Nurses Dissatisfied in Five Countries, Study Finds
Although U.S. nurses have often "blamed" managed care for contributing to a decline in the quality of patient care, nurses in other countries that have implemented national health plans "share the same frustrations," a new study in the May/June issue of Health Affairs reveals. Problems such as inadequate nurse staffing and "uneven quality" of patient care are often attributed to the growth of managed care, increased hospital competition, reduced Medicare reimbursements and "other uniquely American phenomena," the study states. But a survey of 43,329 registered nurses working in adult acute care hospitals in the United States, Canada, England, Germany and Scotland found that nurses in all of the countries complained of staffing shortages, limited input in policy decisions and dissatisfaction with patient care. Findings from the study are outlined below.
- Patient care: About 45% of U.S. nurses reported that the "quality of care in their hospital has deteriorated in the past year." About 45% of Canadian nurses, 27.6% of English nurses, 21.5% of Scottish nurses and 17.2% of German nurses also agreed with this statement.
- Staffing levels: Only 33.4% of U.S. nurses agreed with the statement, "There are enough staff to get the work done," compared with 37.4% of Canadian nurses, 28.4% of English nurses, 36.3% of Scottish nurses and 37.7% of German nurses.
- Impact of staffing on patient care: About 34% of U.S. nurses agreed with the statement, "There are enough registered nurses to provide high-quality care." Thirty-five percent of Canadian nurses agreed with this statement, compared with 29% of English nurses, 38.1% of Scottish nurses and 36.5% of German nurses.
- Participation in policy decisions: About 40% of U.S. nurses said that nurses "have the opportunity to participate in policy decisions," compared with nearly 40% of Canadian nurses, 35.8% of English nurses, 32.8% of Scottish nurses and 22.7% of German nurses.
- Salary: Among U.S. nurses, 57% said that nursing salaries were "adequate." Sixty-nine percent of nurses in Canada, 19.9% of nurses in England, 25.9% of Scottish nurses and nearly 41% of German nurses agreed that their salaries were adequate.
- Job satisfaction: Forty-one percent of U.S. nurses said they were "dissatisfied with [their] present job," compared to 32.9% of Canadian nurses, 36.1% of English nurses, 37.7% of Scottish nurses and 17.4% of German nurses. One-third of American nurses under 30 said they were "planning to leave" their jobs within the next year, compared to 29.4% of Canadian nurses, 53.7% of English nureses, 46% of Scottish nurses and 26.5% of German nurses in the same age group.
The study concluded that "all is not well in hospitals," and that this is "not a uniquely American problem," suggesting instead that there is "a fundamental flaw in the design of clinical care services and the management of the hospital workforce" (Aiken et al., Health Affairs, May/June 2001). Lead study author Linda Aiken said, "My interpretation of our findings is that there's a disconnect between the folks that manage hospitals and the major product that they create," noting that hospitals' "major product" is patient care. She added that she is "not convinced" that there is a shortage of nurses, just that hospitals "can't attract enough of them." Aiken said that hospitals could create a "more attractive environment" for nurses and improve patient care without spending a lot of money (Burling, Philadelphia Inquirer, 5/7). Researchers suggested that hospitals adopt a different model of management -- "one that makes hands-on patient care the top priority for nurses and makes sure other hospital workers help nurses focus on their essential duties." Pamela Thompson, executive director of the American Organization of Nurse Executives, added that nurses with the highest level of job satisfaction are those with the most input on issues such as patient care and job operation. A spokesperson with the American Hospital Association agreed, stating that hospitals that have found "success" in restructuring delivery of nursing care have done so by "giving front-line nurses a voice in how changes are made" (Allen, Los Angeles Times, 5/7). Aiken said that hospitals also should offer benefits "comparable to those offered by other businesses," such as advancement and lifelong learning opportunities and flexible work schedules, over "popular short term strategies such as signing bonuses and use of temporary personnel" (Bergstrom, AP/Ft. Worth Star-Telegram, 5/7).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.