Del.icio.us
Digg
Reddit
Facebook
StumbleUpon
TwitThisDisastrous Shortages
Last year, a research team led by Linda Aiken of the University of Pennsylvania School of Nursing examined the outcomes of 232,342 relatively common operations, from appendectomies to orthopedic procedures. Their study found that when hospitals exceed a ratio of four surgical patients to one nurse -- as many do -- the risk of death increases by 7 percent for each additional patient. So if a nurse who is assigned four patients has to start caring for six, the risk of death for all her patients jumps by 14 percent. If the patient-to-nurse ratio increases to eight to one, the risk of death jumps 31 percent."Of the hospitals we looked at," Aiken says, "88 percent had patient-to-nurse ratios greater than four to one." Only 12 percent had four patients or fewer per nurse.
At the time of Mike Hurewitz's death, the patient-to-nurse ratio in Mount Sinai's liver transplant unit was seven to one, according to New York State. At Wesley Medical Center, a large for-profit hospital in Wichita, Kan., one RN sometimes cared for up to 15 patients, according to court records. This may have contributed to the death of 38-year-old Deedra Tolson, who underwent a routine hysterectomy at Wesley in 1997. After surgery, Tolson, mother of a two-year-old boy, experienced a steady drop in blood pressure and urine output, both signs that she was bleeding internally. But nurses were too busy to check on her, says Brad Prochaska, the attorney who brought suit on behalf of Deedra's husband, Craig. Tolson slipped into a coma and died four days after surgery. In 1999, the hospital agreed to pay nearly $1 million to settle the case (although it never admitted fault).
Given the pressures and anxieties within the profession today, it is no surprise that the nurse pipeline is drying up. Between 1995 and 2001, the number of nursing candidates taking the U.S. national licensing exam fell 28.7 percent. A 2002 survey found that only 4.5 percent of female college freshmen, and less than 1 percent of male freshmen, plan to become nurses.
One student who did intend to go into nursing was Jessica Young, 24, who came within a year of completing her RN course work at the University of Maryland, Baltimore. But she became discouraged, in part because she spent time in a hospital observing nurses on the job. "I saw how short-staffed they were," Young says. "They were just running all the time." Young decided to drop out of her RN training program and got a degree in health management instead. Today she works for a pharmaceutical firm.
The fact that not enough young people are replacing the nurses who are retiring or quitting helps explain why, nationally, 126,000 hospital nursing positions -- 12 percent of the total -- remain unfilled.
While no one has a surefire cure for this nursing crisis, some pin their hopes on new medical technologies. Already, in patients' rooms and at nurses stations, digital monitors give constant readouts of vital signs such as heart rate, EKG tracings and blood pressure -- sparing nurses a lot of time-consuming work at the patient's bedside.
Other technologies now enable patients to administer their own intravenous pain medication with the touch of a button (calibrated to prevent overdoses). Computer bar codes, similar to those imprinted on supermarket items, are starting to be used to safely and accurately match patients with their prescribed medication.
Advertisement 
