3:48am

Fri May 25, 2012
Shots - Health Blog

Need A Nurse? You May Have To Wait

Originally published on Fri May 25, 2012 10:15 pm

Nurses are the backbone of the hospital — just ask pretty much any doctor or patient. But a new poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds 34 percent of patients hospitalized for at least one night in the past year said "nurses weren't available when needed or didn't respond quickly to requests for help."

Since nurses provide most of the patient care in hospitals, we were surprised at the findings. We wanted to find out more. We wanted to know what was going on from nurses themselves. So we put a call-out on Facebook.

We received hundreds of responses and read them all: piles of stories about nurses feeling overworked, getting no breaks, no lunches and barely enough time to go to the bathroom. Even worse, many nurses say breaks and lunchtimes are figured into their salaries and deducted, whether they take them or not.

When we asked nurses who responded to our call-out if we could interview them for broadcast, most said no. They worried about their employers' reaction. Many would be interviewed only anonymously.

"We're always afraid that something will happen to our patients during the time we're off the floor," one nurse says, "and I personally don't feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I'm off the floor."

This nurse says she rarely stops. Not for 12 hours. She's an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more — often eight, if she's covering for a colleague taking a lunch break. She says there are times when she can't leave patients' bedsides.

"Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn't harm them," she says, "and I can see the call bell going off in the hallway, and there's no way I could respond to that."

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she "missed something."

Another nurse likens her job to "spinning plates," just "praying," she says, that one doesn't fall. "And these are human beings," she says, "not products on conveyor belts."

Stories like this suggest there's a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that's not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs.

"There's not an actual nursing shortage," Aiken says. "There's a shortage of nursing care in hospitals and other health care facilities."

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

"In part, it's because our patients are sicker — coming to us with more intense diseases and disorders than they did 25 years ago," she says. "In part, it's because there's so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health."

That is terrific, of course, but it's not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

"Nurses are the surveillance system in hospitals for early detection and intervention [to save patients' lives]," she says.

According to one nurse, little clues from patients are critical.

"I mean, you might walk into a room, and they are breathing and answering your questions," the nurse says, "but if you look at their neck and the jugular vein is slightly distended ... taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast."

In our poll, 51 percent of those who were hospitalized overnight in the past year said they were "very" satisfied with their care. An additional 32 percent said they were "somewhat satisfied" — some things could have been better. Only 16 percent said they were dissatisfied.

It's not all bad news, but with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. Plus, while our call-out to nurses on Facebook was not scientific, the NPR/RWJ/Harvard poll is, and it does point to significant problems when it comes to the availability of nurses at the hospital bedside.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

Transcript

RENEE MONTAGNE, HOST:

This is MORNING EDITION from NPR News. Good morning. I'm Renee Montagne. Nurses are the backbone of hospitals. Pretty much any patient or doctor will tell you that. Still, a new poll by NPR, the Robert Wood Johnson Foundation, and the Harvard School of Public Health, finds that one-third of hospitalized patients say nurses weren't available when needed or didn't respond quickly to requests for help.

As part of our series "Sick in America," NPR's Patti Neighmond looks at what's behind this finding.

PATTI NEIGHMOND, BYLINE: Nurses provide most of the hands-on patient care, so we were surprised when our polls showed in many cases nurses weren't available. We wanted to find out what was going on from nurses themselves. We put a call out on Facebook and got hundreds of responses, nurses telling us they get no breaks, no lunches, barely time for the bathroom.

UNIDENTIFIED WOMAN: We're always afraid that something will happen to our patients during the time we're off the floor, and I personally don't feel comfortable leaving my patients unless I know that a co-worker is actually looking after them during the time that I'm off the floor.

NEIGHMOND: This nurse responded to our call out, and like nearly all we talked to, she didn't want her name used because she's worried about retaliation from her employer. She says she rarely stops. Not for 12 hours. She's an emergency room nurse in a busy urban hospital.

The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more - often eight, if she's covering for a colleague taking a lunch break.

UNIDENTIFIED WOMAN: There are times that I've been with a patient where I literally could not leave their bedside because maybe I was injecting a medication that you have to push slowly over five to 10 minutes so it doesn't harm them, and I can see a call bell going off down the hallway, and there's no way I can go and respond to that.

NEIGHMOND: The only option: Yell down the hallway and hope another nurse hears her and responds to the patient call bell.

UNIDENTIFIED WOMAN: There have been shifts where I've driven home at the end of 12 hours and I'm gripping the steering wheel and all I can think of is, what happened during my shift? Did I miss anything? I've run ragged. I didn't get a break. My knuckles are white. And what can we do to make this situation better for both the patients and the nurses?

NEIGHMOND: Stories like this suggest there's a shortage of nurses. But there isn't.

: We have a shortage or nursing care, but not a shortage of nurses.

NEIGHMOND: Linda Aiken's a researcher and professor of nursing at the University of Pennsylvania. There was a shortage about a decade ago, she says, but today that's changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs. Nancy Foster is a vice president with the American Hospital Association. She says hospitals are facing big financial challenges.

NANCY FOSTER: In part it's because our patients are sicker. They are coming to us with many more intense diseases and disorders than they would have 25 years ago. In part that's because there are so many more medications and devices and other interventions at our fingertips; we can help many more people than we could have 25 years ago and restore them to health.

NEIGHMOND: Nurses, says Foster, aren't alone in feeling the crunch, but nursing researcher Aiken says any reductions in nurse staffing at a time of increasing patient demand jeopardizes care.

, UNIVERSITY OF PENNSYLVANIA: Nurses are the surveillance system in hospitals for the early detection and intervention to save a patient.

NEIGHMOND: And if there's not enough time with patients, early detection may not happen. Our nurse says that's her biggest fear.

UNIDENTIFIED WOMAN: You know, you might walk into a room, and they're breathing and they look OK and they answer your questions, but if you look at their neck and their jugular vein is just slightly distended, or you check their nail beds and they're a little bit dusky, you know, taking the time to pick up on the small details like that, those are the early warning signs that somebody is getting sicker fast.

NEIGHMOND: In our poll, half of Americans who were hospitalized overnight in the past year said they were very satisfied with their care. Another third said they were somewhat satisfied but some things could have been better. Only 16 percent said they were dissatisfied, so it's not all bad news.

But with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. And for our overworked nurse, this takes a toll on a career she's always loved.

UNIDENTIFIED WOMAN: I've thought before that the day that I come home and look back and realize that I made a mistake because the demands exceeded any reasonable capacity on the part of a nurse, that's the day that I never want to be a nurse again.

NEIGHMOND: Now, our call out on Facebook was not scientific. Many nurses may not share the feelings of this overworked nurse, but our poll is scientific and it does point to significant problems when it comes to the availability of nurses at the bedside. Patti Neighmond, NPR News. Transcript provided by NPR, Copyright National Public Radio.