Two new studies say understaffed health care facilities and poor working conditions for health care professionals are to blame for "medical errors" that annually kill more people in the United States than traffic fatalities, breast cancer and AIDS.
The issue of medical errors made headline news in November 1999 when the Institute of Medicine, a quasi-governmental organization that analyzes health policy information, released a study called To Err is Human: Building a Safer Health System.
That study estimated that medical errors kill anywhere from 44,000 to 98,000 people in U.S. hospitals each year, a finding that spurred many state policymakers to take quick action.
"The Chicago Tribune did a three-part series on nurses and errors, and the unfortunate part is the articles were about nurses committing errors. But when you read the articles, the real story was about facilities that caused the errors in which nurses work," says Cheryl Peterson, a senior policy fellow at the American Nurses Association's (ANA) Nursing Practice Policy Division. Peterson, who is also a Registered Nurse (RN), says what's needed is a system that allows providers to say, "I made an error. Right now, there's such an attitude of blame that nurses don't want to report [an incident]."
To highlight the prevalence of deteriorating working conditions for RNs in the U.S., the ANA on Feb. 6 released a national staffing survey. Among the group's findings:
- 75 percent of more than 7,000 nurses surveyed said the quality of nursing care at the facility in which they work has declined over the past two years,
- 56 percent said the time available to care for patients has decreased,
- More than 40 percent said they would not feel comfortable having a family member or someone close to them cared for in the facility in which they work, and
- More than 54 percent of nurses would not recommend their profession to their children or friends.
Though the numbers cited above may sound alarmingly high, Peterson says from the ANA's perspective, "it's a reaffirmation of what we've been saying anecdotally, that working conditions are poor for nurses."
A Feb. 5 report from the Center for Health Professions at the University of California, San Francisco (UCSF) adds to the outcry over poor working conditions for nurses. Though Nursing in California: A Workforce Crisis specifically looks at the Golden State, where the problem has been in the spotlight for several years, its findings go arm-in-arm with the ANA survey, It shows that:
Experts have talked about a general nursing shortage for years, but "this isn't just another cyclical shortage," said UCSF's Janet Coffman, associate director of the center's Workforce Policy & Analysis division and an author of the report. "There's a real need for facilities to really step back and address the work environment for nurses," she adds. One way that hospital executives and lawmakers can take to make work a better place for RNs is by eliminating mandatory overtime policies.
- One in five RNs is age 55 or older,
- Stress in the workplace has skyrocketed for nurses, due to pressure to keep costs low for hospital services,
- 95 percent of nurses are women, and with today's wider range of career opportunities for women, a smaller number actually choose the profession.
Coffman and her colleagues say it's a myth that there are a lot of nurses out there, but they've gone into other jobs besides health care or they're home with the kids.
"Nationwide, 85 percent of RNs are in nursing in some capacity," she says. "A lot who aren't are not working, period, or are retired."
Is there a role for state policy makers in addressing the nursing workforce crisis? Yes, says Coffman. "One of the biggest roles for state lawmakers is supporting the expansion of education and providing financial aid," she says.
"States can also provide incentives or carrots for making education more accessible, adding evening and weekend classes, and expanding non-traditional pathways or programs for people who have bachelors (degrees) in another field and fast-track them in nursing."ANA also supports state legislative intervention, and is encouraging states to pass measures that protect whistleblowers, eliminate mandatory overtime, and collect state data on nursing supply, quality and staffing.
"A lot of states are lined up to really push this," says Peterson. "One issue that's so critical to the nursing profession is the staffing shortage, and it's getting to the point where it is a public health crisis," she adds.
Thirty-two states introduced medical errors-related measures in 2000. Only California, New York, South Dakota and Washington enacted laws, but general interest remains high across the country.