Remarks of Mary Foley, MS, RN
President, American Nurses Association
ANA Staffing Survey Press Conference
National Press Club, Washington, DC February 6, 2001
Good morning. I am Mary Foley, president of the American Nurses Association.
We are here this morning to discuss the findings of an ANA survey on staffing and why it reflects a crisis that is going on in health care today. We have known for years that working conditions in nursing have been getting worse, and this survey confirms it. We believe it is a crisis when so many registered nurses are saying they would not feel comfortable having a family member cared for in the facility in which they work, when so many are saying they wouldn't recommend the nursing profession to others, and when they say they are having such a difficult time providing even basic care.
The primary purpose of the ANA Staffing Survey was to measure nurses' perceptions concerning their work environments, and to gauge their reactions in terms of current nursing issues. Such issues include short staffing, mandatory overtime, occupational health and safety concerns, and the practice of "floating" nurses to unfamiliar units that do not match their training or expertise.
The other purpose of the survey was to help us come up with solutions. And we have those solutions: in the form of ANA's and its Constituent Member Associations' proposed 2001 state legislative priorities, which we will also talk about after we discuss the survey findings.
Joining me today is Ann Converso, Vice Chairperson of the United American Nurses, ANA's labor arm and the largest union for RNs. Ann will discuss the labor implications presented by the survey's findings and what the UAN is doing to support the nationwide state legislative agenda.
In addition to Ann, we also have Nona Campbell, a nurse who works in the Critical Care Unit of a Washington, DC, area hospital. Nona will provide a frontline perspective of how difficult working conditions can be for nurses, and will also be on hand to answer questions.
Also joining me is Becky Hartman of Wichita, Kansas. Becky is here to talk about her mother, Shirley Keck, who was permanently disabled as a result of insufficient nurse staffing during a hospital stay. The family has received a $2.7 million-dollar settlement from Wesley Medical Center in Wichita to pay for the custodial care needed as a result. Experts have warned that as the shortage of nurses worsens, we may see many more cases of such individuals.
And finally, we have John Houle, from Cornerstone Communications, the firm that developed the survey and analyzed the results. John created the survey charts we will be taking a look at shortly, and he will be available after our presentation to answer questions.
But before we get into the survey results and our analysis of them, I would like to spend a few moments discussing the state of health care today and why ANA felt it was necessary to develop and employ a nurse staffing survey in the first place.
In 1998, the Institute of Medicine came out with a shocking report, which found that between 44,000 and 98,000 persons are injured every year by medical errors. In its response to that report, ANA noted that the majority of medical errors do not result from individual recklessness, but from basic flaws in the way the health delivery system is organized, and ANA stated its contention that the report reinforces the need to address all systems issues, including staffing.
Additional analysis of medical errors in 1999 is found in a report released this past December by U.S. Pharmacopeia. What is significant about the USP report is that the primary contributing factors to medication errors were distractions and workload increases -- findings which correlate with ANA's concerns.
Another factor that has been reported on extensively is the direness of the current nursing shortage, which is expected to worsen over time. Traditionally, such shortages in nursing have been very cyclical in nature. But this one is different, the experts say. And they are warning us that this is only the tip of the iceberg.
For example, a study completed by Peter Buerhaus of Vanderbilt University School of Nursing and published in the June 14, 2000, Journal of the American Medical Association (JAMA), has found that the bulk of the nation's nursing workforce is aging significantly, with the number of full-time equivalent RNs per capita forecasted to fall 20 percent below demand by 2010. So, today's problem will not go away. Instead, it is expected to escalate in the next 5-10 years as today's nurses retire and baby boomers' health care needs grow.
And while there are a multitude of factors that contribute to the crisis we are seeing in health care today, the American Nurses Association sees working conditions as the primary culprit. The problem is not that we don't have enough professional nurses. We have an adequate supply of nurses. The problem is that we don't have enough nurses who are willing to work in today's health care environments. To change that, we need to improve working conditions. Without better working conditions, the shortage, and the problems that go with it, will only get worse. That's why we conducted the Staffing Survey - - to help sort out the many issues that are involved and to give a greater voice to nurses' concerns.
