Study finds overtired nurses err

Area providers agree there is
a need to revamp working conditions and hours.
Monday, November 10, 2003 | 12:00 a.m. CST; updated 7:17 a.m. CDT, Tuesday, July 22, 2008

Too many hours, too many patients and a lack of trust between nurses and management are to blame for nursing errors, according to a study released last week by the Institute of Medicine.

The study claimed the work environment of nurses needs to be revamped to protect patients from mistakes.

Columbia health care providers agree with the general findings of the study but disagree on what should be done to improve working conditions in hospitals and nursing homes.

“It sounds like they recognize a lot of things that many nurses have been concerned about for some time,” said Myra Aud, an assistant professor at the MU School of Nursing.

The study showed an increase of infections, bleeding, cardiac and respiratory failure among patients in hospitals with inadequate staffing.

It also stated that nurses working long hours suffer from exhaustion, which affects reaction time, causes an inattention to detail and can lead to mistakes with medication.

Registered nurse Nancy Schuenemeyer, a clinical practitioner educator, said the nurses at Boone Hospital Center usually work 8- or 12-hour shifts, but will sometimes take extra hours if someone calls in sick.

“We’re all very dedicated,” Schuenemeyer said. “If somebody calls in sick, then somebody has got to take care of those patients. Sometimes we do have to work longer hours.”

While longer hours are part of the job, Schuenemeyer said Boone Hospital Center does not overburden nurses with a large patient-to-nurse ratio.

The study showed the level of distrust between managers and nurses increased in the mid 1980s when changes to insurance payment plans forced hospitals to alter the way nurses provided care. This created a more stressful working environment for nurses and led to more mistakes. The study’s committee recommended involving nurses in management discussions and decisions in order to restore trust.

Aud, who teaches a leadership class in the nursing school, said she supported the recommendation.

“I think in long-term care nurses are ideally positioned to be a strong voice in management decisions,” Aud said. She added that nurses need to be prepared to have a strong voice in management decisions as they tend to emphasize providing good patient care at the beginning of their careers.

The committee also said nurses need to receive regular updates on new developments in medical technology.

Schuenemeyer said Boone Hospital Center recently lengthened the sessions in its orientation education program. She said the hospital is constantly sending staff to conferences, conducting around-the-clock training on new equipment and doing clinical updates.

While updated training helps prevent some errors, it still doesn’t address the problem of nurses working too many hours. The study suggests imposing guidelines on nursing facilities to make sure nurses don’t overextend themselves.

“State regulatory bodies should prohibit nursing staff from working longer than 12 hours a day and more than 60 hours per week,” the committee said.

It also suggested adding staff when patient loads increased.

Aud opposes regulating staffing levels. She said each nursing home has different staffing needs.

“I know one of the concerns some of my colleagues in long-term care have had is that all nursing homes are not alike,” Aud said. “And there’s the chance that making a regulation would not apply well to the great variety of nursing home situations.”

One thing health care officials can agree on is that a chronic shortage of nurses is a large part of the problem.

“We need to recruit good people,” Schuenemeyer said. “And then do things to retain them such as provide a good work environment. That means a good education, keeping your patient ratio reasonable and not asking them to do long shifts unless there’s an emergency.”

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