Joseph Q. Jarvis and Kindra Celani: When nurses are not safe, patients are not safe

Hospitals protect their bottom line by hiring too few nurses and giving them too little support.

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The burden of care in hospitals falls mostly on nurses. They are the eyes of health care at the bedside and the arms offering comfort. It is on the shoulders of nurses that recovering patients lean as they begin post-operative recovery.

Doctors may write the orders for patients, but nurses deliver the IV fluids, insert the needles, count the pills and bring the relief. Patient safety and hygiene are mostly in the hands of nurses. Health care is a labor-intensive enterprise and nurses are its backbone.

Modern hospital management, however, has come to see the cost of nursing as a major obstacle to optimal profits. Under the guise of efficiency, fewer nurses are deployed throughout the hospital each shift. The ratio of registered nurses (RNs) to patients has been steadily falling for several years. These efficiencies, however, come at a cost.

When RNs have too many patients in their care, patients experience increased risk for medical errors, complications, falls and other injuries, pressure sores, increased hospital length of stay and readmission after discharge. For each added surgical patient in an RN’s workload beyond the established ratio of 1:4, the likelihood of patient death within 30 days of surgery increases by 7%.

A 2006 study demonstrated that increasing RN staffing nationwide to match the best-staffed hospitals across the country would reduce in-hospital deaths by 5,000 per year and prevent 60,000 adverse outcome each year. American hospital patients need better nursing.

Recently, Dr. Marc Harrison announced that he would be resigning his position at Intermountain Health Care as CEO. The news articles that covered his announcement received hundreds of comments, many referring to nurse staffing ratios. For example, one commenter at KSL.com stated:

“[Dr. Harrison has been] sacrificing quality of care for the sake of more money. He changed staffing ratios so that the nurses and CNAs have to take on a MUCH heavier patient load as well as being short staffed. . .Intermountain Healthcare used to be a company that really took care of their employees. I worked for them for 13 years. But over the last 6 years, they have really gone downhill in employee satisfaction and patient experience.”

Given the enormous burden of nursing in the care of hospitalized patients, it should not be surprising to find hospital employees recognizing the relationship between the support they receive from their employer (or lack of it) and the care delivered to patients at the bedside.

RN staffing ratios are but one way of characterizing how well hospital employees are supported by health care managers. Another would be offering nurses a protected pathway for providing comment about unsafe practices observed at the workplace. Optimal care of patients requires best practices in managing the corporate environment in which nurses work. It appears that IHC has been failing Utah patients by failing to support our nurses.

If nurses aren’t safe, then patients aren’t safe. Nurses who work too many hours and are assigned to care for too many patients may boost the corporate bottom line, but they are not safe, and neither are their patients.

Nurses at IHC often feel that they cannot report the unsafe behaviors they observe while at work because they fear push back from colleagues, physicians or management. Nurses may, through their silence, foster an appearance that all is well, but no nurse or patient is safe under those circumstances.

Nurses are at high risk of developing PTSD as they are exposed to ongoing and unpredictable trauma at the bedsides of sick and dying patients. This is compounded by a hostile and retaliatory work environment where it is unsafe to speak up for positive changes to the system or to report errors for fear of scapegoating, retaliation and threats to the license and livelihood of already severely underpaid nurses.

Utah patients need safe and supported nurses. IHC is at a crossroads as it chooses new leadership. It is time to place nurse safety and patient safety before any other concern. Choose a new corporate leader wisely or expect a ground-up nursing movement like unionization to improve patient safety through advocacy for nurses.

Joseph Jarvis

Joseph Q. Jarvis, M.D., Salt Lake City, a public health physician, has published two books about reforming the U.S. health care system:The Purple World: Healing the Harm in American Health Care” andFor the Hurt of My People: Original Conservatism and Better, Simpler Health Care.”

Kindra Celani

Kindra Celani, St. George, is a nurse practitioner caring for advanced heart failure patients, former assistant professor of nursing, experienced ICU and ER nurse, advocate for nurses and patients, founder of Latter Day Survivors podcast and survivor living with complex post traumatic stress disorder. She has a doctor of nursing practice degree from Rocky Mountain University of Health Professions.