Undertrained, Overworked Nurses Can Lead to Medical Errors, IOM Report Says
Nurses' long hours, insufficient training and overload of paperwork often contribute to medical errors that cause preventable deaths and injuries, according to a report released Tuesday by the Institute of Medicine of the National Academies, the Baltimore Sun reports. The 327-page report, "Keeping Patients Safe: Transforming the Work Environment of Nurses," examines nursing staffing at hospitals, nursing homes and other environments amid a nationwide nursing shortage, according to the Sun (Bell, Baltimore Sun, 11/5). It is the latest of three studies issued by the institute since 1999 as part of an effort to reduce patient deaths that result from medical errors (Anstett, Detroit Free Press, 11/5). The report offers 18 recommendations for nursing reform (Baltimore Sun, 11/5). Summaries of some of the report's recommendations appear below.
- Panelists recommended that state officials prohibit nurses from working more than 12 hours during a 24-hour period or more than 60 hours a week.
- The panel recommended that intensive care units should be required to have one licensed nurse on duty for every two patients and that nursing homes should be required to have one registered nurse for every 32 patients and one nursing assistant for every 8.5 patients (Pear, New York Times, 11/5).
- The panel recommended that nurses be relieved of duties such as transferring patients so they have more time to monitor patients. It also suggested time-saving measures, such as storing supplies in rooms where work is performed to reduce the time nurses spend collecting necessary items (Baltimore Sun, 11/5).
- The report suggested limiting the number of temporary nurses allowed on staff because some studies found that temporary workers contribute to higher rates of medical errors (Detroit Free Press, 11/5).
- The panel urged hospitals and nursing homes to offer more training opportunities for nurses throughout their careers (MacDonald, Hartford Courant, 11/5).
- The report suggested that nurses should be allowed to halt admissions when they believe staffing levels are too low (Lasalandra, Boston Herald, 11/5).
In addition, the report found that some nursing departments have been cut and chief nursing officers' power has been reduced. "The situation hampers nurses' ability to fix problems in their work environments that threaten patient safety," the report stated. Panelists suggested that nurses should participate in decision-making at all levels (Baltimore Sun, 11/5).
An abstract of the report is available online.
Sen. Charles Grassley (R-Iowa), who has been investigating nursing homes since 1997, said he opposes setting requirements for nursing home staff, adding, "If we mandate minimum staffing levels, the nursing home industry will want more money." However, Dr. William Rupp, a panel member and president of a Mayo Health System hospital in Mankato, Minn., said that measures should be taken to relieve overworked workers. "Virtually every other industry in the country pays more attention to fatigue than we do," he said (New York Times, 11/5). "There was nothing new here, but it was great to have the research behind it," Patricia Duclos-Miller, president of the Connecticut Nurses' Association, said (Hartford Courant, 11/5).