Patient care suffers when nurses are overloaded with work

A recent article, “Burned Out Nurses Linked to More Infections,” addresses an important issue that is often overlooked and ignored. Let’s be brutally honest, without an appropriate nursing workforce, our entire healthcare system would collapse.  As our healthcare system continues to shift to a business and profit model, both nurse and physician burnout will only increase.

Decisions to “cut corners” by not providing adequate nursing staff are made on a daily basis to our detriment. There was a time when additional nurses would be brought in based on the patient census for the day or evening shift but those days are gone forever.

According to a recent medical study, for every extra patient added to a nurse’s workload, there is one hospital acquired infection for every 1,000 patients. While this may not sound significant to the uninitiated, a hospital acquired infection can wreck havoc because it is usually caused by antibiotic-resistant bacteria that are difficult to treat and Methicillin-Resistant Staph Aureus (aka flesh-eating bacteria) or MRSA is a perfect example.

The study goes on to report that when an additional patient is added to 5.7 patients per nurse, 1,351 additional hospital infections occur that are preventable. The statistics are alarming.

A few months ago I reviewed a medical OB-GYN case where the labor room nurses were short-staffed and the patient unfortunately died of complications. The physician had patients in labor but chose to finish his office hours rather than attend to a sick patient so the short-staffed labor room nurses were essentially managing his high-risk patients.

What can a patient do? Plenty.

  1. Ask what the patient to nurse ratio on the day of your hospital admission and if the nursing staff pattern is inappropriate, ask your insurance company if you are eligible for a private duty nurse based on the increased hazards associated with inadequate nursing staffs.
  2. Ask your physician to come to the hospital to closely oversee your care or make sure there’s a hospitalist on duty
  3. File a formal complaint with the hospital administrators, State Board of Nursing and the Joint Hospital Commission for jeopardizing your patient safety based on inadequate staffing patterns

When nurses are overloaded with work, an entire community suffers.

Linda Burke-Galloway is an obstetrician-gynecologist and author of The Smart Mother’s Guide to a Better Pregnancy. She blogs at her self-titled site, Dr. Linda Burke-Galloway.

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  • Dike Drummond MD

    Amen to that.

    It is the NURSES that provide the care in the hospital and office settings. Doctors will often be in the patient’s room no more than 10 minutes a day (and that is being generous). We give orders and walk out leaving the nurses and other direct care providers ALL the activities supporting the patient and the other 23 hours and 50 minutes. It’s hard work with LOTS of moving parts. When staffing is inadequate … all sorts of bad things happen.

    This study just points out one of many bad things understaffing produces. If we looked at medical errors, length of stay, patient satisfaction .. I am certain these would be impacted as well. AND it is NOT THE NURSES FAULT. This is a business decision from the organization.

    This study documents a linear correlation between staffing levels and a specific complication. We know how many hospital acquired infections will occur based on the number of patients per nurse. The real question is – knowing this – what is your organization’s standard of care. What is “acceptable risk” realizing if it is my daughter in your hospital, I won’t accept anything more than 0% tolerance.

    Medicine is a both a business and a higher calling. Medical companies must find that sweet spot between cost (staffing) and Return on Investment (complication rates) … my hope is that they err on the side of quality care … and give the nurses on the front line as much support as their budget will allow.

    Dike Drummond MD

    • wendyzhw

      Good point, Dr. Drummond. I have been a bedside nurse for three years, and I have seen too many issues related to staffing. It’s not about one or several hospitals, it’s the culture/module of the US health care system. The hospitals are run by business people, usually MBAs seeking maximum profits–it doesn’t matter the organizations are in the stock market or they label themselves “non-profits”. I don’t know about other areas of the US, but in north Texas, new hospitals, small or big, are built very fast, leading to painful competition against each other. Most hospitals focus on attracting patients with hardwares, hotelizing the hospitals. If the administrators need to cut cost at the same time, they can only work on software, including staffing.

  • boucains

    At the large university medical center where I get my primary care, the people who used to answer the phone and make appointments now triage private electronic messages originally meant to be between patient and physician. The administration does not consider this a HIPPA violation because these medically untrained people get a course on privacy. My mother is an RN. I haven’t seen an RN since my last ER visit. While the business office gets payment from the insurer in 3 days, mistakes move just as fast. Due to overwork and under-trained staff at every part of the process, for the first 6 months of 2012 I received only 66% of the class II medication prescribed by my PCP. None of these mistakes would have made it by an LVN much less an RN.

    While I completely agree with Dr. Burke-Galloway, I also think that the lower-level staff asked to do tasks previously done by better trained but more costly nurses is losing track of the difference. I’ve had 20 yr. old MAs tell me that the small BP cuff they are using is the biggest cuff made – and had them backed up by the office manager. They both stood firm even though a Internet connection and 3 minutes would change their minds. They were not even willing to TRY to look.

    I’ve had too many similar incidents to mention, but there is one thing that works against doctors, nurses AND patients. My PCP is a great PA-C. I respect his judgment. He is good at knowing what isn’t a big deal and what needs to be checked into further. Isn’t that what a PA is supposed to do? I think we would agree that this is acceptable and appropriate, but what about the fact that ALL of the staff refers to him as “doctor”? When you are sick or in pain, are you going to notice a nametag in enough detail to realize that the smiling person who is taking care of you isn’t really a doctor? How will you find out when the staff refers to them as “doctor”? Blurring
    those lines is great for the bottom line until someone wins a lawsuit.

  • lauramitchellrn

    Thank you for recognizing the work that nurses do. Intentional under staffing is indeed a business decision. But what might save money at the front end usually costs money at the back end.

  • militarymedical

    WHEN will we see the elephant in the room and remove non-medical people from decision-making positions, especially those positions of authority. I’m not talking about receptionists, secretaries and the like. I mean the MBAs, JDs and other over-educated bean-counters who “manage” health care for the bottom line, not for either patients or those with the appropriate education, training and skills to provide the care to patients.

  • southerndoc1

    Great post. This is huge problem and it will only get worse as the profit motive comes to totally dominate health care.
    So much of what goes on in medicine in terms of quality control, pay for performance, protocols, EMR reminders, etc. is really just stop-gap measures to make up for the degradation of the nurse/patient relationship.

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