Newsweek: "Not Enough Nurses"

December 12, 2005 -- This week Newsweek ran a fairly short story by Anne Underwood headlined "Diagnosis: Not Enough Nurses." The piece highlights some important aspects of the current nursing shortage and has some good expert quotes, though it omits the key roles that budget-driven short-staffing and nurses' poor image play in the crisis. One especially good aspect of the piece is its point that "nursing is crucial to patient safety."

Underwood frames the piece with the story of nurse Liz Tattersall, who burned out after six stressful years as a triage nurse at a Connecticut community clinic and went to work for a drug company. The piece suggests that thousands of other nurses have likewise followed the other career paths open to them, leading to a nationwide shortage that is "going to get worse." This is cause for concern because "[n]urses are the key to safety in hospitals and nursing homes." American Nurses Association CEO Linda Stierle is quoted noting that patients are admitted to hospitals for nursing care: "If they keep you in the hospital, it's because you need someone to monitor you 24/7." The piece explains that the need for nurses is especially intense because of the aging population, the aging nursing workforce, faculty shortages, and a lack of adequate federal support for nursing education. Vanderbilt "health economist" Peter Buerhaus--who should have been identified as a nurse--makes a good point about the need for government support: "We're talking decimal dust compared to the billions spent in Washington. Nursing levels could be a national-security issue if bird flu or bioterror strikes."

The piece cites two key studies showing how important nurses are to patient outcomes. First is the "landmark 2002 study" (by Linda Aiken and her colleagues at the University of Pennsylvania) showing that mortality increased 7 percent for every additional post-surgical patient a nurse was assigned. The piece also describes a recent study by Susan Horn of the University of Utah finding that when nurses spent less than 15 minutes a day with nursing home patients, the patients had higher rates of a number of serious adverse events and hospitalizations. With 30-40 minutes of "daily nursing time," Horn reportedly found that "it was actually cheaper to hire more nurses."

In briefly exploring potential solutions, the piece says that nurses from overseas have "filled many of the gaps." But it rightly notes that this has caused shortages in many developing nations like the Philippines, where 1,000 private hospitals have reportedly closed in the last five years. The piece quotes American Journal of Nursing editor Diana Mason (who serves on the Center's advisory panel) as observing that "we will never have enough nurses unless we fix the work environment." The piece says that is "exactly what some hospitals are trying to do," citing increases in entry-level wages, reductions in mandatory overtime, and the increase in "magnet" hospitals recognized by the American Nurses Credentialing Center "for their ability to attract and retain nurses through an emphasis on excellence in nursing." The piece does not note that none of these measures will necessarily improve staffing, since even the magnet program has met with mixed reviews as to whether it actually improves bedside nurses' working conditions. Many nurses in the roughly 3% of U.S. hospitals with magnet status see the current program as primarily a hospital marketing tool. The piece closes on a less than encouraging note, stating that drug company employee Tattersall recently considered going back to bedside nursing, but "the urge passed quickly."

We thank Ms. Underwood and Newsweek for covering these critical issues.

See the article "Diagnosis: Not Enough Nurses" by Anne Underwood from the December 12, 2005 issue of Newsweek.