The Importance of Nursing Care
II recently responded to a question on my message board in which an individual asked about the potential benefits of being taken care of by "big city" versus a "small city" cardiologist. Apparently the poster was having a discussion with a sibling, who thought that their mom should be going to the city for her medical care.
In my response I pointed out that the most important factor in hospitalization and recovery without complications is not the surgeon or the physician, it's the nursing care. Now before all my physician readers get their knickers in a knot (sorry, I just love that visual), I did point out that it is important to make sure that the doctor is qualified to perform the surgery or manage the type of illness in question, and that there are circumstances in which a city hospital's expertise is warranted. In other words, you might want to read the original message.
Now in the journal "Health Affairs" and reported on Reuters Health Information, there is an article about a study that attempts to quantify the potential costs and savings to hospitals by increasing registered nursing hours.
Based on data from 800 acute-care hospitals, researchers concluded that increasing the RN to LPN ratio, while keeping the number of total nursing hours the same, would cost hospitals $811 million, but save $1 billion in the short term. The study found that hospitals could avoid 5,000 annual patient deaths if they boosted the number of registered nurses by replacing some licensed practical nurses with RNs; LPNs require less training and education compared with RNs. Although this appears to limit job opportunities for LPNs, the study actually calls for an overall increase in the number of RNs and LPNs in practice; it just changes the "mix" on any given unit and shift.
A number of studies in the last decade have pointed to human error in the frequency of patient deaths, and in hospital complications such as urinary tract infections, heart attacks, and poor post-operative outcomes.
A large number of these studies point to improved outcomes with increased nurse to patient ratios. As a result the state of Rhode Island, where I practice, is going to start publishing the nurse to patient ratios at all of the state's hospitals annually, so that individuals may use this as a factor in their choice of hospital for elective admissions. It will be amazing to see what happens to nursing salaries once this goes into effect and hospitals have to compete with one another for staff. Stay tuned for that ride folks!
So as I pointed out to the person writing to me at WebMD, the best choice may be the facility that has the greatest number of registered nurses on staff. There is just one problem with this plan: there aren't enough nurses to go around. The state of California implemented laws to mandate staffing ratios in 2004, but many hospitals haven't been able to implement them due to the nursing shortage. Other countries, such as England and Australia are complaining about U.S. efforts to recruit nurses away from home with higher salaries; those countries are suffering similar nursing shortages and have lower pay scales. The U.S. Department of Labor projects that we will need 1 million replacement nurses by 2012, just 6 years from now, and yet the American Association of Colleges of Nursing reports that nursing schools turned away 32,000 interested students in 2004 because they didn't have enough faculty to teach them.
Fixing nursing ratios will take time and money; in the current political climate it seems unlikely that additional federal funding will be forthcoming to encourage students to go to nursing school, to provide LPN to RN training for experienced practical nurses, and to encourage nursing leaders to teach by improving salaries of those who take on this challenging career. It's too bad that the value of saving human lives matters so little to our current administration. But that's the subject of another blog....
Laurie
The art of medicine consists in amusing the patient while nature cures the disease.
Voltaire (1694 - 1778)
Fortunately nurses are good at this...
Related Topics: The Baby Boomer Heart: A User's Guide, Finding Good Medical Care
Technorati Tags: healthcare, nurse, RN, LPN
In my response I pointed out that the most important factor in hospitalization and recovery without complications is not the surgeon or the physician, it's the nursing care. Now before all my physician readers get their knickers in a knot (sorry, I just love that visual), I did point out that it is important to make sure that the doctor is qualified to perform the surgery or manage the type of illness in question, and that there are circumstances in which a city hospital's expertise is warranted. In other words, you might want to read the original message.
Now in the journal "Health Affairs" and reported on Reuters Health Information, there is an article about a study that attempts to quantify the potential costs and savings to hospitals by increasing registered nursing hours.
