Nursing Safety Net Frayed, Report Says

Poor working environments in hospitals and nursing homes and a shortage of nurses are the greatest threats to patient safety, according to a report issued Tuesday by the Institute of Medicine of the National Academies.

“We’re talking about an entire cultural change,” said Ada Sue Hinshaw, a member of the committee that produced the report

“When there’s an inadequate number of staff there are clear complications for patients. It is nurses who provide front line surveillance,” said Hinshaw, dean of the University of Michigan School of Nursing at Ann Arbor.

The report, which comes amid a national nursing shortage, cites a study of two hospitals that found nurses intercepted 86% of medication errors before they reached patients.

The author of the report, Donald M. Steinwachs, chair of the department of health policy and management at the Bloomberg School of Public Health at Johns Hopkins University, said the powerful correlation between patient safety and adequate nursing makes changing current practices urgent.

“When you have workers who are spread too thin ... you are compromising patient safety,” Steinwachs said.

In its recommendations, the medical advisory panel calls for mandatory scheduling and minimum staffing levels in nursing homes and intensive care units.

The Institute of Medicine issued a landmark report in 2000 that estimated as many as 98,000 hospitalized Americans die each year because of errors.

Tuesday’s report cited studies that showed increased infections and cardiac and respiratory failure were associated with inadequate numbers of nurses.

The California Nurses’ Assn., which fought for mandatory nurse-to-patient ratios that take effect in January, said the report boosted its position.

The California Healthcare Assn., which represents hospitals, asked how hospitals could beef up staffing when there are too few nurses.