When Bessie Gray starts her shift as a labor and delivery nurse at Research Medical Center, she doesn’t expect to get a meal break.
There’s just too much work, she says, and too few nurses to fill in for her if she tries to grab a bite.
Going without a meal is more than just an inconvenience. “You start to get tired, and that’s when you start making medical mistakes,” Gray said as she walked a picket line Thursday evening outside her hospital. Passing cars honked in solidarity as she spoke.
Unionized nurses at Research and its HCA sister hospital Menorah Medical Center are in the midst of contract negotiations. While Research points to high grades for safety and quality care that it has received from health care organizations, the nurses cite data that the hospital is, at times, out of compliance with its own staffing levels for nurses.
For example, Research’s progressive care unit, which is one step down from intensive care, was understaffed 68 percent of the time from December through February.
Meanwhile, nurses with similar complaints of understaffing have been setting up picket lines or even going on strike at hospitals from California to upstate New York and the suburbs of Boston.
Yes, labor contracts are at stake. But there’s plenty of evidence that this current discontent is more than just a bargaining tactic. Survey after survey finds that many nurses are working long hours under stressful conditions that put their patients in jeopardy and take a toll on their own health, as well.
According to the American Nurses Association, two out of five nurses say their hospital units are short staffed; 54 percent say their workloads are excessive; and half say they don’t have enough time to spend with their patients. About three-fourths of nurses work 12-hour shifts, and 43 percent say they’re working more overtime. It’s no wonder that 96 out of 100 nurses report being fatigued at the beginning of their shifts.
Researchers have found that patients can suffer grievously when there aren’t enough nurses. Understaffed hospitals tend to have more deaths among abdominal aortic aneurysm surgery patients, one recent study found. According to another study, having too few nurses in neonatal intensive care units is associated with increased risks of infections and death among the infants. And as the number of nurses falls below minimum staffing levels, medication errors rise, a third study concluded.
Even something as basic as a patient calling a nurse for help getting out of bed to go to the bathroom can lead to complications when there aren’t enough nurses, said Gray, the Research Medical Center nurse.
If a nurse can’t take a call because she’s attending to another patient and there’s no one to provide backup, a frail or sedated patient may give up waiting and try to get out of bed on his own. “Without help, patients can fall,” Gray said.
A spokeswoman for Research Medical Center said the hospital is “always focused on staffing to appropriately meet our patients’ needs.”
But hospitals would be well-advised to heed the concerns of nurses like those at Research, a leading researcher on nurses’ workplace issues said.
“Nurses are driven by their concerns for patients. There’s plenty of evidence to say that when nurses say there is a problem, there almost always is,” said the researcher, Linda Aiken of the University of Pennsylvania. “Nurses are like the canaries in the coal mines. It’s in the interest of hospitals to take nurses’ concerns seriously. They are the early warning system.”
Aiken said nurses often face chaotic workplaces where their needs and those of their patients aren’t fully appreciated. They must cope with missing or broken equipment, incorrect doses of medications, wrong or missing patient meals.
When speaking to groups of nurses, Aiken often will ask them whether they hoard pillows at work. “You’d be amazed how many raise their hands.”
That’s because it can take a half-dozen pillows to properly elevate and position a patient after surgery, but hospitals typically allot just one or two pillows per bed. “And these are billion-dollar businesses,” she said.
Understaffing at hospitals has been a problem “forever and ever,” Aiken said. “But it’s becoming more serious because patients in hospitals are more ill and need more care.” And treatments, such as regimens of chemotherapy drugs, have become more complicated and potentially dangerous. “That makes the risks greater.”
Aiken said hospitals need to create work environments where nurses can be efficient and effective and budget for them accordingly.
“We need to come to an understanding that hospitals are nursing care institutions,” she said. “But hospitals don’t accept that. Nursing is looked at as a soft target for cost reductions when it’s actually their main service.”
Consumers looking for hospitals that emphasize high-quality nursing care should consider those with Magnet designation, Aiken said.
Magnet status is awarded by the American Nurses Credentialing Center, an affiliate of the American Nurses Association, to hospitals meeting criteria designed to measure the strength and quality of their nursing. In the Kansas City area, the University of Kansas Hospital, Children’s Mercy Hospital, St. Luke’s Hospital, St. Joseph Medical Center and St. Mary’s Medical Center have received Magnet hospital designation.
Dave Dillon, spokesman of the Missouri Hospital Association, said labor unrest is uncommon at hospitals in the state — nurses at one St. Louis hospital even decertified their union recently — and hospitals make great efforts to create good work environments.
“There’s too much at stake not to treat your nurses well,” Dillon said. “Nurses are the front line of patient satisfaction. To discount the staffing level to save money could only cause you to lose money.”
Even so, a recent hospital association report found high turnover rates and large numbers of job vacancies for nursing positions at Missouri hospitals. Dillon preferred to attribute this to competition among hospitals for a short supply of nurses rather than to nurses leaving hospitals because they were dissatisfied with their jobs.