Based on data from 800 acute-care hospitals, researchers concluded that increasing the RN to LPN ratio, while keeping the number of total nursing hours the same, would cost hospitals $811 million, but save $1 billion in the short term. The study found that hospitals could avoid 5,000 annual patient deaths if they boosted the number of registered nurses by replacing some licensed practical nurses with RNs; LPNs require less training and education compared with RNs. Although this appears to limit job opportunities for LPNs, the study actually calls for an overall increase in the number of RNs and LPNs in practice; it just changes the "mix" on any given unit and shift.
A number of studies in the last decade have pointed to human error in the frequency of patient deaths, and in hospital complications such as urinary tract infections, heart attacks, and poor post-operative outcomes.
A large number of these studies point to improved outcomes with increased nurse to patient ratios. As a result the state of Rhode Island, where I practice, is going to start publishing the nurse to patient ratios at all of the state's hospitals annually, so that individuals may use this as a factor in their choice of hospital for elective admissions. It will be amazing to see what happens to nursing salaries once this goes into effect and hospitals have to compete with one another for staff. Stay tuned for that ride folks!
So as I pointed out to the person writing to me at WebMD, the best choice may be the facility that has the greatest number of registered nurses on staff. There is just one problem with this plan: there aren't enough nurses to go around. The state of California implemented laws to mandate staffing ratios in 2004, but many hospitals haven't been able to implement them due to the nursing shortage. Other countries, such as England and Australia are complaining about U.S. efforts to recruit nurses away from home with higher salaries; those countries are suffering similar nursing shortages and have lower pay scales. The U.S. Department of Labor projects that we will need 1 million replacement nurses by 2012, just 6 years from now, and yet the American Association of Colleges of Nursing reports that nursing schools turned away 32,000 interested students in 2004 because they didn't have enough faculty to teach them.
Fixing nursing ratios will take time and money; in the current political climate it seems unlikely that additional federal funding will be forthcoming to encourage students to go to nursing school, to provide LPN to RN training for experienced practical nurses, and to encourage nursing leaders to teach by improving salaries of those who take on this challenging career. It's too bad that the value of saving human lives matters so little to our current administration. But that's the subject of another blog....
Laurie
The art of medicine consists in amusing the patient while nature cures the disease.
Voltaire (1694 - 1778)
Fortunately nurses are good at this...
Related Topics: The Baby Boomer Heart: A User's Guide, Finding Good Medical Care
Technorati Tags: healthcare, nurse, RN, LPN
6 Comments:
I see your point, but I just wanted to point out one more thought. Many small towns, are far away from other small towns. Ever noticed that? So, when there's an emergency, we do not have much of a choice anyway. When I had my daughter last year, there were 14 babies being born that night. Mine was the 11th. No one had been in for quite some time. Last I'd seen anyone, I was at a four. Having a prolapsed mitrovalve, I was on antibiotics and my bag ran dry, so did my second bag of pits. When my husband finally found a nurse (no problem, I know they were extremely busy) I had to beg her to check my dialation. The baby was taking her time and no one was worried about how far along I was yet. She hesitated, but we begged, and she gave in. Apparently IT WAS TIME. She didn't leave my side after that, and yelled for help. Our daughter's heartrate had slowed alarmingly. I have no idea how long I had been at a ten. Granted, our daughter was born healthy and beautiful. The staff really was great, but I could tell, they were definately understaffed.
Many articles state that there is a nursing shortage. Face reality!
There is NOT A NURSING SHORTAGE! The shortage is actually the number of nurses working at bedside nursing. Because hospitals refuse to pay an adequate salary, many liscensed nurses are finding less risky, better compensated ways to make a living. Additionally, because many Nurse Managers "salary" is inadequate for the responsibilities, and "labor intensive" duties required to manage their respective units, "bonuses" are added to the "salaries" as incentives to encourage inappropriate staffing ratios [lower costs for staffing]. Therefore, the bedside nurse, and the pt. are placed at increased risk, and the Nurse Managers, and Administrators reap the financial "reward" .
