Many hospitals and nursing homes are increasing the likelihood of errors by allowing or requiring nurses to work more than 12 hours a day, according to a new report by the Institute of Medicine.
The report, "Keeping Patients Safe: Transforming the Work Environment of Nurses," calls for changes in how nurse staffing levels are established and mandatory limits on nurses' work hours.
"Creating work environments that reduce errors and increase patient safety will require fundamental changes in how nurses work, how they are deployed, and how the very culture of the organization understands and acts on safety," writes Donald Steinwachs, chair of the committee that wrote the report. Steinwachs is chair of the department of health policy and management at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore.
While most nurses typically work eight- to 12-hour shifts, some work even longer hours, the report says.
"Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, decreases energy, diminishes attention to detail, and otherwise contributes to errors," says a release about the report, issued Tuesday.
Patients are also concerned about nurses and others working long hours, according to a nationwide survey released today by Siemens Medical Solutions in Malvern, Pa. The survey, by Opinion Research Corp., indicates that 43% of Americans believe overworked staff is the leading cause of medical errors in hospitals.
The IOM committee recommended that:
- State regulators should prohibit nursing staff from working longer than 12 hours a day and more than 60 hours per week, the committee said.
- Nursing homes increase internal oversight of their staffing practices and effects on patient safety whenever staffing falls below one R.N. for every 32 residents, one licensed nurse per 18 residents, and one nurse assistant per 8.5 residents per day.
- Hospital intensive care units should increase internal oversight when staffing falls below one nurse for every two ICU patients.
- Federal and state report cards on nursing homes should include information on nursing staff levels, and measures of staffing levels should be developed for hospital report cards. Whenever possible, healthcare facilities should avoid using nurses from temporary agencies to fill staffing shortages.