Nursing shortage with Chinese characteristics

May 11, 2006 -- Today the People's Daily web site posted a short unsigned piece from China Daily headlined "Ministry warns of nurse shortage." The article appeared to be based mainly on a press conference held by a Ministry of Health representative, though it also included a brief quote from a nurse working in a provincial capital. She underlined the Ministry's point that many nurses "lack time for patient support." The piece gave some basic information about the scope of the nation's shortage, which includes a nurse-to-population ratio of about 1:1,000. It also briefly explored one potential reason for the shortage: according to "experts," many hospitals prefer hiring physicians to "attract more patients, which leads to higher profits." The piece might have explored other potential reasons for the shortage, such as working conditions, as well as some of the more tangible effects of too few nurses, such as higher morbidity and mortality. The piece also explains that the Ministry has proposed a regulation on nurse staffing and nurses' rights, but it gives no details. Although the item could have used more specifics, we thank those responsible for this generally helpful piece.

The piece reports that Ministry "spokesman" Mao Qun'an warned that China lacks the nurses needed to cope with the "rising demand" for health services in "an aging society." The piece says that at the end of 2005, the nation had about 1.35 million nurses, or one for every 1,000 residents. It notes that the "World Health Organization standard" is 1:500; it does not note that many developed nations have ratios on the order of 1:100. The piece, apparently relying on Mao, also describes a 2005 Ministry survey of major hospitals that found the average ratio of "nurses to beds" was 0.33 to 1. The Ministry's "stipulated ratio for major hospitals is 0.4 to 1." However, Mao notes that these hospitals were (in the piece's words) "the best ones in the biggest cities, so it likely that the situation at county or town-level hospitals is worse."

To its credit, China Daily interviewed Yuan Ling, a nurse at Hunan Xiangya Hospital in Changsha, which is the capital of Hunan Province. She notes that in her department (in the piece's words) "about seven nurses have to perform the duties of 40 nurses during the daytime." She also says: "It is wrong to say that I do not want to give more care to my patients. I am just so tired, and I have no time to give them more than just the regular service." Mao himself notes that "time-consuming duties such as assisting doctors and administering medication" mean "nurses often lack time for patient support." We're not sure what would constitute "patient support" or "more than just regular service." Readers may assume that this refers solely to the emotional support that many continue to believe is the main task of nursing. Emotional support is important, but short-staffed nurses have difficulty providing the expert clinical care needed to improve patient outcomes through both physiological and psychosocial care. Lives are at stake. The "assisting doctors" comment may also send the unfortunate message that nurses' job is to work for physicians, rather than care for patients under their own distinct practice model. But the quotes do suggest that nurses are too stretched to provide more than the basic minimum of care. And the nurse's comment about how tired she is at least hints at the effects short-staffing can have on nurses' own mental state. That, in turn, affects a nurse's ability to provide psychosocial care that may be vital to patients' recovery.

The piece offers one potential reason for the nursing shortage in China. Mao reportedly says that "many hospitals prefer to hire more doctors than nurses," and "experts" say that's because "hospital managers believe doctors can attract more patients, which leads to higher profits." Of course, since only Hollywood physicians can provide skilled nursing care, such a business model would presumably have a strong negative effect on patient outcomes. The piece might have explored that, as well as other potential reasons for the shortage, such as the working conditions the piece itself describes.

The article includes discussion of how hospitals appear to be trying to "fill the gap," and of a more promising proposal from the Ministry. The piece notes that many hospitals hire "temporary workers," most of whom are "from rural areas and lack experience." Mao notes that these workers can help care for patients, but cannot "administer medical treatment." The piece goes on to explain that, to "combat the shortage," the Ministry has proposed a regulation to "require hospitals to employ a sufficient number of nurses and protect their rights." It is not clear when that might be implemented, and of course, the regulation could mean almost anything based on this description. The piece might have explained exactly what it requires, and in particular, how much discretion hospitals would retain in determining nurse staffing and working conditions. Likewise, the piece closes with the note that even before the regulation becomes effective "hospitals will be asked to employ and train more nurses," but it is not clear what that means.

The China Daily piece could have provided more detail as to the causes and effects of the nursing shortage and potential solutions, but we thank those responsible for including some candid information about the dimensions and effects of the crisis.

See the article "Ministry warns of nurse shortage" in the May 11, 2006 edition of the People's Daily.