Healthcare Hygiene magazine September 2020 September 2020 | Page 6
from the editor
COVID-19 Reveals the Danger
of Chronic Nurse Understaffing
Nursing may be one of the most trusted
professions, but it continues to suffer
chronic understaffing, brought to light
once more by the COVID-19 pandemic.
A new study documents staffing ratios
that varied from 3 to 10 patients for each
nurse on general adult medical and surgical
units – with ICU nurse staffing faring only
slightly better.
The study points out that New York
City, the early epicenter of the COVID-19
surge in the U.S., had the poorest average
hospital nurse staffing on the eve of this
public health emergency.
Researchers at the University of Pennsylvania
found that the workload had
adverse consequences on nurses and on
patient care, with serious repercussions
for the future.
“Half of nurses right before the
COVID-19 emergency scored in the high
burnout range due to high workloads, and
1 in 5 nurses said they planned to leave their
jobs within a year,” says lead author Karen
Lasater, PhD, RN, an assistant professor
and researcher at the Center for Health
Outcomes and Policy Research (CHOPR)
at the University of Pennsylvania School of
Nursing. “It is an immense credit to nurses
that in such an exhausted and depleted
state before the pandemic they were able
to reach deep within themselves to stay at
the hospital bedside very long hours and
save lives during the emergency.”
Researcher and CHOPR director Linda
Aiken, PhD, RN, notes that half of nurses in
the study gave their hospitals unfavorable
grades on patient safety, and two-thirds
would not recommend their hospital to
family and friends.
The researchers surveyed all RNs holding
active licenses to practice in New York and
Illinois from Dec. 16, 2019 to Feb. 24, 2020.
Hospital nurses reported on the number
of patients assigned to them to care for at
one time. These nurse reports were linked
to Medicare patient-reported outcomes
for the same hospitals. They studied 254
hospitals throughout New York and Illinois.
Notably, these two states have pending
legislation requiring hospitals to meet
minimum safe nurse staffing standards
– no more than four patients per nurse on
adult general medical and surgical units.
The study found that most hospitals in
both states currently do not meet these
proposed standards, nor do they even
meet the safe nurse staffing standard of
five patients per nurse set by legislation in
California 20 years ago.
The study found that each additional
patient per nurse significantly increased
the proportion of both patients and nurses
giving unfavorable hospital quality and
safety ratings, after differences in hospital
characteristics such as teaching status, size
and technology availability were taken
into account.
Half of the nurses were burned out, 31
percent were dissatisfied with their jobs,
and 22 percent intended to leave their jobs
within a year. Half of the nurses also gave
their hospitals an unfavorable grade on
patient safety, one-third gave unfavorable
ratings on prevention of infections, and 70
percent would not definitely recommend
the hospital where they worked to a family
member or friend.
A majority of nurses reported that
delays in care were common because
of insufficient staff, and many reported
frequent delays in care due to missing
supplies including medications and missing
or broken equipment.
Nurses are the backbone of healthcare
delivery. Like our lackluster readiness for the
pandemic, our inability to support these
frontline warriors is shameful.
Let’s hope that in hindsight, as the
pandemic continues to be dissected and
analyzed for gaps in response, the hero
status of nurses becomes more than just
lip service.
Until next month, bust those bugs!
Kelly M. Pyrek
Editor & Publisher
[email protected]
healthcarehygienemagazine
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Reference: Lasater KB, Aiken LH, et al.
Chronic Hospital Nurse Understaffing Meets
COVID-19: An Observational Study. BMJ Q&S.
2020. DOI: 10.1136/bmjqs-2020-011512
6 september 2020 • www.healthcarehygienemagazine.com