California has the right idea in legislating staffing ratios, but those of us in the "sunbelt states" are often hampered by "open shop" rules ment to discourage union activity. Therefore, these legislative relief measures are unavailable.
There are >180,000 RN's in Texas, but <100,000 are working "at the bedside". With the "baby boom" generation nearing "retirement" what will it take to generate adequate staffing levels for now, and the future?
TEXAS RN
I agree that nurses are probably the most important aspect of being an inpatient.I recently had that proved to me. We seem to have a war going on in the town I live in between the 2 local hospitals and some of the physician's.
One hospital is quite large and is constantly expanding. In my 53 years, it is the hosp. I have always went to for out-patient tests, surgery, hospitalizations, etc..I have always received wonderful care there. The second one is much smaller and always seems kind of like a ghost town when I have been there to visit friends. It's actually kind of scary walking down the halls, because there is just not the commotion going on that you see at most hospitals.
I recently had to have major surgery that required 6 days of inpatient care. My surgeon informed me that he would not go to the large hosp. but only to the smaller one. He explained that he "didn't like the way the larger hospital treated patients and he would not take any of his patients there."
Rather than change surgeons, I decided to go to the smaller hospital. I thought that I would really receive great care. I always got good care at the larger hosp. so if my Dr. thought they gave bad care, this smaller one must be really good.The fact that they have very few patients didn't register with me at all.
It was the worst care I could ever imagine receiving. What my Dr. really liked was the way the nursing staff treated HIM, which had nothing to do with how they treated me!
I would call for pain medication and maybe receive it an hour and a half later. Once I received the wrong medication. I said to the nurse, "are you sure this is my medicine, it doesn't look like it." Her response was "Of course it's your medicine, what's your name." I'm almost certain she was supposed to check my arm band for my ID before opening that medication and placing it in my hand. When I told her my name she grabbed the medicine out of my hand and said "No, this is not your medicine." I felt like I had done something wrong. Then, I had to wait for her to dig through the trash can to find the plastic push out wrapping that had covered that medication before she could go get MY medicine.
On the morning following my surgery while being on complete bed rest I was given all of my blood pressure medication (Demadex20mg, toprol XL, and Hyzaar) Everyone knows that 2 of those are either a diuretic or have a diuretic in them. A half hour later I had to use the restroom. The nurse helped me onto the bedpan. After waiting as long as possible, in about another 30 minutes, I had to go to the bathroom again. This is normal morning procedure after taking my BP meds, it goes on for about 2 hrs..When I called her the second time she came flying into the room and screamed "this time I'm getting you out of bed and walking you to the bathroom so you can completely clean out your bladder." This nurse had no clue as to how BP medication works!
The whole hospitalization turned me off with ever wanting anything done again. I have lost all respect for my surgeon and would NEVER return to this hosp.
It's a proven fact that patient care goes to the toilet when the ratios are too high! I hate that I can't educate my patients and spend the time necessary to really assess them when we are understaffed. I agree that the shortage comes from both aspects, the educators are making less money than floor nurses and the fact that more nurses are trying to get away from the floor if they can..It's a viscious cycle.. Patients really notice when we are hurried..
A hospital executive would feel more comfortable contracting a nurses from an agency dedicated to temporary medical staffing than from a one-stop-shop that also places welders, janitors and filing clerks.
Try to visit this site Starting a nursing home its a nursing guide.. And its a solution to the nursing shortage crisis.
I don't know what the person who said there is not a nursing shortage was reading, but there is definitely a nursing shortage with much evidence to support it. The fact is patient care does become sub-standard if RN-PT ratios are too high. We have a high burnout rate, and the compensation for our work is not very good. We are not respected as a professional organization, but if you look at nursing theory, it is all derived from evidence based practice, no other professional organization can say that.
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