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shortage of nurses; they're just overworked By Jeanine Hickey and Joanne Laschi According to the latest medical and nursing research, the most important factor determining your safety as a hospital patient is the number of other patients you are sharing your nurse with. If your nurse has too many patients, your risk of dying increases. The fewer patients your nurse is assigned, the better your care will be. The Journal of the American Medical Association reports that in a study of 232,000 surgical patients, the more patients a nurse has to care for, the more likely that serious complications or death will ensue. The study found that each additional patient above four that a nurse is caring for produces a 7 percent increase in mortality. If a nurse is caring for eight patients instead of four, that is a 31 percent increase in the risk of death. Another study of six million patients published in the New England Journal of Medicine shows that patients without adequate nursing attention are more likely to die or suffer serious complications. Here in Essex County, it is not uncommon for nurses on a typical hospital floor to be caring for six, eight or even 10 patients at a time. These ratios are dangerous. Every day in Massachusetts and here in Essex County, patients in our hospitals push a call button and wait -- and wait -- for a registered nurse to come to their aid. These patients might be in severe pain, they may be frightened or disoriented; they need help, but they wait to receive the care they need. In some cases, the wait causes no serious harm, but in others, the wait and lack of a quick response from a nurse triggers a downturn in a patient's condition, or leads to a serious and costly complication. A two-day hospital stay turns into a six-day stay. The true cause of the poor staffing conditions in our hospitals is at the center of an intense debate being waged in hospital boardrooms, on Beacon Hill and in the halls of Congress. What will it take to improve the odds that a patient leaves the hospital in better shape than he or she entered it? The health care industry claims there are not enough nurses to fill open positions. Nurses on the front line, those who have been working in the system, those who answer those call lights and struggle with increasing patient loads, tell a different story. The fact is there is no shortage of nurses in Massachusetts. We have the highest per capita population of nurses in the nation. What we have is a shortage of nurses willing to work under the current conditions. According to one national survey of nurses, one out of five nurses now working is seriously considering leaving the profession in the next five years. More than 85 percent of nurses surveyed said they would stay in nursing if they had better RN-to-patient ratios. In addressing the problem of RN staffing, policymakers miss the point if they focus on simply recruiting more nurses. The real and lasting solution lies in passing legislation, similar to that which has been made law in California, to regulate safe registered nurse-to-patient ratios in our hospitals. Such legislation, H. 1282, An Act Ensuring Quality Patient Care and Safe RN Staffing, is currently being considered by the Massachusetts Legislature, with hearings on the bill scheduled for this Wednesday, June 18. Using the scientific evidence reported in the JAMA study, and based on the input of nurses from all areas of nursing practice, the proposed law would require hospitals in Massachusetts to establish ratios of one nurse to a maximum of four patients on a typical hospital floor, and one nurse to a maximum of two patients in an intensive care unit, with specific ratios established for every unit and area of the hospital. To provide flexibility and to account for patients' differing severity of illness and changing needs, the Safe Staffing bill mandates that staffing ratios be improved when the patient's condition warrants more nursing care. Support among the public for this legislation is growing in Massachusetts. A recent poll of Massachusetts residents found that more than 82 percent of the public supports legislation regulating RN-to-patient ratios. To date, 57 health care and consumer advocacy organizations have endorsed the bill. As to the cost of providing appropriate staffing in our hospitals, studies conducted in California and reported in the New England Journal of Medicine, show that the average hospital will experience only a 1 percent increase in operating costs if ratios are introduced. On the other hand, because patients will receive better care and experience shorter hospital visits and fewer complications, billions of health care dollars will be saved. When the patient pushes that call button, there should be a registered nurse ready to respond. Passing an RN-to-patient ratio bill is the most important step to making that a reality. Jeanine Hickey, RN, of Merrimack Valley Hospital in Methuen and Joanne Laschi,, RN, of Beverly-based Northeast Health Systems, are members of the Massachusetts Nurses Association, the Nurses Coalition of the North Shore and the Essex County Coalition of Registered Nurses, which includes nurses from nearly every hospital in Essex County. David Schildmeier |