Nursing Shortage Contributes to Medical Errors and Patient Deaths, JCAHO Says

The nation's current nursing shortage contributes to "tens of thousands" of deaths from hospital errors, such as patient falls and hospital-acquired infections, each year, according to a new report to be released today by the Joint Commission on Accreditation of Healthcare Organizations, the Boston Globe reports (Barnard, Boston Globe, 8/7). There are currently 126,000 vacant nursing positions at hospitals nationwide, and that number is expected to reach 400,000 by 2020, the report found (Ritter, Chicago Sun-Times, 8/7). The commission, a not-for-profit group that inspects and accredits hospitals and nursing homes, studied 1,609 adverse events that hospital officials voluntarily reported to the group between January 1996 and March 2002 and found that 24% were related to an "insufficient number of registered nurses on the job," according to hospital officials. JCAHO President Dr. Dennis O'Leary said that although medical errors and the nursing shortage have received increased attention, hospital administrators and lawmakers have not devised an adequate solution. O'Leary said, "There seems to be a tacit belief that where we are now is OK. We're saying somebody ought to be really bothered about this right now, and it's probably going to get worse if we don't wake up." He added that the report may "understate" the impact the nursing shortage has on adverse events because medication errors are often under-reported, and hospital officials often blame errors on "miscommunication or insufficient training" instead of on the shortage. Jeanette Clough, a registered nurse and president of Mount Auburn Hospital in Massachusetts, said, "Now we have data to really demonstrate that this [nursing shortage] ... affects patient care."

The report, produced for JCAHO by a committee of academics, nurse executives and a union representative, offers several initiatives to reduce the shortage (Barnard, Boston Globe, 8/7). The report proposes establishing "magnet hospitals" that would be designed to attract and retain nurses by offering improved training, setting staffing levels and establishing a zero-tolerance policy for abuse against nurses. The report also calls for increased government funding for nurse education and a standardized post-graduate nursing residency program, the Boston Herald reports. Further, the report proposes linking federal and private-payer hospital reimbursement to staffing levels. Some say that the proposed solutions are not comprehensive enough, the Herald reports. David Schildmeier, a spokesperson for the Massachusetts Nurses Association, said, "The thing that's missing here is setting nurse-to-patient staffing ratios, which is the key to addressing the shortage and keeping nurses at the bedside" (Heldt Powell, Boston Herald, 8/7). The full report is available online.

In related news, President Bush last week signed the Nurse Reinvestment Act, legislation intended to ease the nationwide nursing shortage in part by expanding loan-repayment programs. The legislation authorizes the programs but does not allocate funding for them. The following are summaries of editorials and opinion pieces addressing the passage of the legislation.

• David Broder, Washington Post: The Nurse Reinvestment Act has gone "unnoticed and uncelebrated by almost everyone outside the health profession," David Broder writes in a Washington Post opinion piece. With the country facing a "critical shortage of nurses," the legislation is "well designed" to address the three trends "jeopardiz[ing]" health care: a growing number of U.S. residents over age 65 needing medical assistance; the increasing retirement or "dropout" rate among "already aging and overworked" nurses; and a sharp drop in the number of people entering the nursing profession. Broder says that the Nurse Reinvestment Act has "the potential to bring substantial benefits to untold millions of people during the decades ahead" (Broder, Washington Post, 8/7).
  
• Nashville Tennessean: The passage of the Nurse Reinvestment Act shows that "Congress has come a long way to restore the health of nursing ranks," but lawmakers "still have much more to do," according to a Nashville Tennessean editorial. Addressing the nursing shortage is a "problem that's gotten lost as Congress and health organizations battle over other cost issues of care and prescription drugs." Although the passage of the bill indicates a "noble sentiment," the editorial concludes, "Now Congress needs to provide adequate funding to back up its good intentions" (Nashville Tennessean, 8/7).