FOR IMMEDIATE RELEASE
September 15, 2000

CONTACT:
Joan Meehan-Hurwitz, 202-651-7020
Cindy Price, 202-651-7038
rn=realnews@ana.org
www.nursingworld.org/rnrealnews

Washington, DC -- The Sept. 10-12 three-part series on nursing errors, written by Chicago Tribune reporter Michael J. Berens, dramatically brought to the public's attention the deplorable situation of inadequate nurse staffing in our nation's hospitals, a situation that the American Nurses Association (ANA) has called a "public health crisis."

However, the ANA thinks that Berens' overpowering headlines, [Nursing mistakes kill, injure thousands, Sept. 10; Nursing accidents unleash silent killer, Sept. 11; and Problem nurses escape punishment, Sept. 12], followed by an overwhelmingly narrow focus on a handful of problem nurses, minimize the larger safety concerns, such as chronic understaffing, which, when "remedied" by use of chronic overtime, creates an environment where errors are more likely to occur.

"We understand that health care employers face a tough situation when it comes to balancing services and costs, but we also feel strongly that bottom-line decisions should not come at the expense of patient or nurse safety," said ANA First Vice President Patricia Underwood, PhD, RN. "The truth is that the majority of medical errors in the health care delivery system arise as a result of cost-cutting measures, not from individual recklessness. Thus, focusing blame on individual nurses, rather than addressing larger systemic concerns, will not solve the problem."

Contrary to Berens' reporting, ANA has not identified specific nurse-to-patient ratios. Rather than relying on ratios, ANA developed a tool to better gauge appropriate staffing. Known as ANA's Principles for Nurse Staffing, this tool not only takes into account the number of patients, but also looks at other important staffing considerations, such as the experience level of nurses on the unit, the severity of patient's conditions and the availability of support services and resources. The principles are used to educate, to guide staffing and to evaluate the sufficiency of staffing tools used by health care facilities.

A second error is Berens' attribution to ANA the statement that the reliance on temporary nurses has quadrupled in the last five years, statistics that ANA does not have.

Missing from the Berens' article was mention of ANA's persistent work on federal and state whistleblower protection, which prohibits health care facilities from discharging, discriminating against or retaliating against anyone who reports on incompetent, unethical or illegal practices. To date, 15 states, including Illinois, have passed whistleblower legislation.

Also absent from Berens' account was mention of ANA's efforts with regard to patient safety legislation, as well as ANA's advocacy efforts for enactment of legislation to require health care institutions to make public specific information on staffing levels, staffing mix and patient outcomes. ANA has recommended that, at a minimum, institutions should publicize the number of RNs providing direct care; the number of unlicensed assistive personnel providing direct care; the average number of patients per RN; patient mortality rates; frequency of adverse patient-care incidents; and methods used for determining and adjusting staffing levels and patient-care needs.

Testifying on staffing issues at a daylong National Summit on Medical Errors and Patient Safety Research in Washington, D.C., on Sept. 11, Underwood stated that because of cost-containment measures, nurses, physicians and others are asked to do more with less. "As hospitals have reorganized and put fewer nurses at the bedside, and as more hospitals have come to rely on use of overtime as a ‘solution' to inadequate staffing, the most common complaint we hear from our members is their belief and concern that these changes are putting patients at risk," she said.

The summit was held as part of the federal government's response to last year's Institute of Medicine report, which noted that up to 98,000 patients are killed each year from medical errors. ANA supports the IOM report recommendations, which include developing a National Center for Patient Safety; establishing a nationwide mandatory, state-based error reporting system; implementing systems that don't blame individuals; developing performance standards for health care organizations; and implementing proven medication safety systems and practices.

But missing from the report's findings, Underwood noted, is an examination of the "full range of staffing issues," including the alarming incidence of mandatory overtime currently being used to fill gaps in staffing. "We know enough about the impact of fatigue on human judgment, and on cognitive abilities, to recognize that having a 47-year-old nurse working 16-hour shifts for three or four days in a row is dangerous," she testified.

Another staffing issue of concern to ANA is the replacement of nurses who have years of experience with lesser-trained, lower-paid unlicensed assistive personnel. "These unlicensed assistants do not have the academic backgrounds that RNs have, and they lack the necessary training to assess and evaluate patients," said Underwood. "Often times patients assume they are receiving professional nursing care, when in reality they are not," she added.

"As Berens rightfully points out, nurses are the 24-hour care givers in health care institutions and the patient's first line of defense," Underwood said. "Patients need nurses -- nurses are the quality difference, as research has indicated. However, until all parties value quality nursing care and make it a priority, where adequate staff and training are planned and budgeted for, the situation likely will remain the same.

"So far, most hospitals and heath care organizations have ignored nurses. Instead, they have been fighting nurses at the bargaining table, forcing strikes and opposing patient safety legislation. What is needed is a public call to action, a partnership between consumers and patients -- to encourage health care decision makers to do the right thing and put patient safety first, ahead of the bottom line."

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The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

Op-Ed

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