The Survey and Its Findings.... The ANA Staffing Survey was posted on ANA's Web site, http://www.nursingworld.org, between December 7, 2000, and January 19, 2001, and promoted through ANA's media outlets, including ANA's regular news publication, The American Nurse, ANA's online publication the Nursing Insider, and through the American Journal of Nursing.
During the time the survey was posted, seven-thousand-two-hundred-and-ninety-nine nurses from across the United States took the opportunity to express their opinions about their working conditions and what they feel is the current state of health care in America.
Here is what the survey found:
Primarily that America's registered nurses (RNs) feel that deteriorating working conditions have led to a decline in the quality of nursing care, specifically, 75 percent of nurses surveyed feel the quality of nursing care at the facility in which they work has declined over the past two years while 56 percent of nurses surveyed believe that the time they have available for patient care has decreased. In addition, more than 40 percent of nurses surveyed said they would not feel comfortable having a family member or someone close to them cared for in the facility in which they work. And over 54 percent of nurse respondents would not recommend their profession to their children or their friends.
Specifically, out of the nearly 7,300 respondents, over 5,000 nurses cited inadequate staffing as a chief way in which the quality of care declined, followed by decreased nurse satisfaction (over 4,440 nurses) and delays in providing basic care (over 4,200 nurses).
The ANA Staffing Survey, of course, isn't telling us anything we don't already know. The relationship between inadequate staffing and quality of care correlates with a March 2000 study, conducted for ANA by Network, Inc., which found that patients have better health-care outcomes in hospitals with higher staffing levels and higher RN ratios in the staffing mix. Among the study's findings: length of stay, pneumonia, post-operative infections, pressure ulcers and urinary tract infections -- the five outcomes measures that were tracked -- are markedly decreased with higher levels of RN involvement.
The ANA Staffing Survey also reflects similar findings in a 1996 American Journal of Nursing (AJN) survey, which revealed that nearly 9 out of 10 nurses polled expressed serious concerns that the safety and quality of patient care was being diminished by "cost-saving" nursing-staff cutbacks. And a 1999 study by the research firm William Mercer Inc. has noted that market demand combined with workplace issues such as workload, staffing, career prospects and pay are the primary reasons for nursing turnover, and that unless these issues addressed, strategies to increase the overall supply of nurses will not be successful.
But the ANA Staffing Survey results and the personal comments many nurses e-mailed to ANA upon filling out the survey (a compilation of which you'll find in your packets) go one step further by putting a more human face on the situation.
For example, the ANA Staffing survey has found that despite being dissatisfied, nurses are still putting their patients and their patients' safety ahead of their own personal and professional needs. When asked about what they have been experiencing in their workplace, a significant number of respondents indicated they are "skipping meals and breaks to care for patients" (over 5,700); feel "an increased pressure to accomplish work" (over 5,300); are "pressured to work voluntary overtime" (over 4,200); are not able to "attend continuing education programs due to an increased workload" (again over 4,200); and suffer from "increased stress-related illness" (more than 3,700).
In addition, over 3,600 respondents (close to half) said they feel "exhausted and discouraged" when they leave work, with more than 3,200 recognizing that they are "discouraged and saddened by the fact that they couldn't provide basic nursing care for their patients." And, nearly 3,000 of those questioned said they feel "powerless to effect change necessary for safe, quality patient care."
The survey findings are even more alarming when combined with the respondents' demographics. Of the nurses who took the survey, 43.4 percent ranged in age from 41 to 50 years old, and 22.5 percent were 51 to 60 years old, indicating that the majority of respondents (65.9 percent) will likely retire within the next decade. These older nurse demographics reflect the findings of the Peter Buerhaus study, which I mentioned earlier.
Part of the problem, according to Buerhaus, is that younger women now have more lucrative career opportunities in other fields and are not attracted to nursing in the numbers they once were. But the other part of the problem, revealed by the ANA Staffing Survey, is that the nurses who are currently working in the field are exhausted, disheartened and dissatisfied.
