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Patients are at risk because of nurses' long hours, says report

New York Scott Gottlieb

Many hospitals and nursing homes are endangering patients by allowing or requiring nurses to work more than 12 hours a day, according to a report commissioned by the US government.

Long hours cause fatigue, reduce productivity, and increase the risk that the nurses will make mistakes that harm patients, says the report, conducted by the Institute of Medicine.

The report said many nurses and nursing assistants worked more than 12 consecutive hours, with some working double shifts of 16 hours. To reduce "error-producing fatigue," the report said, state officials should prohibit nurses from working more than 12 hours in any 24 hour period or more than 60 hours a week.

The report said, "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." Many hospitals and nursing homes have too few nurses to take proper care of patients, it said.

Intensive care units at hospitals should have one licensed nurse on duty for every two patients, the report said. Nursing homes, it said, should have one registered nurse for every 32 patients and one nursing assistant for every 8.5 patients.

So far, the federal government has not sought to set minimum staffing levels for nursing homes, in part because such requirements would generate billions of dollars in additional costs for Medicaid, Medicare, and nursing homes.

The academy said it found overwhelming evidence that as levels of nurse staffing rose the quality of care improved, because nurses had more time to monitor patients and could more readily detect changes in their conditions.

"Studies show that increased infections, bleeding, and cardiac and respiratory failure are associated with inadequate numbers of nurses," the report said. "Nurses also defend against medical errors. For example, a study in two hospitals found that nurses intercepted 86 percent of medication errors before they reached patients."

Dr William Rupp, a member of the panel and president of a Mayo Health System hospital in Mankato, Minnesota, said, "Virtually every other industry in the country pays more attention to fatigue than we do."

The panel’s recommendations on nurses’ working hours echo changes made by the Accreditation Council for Graduate Medical Education, which set new standards in July limiting hospital work by residents (doctors in training) to 80 hours a week.

Keeping Patients Safe: Transforming the Work Environment of Nurses is at www.iom.edu/report.asp?id=16173
 
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