some of the more nuanced responses to nurse staffing. Why do we automatically assume that somehow patient/nurse ratios are the preferred solution? Who benefits from this world view?


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