These findings reinforce what we already know -- that today's nurses not only are frustrated, but that many soon will be retiring, and that younger people will not choose nursing as a career unless we improve working conditions and compensation, and address health and safety concerns.
What ANA and the CMAs Are Doing
Providing highly sophisticated healthcare services to an aging and increasingly vulnerable consumer population means that a full complement of registered nurses is needed to provide safe, quality care. And, with the current shortage expected to worsen, we are not going to have enough nurses to meet demand, unless we address these important nursing environment issues NOW.
That is why ANA is urging state legislatures around the country to address these issues through legislative and regulatory initiatives. Based on the ANA Staffing Survey's findings and many of the other indicators I have mentioned, ANA and its Constituent Member Associations (CMAs) together have outlined a coordinated national state legislative agenda to address staffing problems, and have identified the following priorities for 2001:
-Increased whistleblower protections -- Nurses want to know they can report unsafe conditions to the appropriate agency without fear of reprisal, especially when those concerns have already been voiced in their facility and no action has been taken.
-Restrictions on the unsafe practice of forced overtime -- Nurses want to know that they will not be required to work mandatory overtime when they are tired, or when they have commitments outside the workplace. Such a provision would establish that no employee of a health care facility can be required or forced to accept work in excess of a predetermined schedule.
-Mandated collection of workforce and nursing-sensitive quality data -- Nurses want to know that health care facilities will be made publicly accountable for the quality -- not just the cost -- of care delivered to patients, and for the staffing levels used to deliver that care. They want to see a mandate that incorporates nursing research, nursing workforce data and other findings into agencies' reports.
-Establishment of patient classification systems --Nurses want hospitals to use better tools to calculate the appropriate level and mix (RN, LPN, unlicensed assistants) of nursing staff required to deliver safe, quality care.
It is obvious that the problems identified are complex and will require more than the bandaid approach that has been used to address past nursing shortage. The nursing shortage this time requires REAL SOLUTIONS -- real solutions to address the real problems of why health care facilities cannot recruit and retain nurses. Real Solutions that support nurses in delivering safe care to patients. Real solutions that ensure that when a patient pushes the call button, there is a nurse there to answer it.
The good news in all of this is that legislative efforts designed to improve health care facility working conditions are already underway in many states. For example, if you'll look at the map in your packet, you'll see that legislation to prohibit mandatory overtime has been introduced in Connecticut, Hawaii, Nevada, New York and Washington state in the 2001 legislative session. And additional bills on the other issues I have mentioned are expected to be introduced in many other states.
Armed with the ANA Staffing Survey findings, many CMAs are mobilizing nurses to educate the public and state legislators regarding the issues and to offer nursing's solutions. Many are holding press conferences and other activities that will coincide with or immediately follow this press event.
The ANA Staffing Survey provides valuable insights into the perceptions of nurses regarding their working conditions and the impact that changes in the health care system are having on patient care and safety. This is important data that ANA and its CMAs can take to state legislatures throughout the nation -- to let legislators know the changes that need to be made in nurses' work environments, in order to protect patients and address the current crisis in health care.
The bottom line is that we have to improve working conditions in order to enable nurses to stay in nursing longer, and so that young people will be attracted into the profession. If we don't, we will find that the current shortage will only escalate in its severity. Which means that we are likely to have many more patient safety issues coming up, and cases like the one involving Becky Hartman's mother, Shirley Keck, which Becky will describe for us in a few moments.
But first, let me turn the microphone over to Ann Converso, who can tell you what the United American Nurses is doing to tackle the problem. Ann....
And now we will hear from Nona Campbell, a critical-care nurse who works in a Washington, DC, hospital. Nona....
And now, Becky Hartman will discuss what happened to her mother, Shirley Keck. Mrs. Keck, a healthy, active woman in her early 60s, went into hospital with cold symptoms and was diagnosed with simple left-side pneumonia. She came out paralyzed on the right side, and is now unable to walk, talk or care for herself. Her family blames a lack of available nurses on staff as the cause of harm...Becky....
Thank you, Becky. And now at this point, I'd like to open up the session for questions. Please remember to identify yourself and your organization before asking your question. Thanks.....
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The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.