A nursing shortage, combined with the aging U.S. population and increased acuity of hospitalized patients, is endangering lives today, and the threat to patient safety will escalate unless nursing is made a more attractive career choice, the Joint Commission on Accreditation of Healthcare Organizations said in a new report.
Indeed, nurse staffing levels factored in 24% of 1,609 sentinel events -- unanticipated events resulting in death, serious injury or permanent loss of function -- reported to the commission since 1997.
The 40-page report, prepared for the JCAHO by a panel of experts, called for immediate changes in the working environment, educational preparation and financial support of nurses. Among the recommendations:
* limiting mandatory overtime to emergency situations;
* adopting "zero tolerance" for abusive behavior toward nurses by physicians and other medical practitioners;
* matching staffing levels to patient acuity and the required mix of nursing skills.
"We must collectively create an organizational culture of retention," said Dennis O'Leary, commission president.
With already insufficient staffing, an aging nursing force -- the average age is 43 -- and an aging nursing faculty, "a perfect storm is brewing," said panel member Marilyn Chow, vice president of patient-care services at Kaiser Permanente, Oakland, Calif. The latest nursing crisis ultimately could be bigger and more lasting than previous episodes such as the shortages of the early 1990s, Chow said.
About 126,000 nursing positions now are vacant at the nation's hospitals, according to the American Hospital Association. The report projected a shortage of 400,000 nurses by 2020, as baby boomers reach retirement age and new technology helps them live longer while complicating hospital care.
The JCAHO has implemented staffing standards that create a framework for measuring and improving nursing care, O'Leary said. But the nursing report takes a leap into public policy, acknowledging accountability must go beyond hospitals to businesses, insurers, nurse executives, nursing schools and policymakers. "We're dealing with multifaceted, complex problems, the answer to which are not standards," O'Leary said.
For example, insurers must recognize the expenses inherent in assuring patient safety, including resolution of the nursing shortage, when they determine reimbursement rates for providers, said Keith Safian, president and CEO of Phelps Memorial Hospital Center, Sleepy Hollow, N.Y. That includes the Medicare program, which in setting annual payment updates is "in complete denial of the reality of the marketplace," Safian said. "We're willing to make these investments, but government payers and insurers have to be part of that solution."
Click here for the full JCAHO report, Health Care at the Crossroads, or an executive summary.