Wide variation across hospitals in nurse staffing is threat to public's
health

Date:
August 18, 2020
Source:
University of Pennsylvania School of Nursing
Summary:
According to a new study, many hospitals in New York and Illinois
were understaffed right before the first surge of critically ill
Covid-19 patients. The study documented staffing ratios that varied
from 3 to 10 patients for each nurse on general adult medical
and surgical units. ICU nurse staffing was better but also varied
significantly across hospitals.



FULL STORY ========================================================================== Philadelphia (August 18, 2020: 7:00 AM EST) - According to a new study published today in BMJ Quality & Safety, many hospitals in New York and Illinois were understaffed right before the first surge of critically ill Covid-19 patients. The study, "Chronic Hospital Nurse Understaffing Meets Covid-19," documented staffing ratios that varied from 3 to 10 patients
for each nurse on general adult medical and surgical units. ICU nurse
staffing was better but also varied significantly across hospitals.


==========================================================================
New York City, an international gateway to the US with three major international airports and the early epicenter of the Covid-19 surge in
the US, had the poorest average hospital nurse staffing on the eve of
the Covid-19 medical emergency.

Researchers at the University of Pennsylvania found that the workload
had adverse consequences on nurses and on patient care. One third of
patients in New York state and Illinois hospitals did not give their
hospitals excellent ratings and would not definitely recommend their
hospital to family and friends needing care.

"Half of nurses right before the Covid-19 emergency scored in the high
burnout range due to high workloads, and one in five nurses said they
planned to leave their jobs within a year," said lead author Karen
Lasater, PhD, RN, an assistant professor and researcher at the Center
for Health Outcomes and Policy Research (CHOPR) at the University
of Pennsylvania School of Nursing (Penn Nursing). "It is an immense
credit to nurses that in such an exhausted and depleted state before the pandemic they were able to reach deep within themselves to stay at the
hospital bedside very long hours and save lives during the emergency," continued Lasater.

"It is very important for the public to take note that in this large
study of nurses practicing in New York and Illinois hospitals, half of
nurses gave their hospitals unfavorable grades on patient safety and
two-thirds would not definitely recommend their hospital to family and friends," said CHOPR Director Linda Aiken, PhD, RN, a senior researcher
and professor at the University of Pennsylvania. She noted that nurses
have been rated in the Gallup poll as the profession most trusted by
the American public for past 18 consecutive years.

The researchers surveyed all registered nurses (RNs) holding active
licenses to practice in New York state and Illinois during the period
December 16, 2019 to February 24, 2020, immediately prior to the Covid-19 medical emergency.

Hospital nurses reported on the number of patients assigned to them
to care for at one time. These nurse reports were linked to Medicare patient-reported outcomes for the same hospitals. They studied 254
hospitals throughout New York state and Illinois, including 47 hospitals
in the metropolitan New York area (the five NYC boroughs plus Nassau
and Westchester counties).



========================================================================== Policy debate on safe nurse staffing standards Both New York state and
Illinois have pending legislation requiring hospitals to meet minimum
safe nurse staffing standards--no more than four patients per nurse
on adult general medical and surgical units. The study found that most hospitals in both states currently do not meet these proposed standards,
nor do they even meet the safe nurse staffing standard of five patients
per nurse set by legislation in California 20 years ago.

"This study provides an important public service by documenting in real
time and in states debating current nurse staffing legislation actual
hospital nurse staffing levels--information not now easily accessible to
the public--and the adverse consequences of such great variation in an essential component of hospital care--nursing," said Maryann Alexander,
PhD, RN, coauthor and Chief Officer, Nursing Regulation at the National
Council of State Boards of Nursing.

The study's authors conclude:
* there is no standardization in nurse staffing in NY and IL
hospitals; * the majority of hospital nurses in these states were
burned out and
working in understaffed conditions immediately prior to the surge
in critically ill Covid-19 patients;
* understaffed hospitals pose a public health risk; * pending
legislation in NY and IL may result in hospital staffing more
aligned with the public's interest;
* the Nurse Licensure Compact also offers a solution and may ease the
strain on hospitals.

More study findings...

* Mean staffing in adult medical and surgical units in NY and IL
hospitals
varied from 3.36 patients-per-nurse to 9.7 patients per nurse and
in ICUs from 1.5 to 4 patients per nurse.

* Each additional patient per nurse significantly increased the
proportion
of both patients and nurses giving unfavorable hospital quality
and safety ratings, after differences in hospital characteristics
such as teaching status, size, and technology availability were
taken into account.

* Half of nurses were burned out, 31 percent were dissatisfied
with their
jobs, and 22 percent intended to leave their jobs within a year.

* Half of nurses gave their hospitals an unfavorable grade on patient
safety, a third gave unfavorable ratings on prevention of
infections, and 70 percent would not definitely recommend the
hospital where they worked to a family member or friend.

* 65 percent of nurses reported delays in care were common because of
insufficient staff and 40 percent reported frequent delays in
care due to missing supplies including medications and missing or
broken equipment.

The study was carried out by the Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing in partnership with
the National Council of State Boards of Nursing. Funding for the study
was from the National Council of State Boards of Nursing, the National Institute of Nursing Research/NIH, and the Leonard Davis Institute of
Health Economics at the University of Pennsylvania.

###


========================================================================== Study Citation Lasater KB, Aiken LH, Sloane DM, French R, Martin B,
Reneau K, Alexander M, McHugh MD. (2020). Chronic Hospital Nurse
Understaffing Meets COVID-19: An Observational Study. BMJ Q&S. doi: 10.1136/bmjqs-2020-011512 About the University of Pennsylvania School
of Nursing The University of Pennsylvania School of Nursing is one of
the world's leading schools of nursing. For the fifth year in a row,
it is ranked the #1 nursing school in the world by QS University and is consistently ranked highly in the U.S. News & World Report annual list of
best graduate schools. Penn Nursing is currently ranked # 1 in funding
from the National Institutes of Health, among other schools of nursing,
for the third consecutive year. Penn Nursing prepares nurse scientists
and nurse leaders to meet the health needs of a global society through innovation in research, education, and practice. Follow Penn Nursing on: Facebook, Twitter, LinkedIn, & Instagram.

About the National Council of State Boards of Nursing The National Council
of State Boards of Nursing (NCSBN) is a non-profit organization based
in Chicago whose US members include the nurse regulatory bodies in the
50 states, the District of Columbia, and four US territories.

NCSBN administers the national registered nurse licensure and other exams
and led the development and implementation of the Nurse Licensure Compact
that allows a nurse to have one multi-state licensure and practice in
the other 34 states that to date have passed the Nurse Licensure Compact.

About the Leonard Davis Institute of Health Economics Since 1967,
the Leonard Davis Institute of Health Economics at the University
of Pennsylvania (Penn LDI) has been the leading university institute
dedicated to data-driven, policy-focused research that improves our
nation's health and health care. Penn LDI connects all twelve of Penn's schools, the University of Pennsylvania Health System, and the Children's Hospital of Philadelphia through its more than 300 Senior Fellows. See
more at ldi.upenn.edu and on Twitter @PennLDI.


========================================================================== Story Source: Materials provided by University_of_Pennsylvania_School_of_Nursing. Note: Content may be edited
for style and length.


==========================================================================


Link to news story: https://www.sciencedaily.com/releases/2020/08/200818094011.htm

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