May 16th, 2011
Sicker patients, longer hours, short staffing, frequent interruptions, working while sick or injured: These are all conditions affecting nurses working in the nation's hospitals. And, when nurses are under so much psychological and physical stress it seems their patients' outcomes are affected. These were the results of a study recently released by the University Of Maryland School Of Nursing.
The link between negative working conditions and employee stress is well known. Work stress is usually related to negative work attitude and performance. In a healthcare setting these conditions can threaten patient care and patient safety.
Researchers from the University of Maryland analyzed data from 633 nurses in 71 hospitals in North Carolina and Illinois and found some disturbing trends. In hospitals where nurses reported increased psychological demands and difficult work schedules there was a greater incidence of patient deaths from pneumonia. Psychological demands were defined by very fast work, lack of time to complete work, excessive required work, being slowed by delays from other workers and frequent interruptions.
Another outcome investigated was the development of deep vein thrombosis in post-surgical patients. In hospitals where high psychological demands were reported there was a higher likelihood patients would develop DVTs. "We selected outcomes that have been reported as nursing-sensitive and that have sufficient rates of occurrence to generate reporting data for over 90 percent of the hospitals, " said lead investigator Alison Trinkoff, ScD, FAAN.
The research team investigated the link between job demands and work schedule and outcomes of patients with heart attacks, congestive heart failure (CHF), stroke and craniotomies. Deaths from heart attacks were associated with nurses frequently working with awkward postures and heavy weekly burdens. They found deaths from CHF were significantly associated with long shifts and nurses working while sick themselves.
Researchers also found patients were more likely to experience post-operative hemorrhaging when their nurses were frequently interrupted. Patients were also more likely to develop respiratory failure and infections when their nurses reported a lack of time away from the job.
Staffing patterns and nurses'working conditions are risk factors for healthcare-associated infections. Staffing shortages, especially of nurses, have been identified as one of the major factors in a hospital's inability to contain future outbreaks of emerging infections. Understanding and improving nurses' working conditions can potentially decrease the incidence of many infectious diseases.
One must believe that working conditions will improve. Some of the stressors currently affecting the healthcare industry are by-products of the continuing economic recession and are likely short-term in nature. Hospitals are hiring fewer employees or not replacing nurses who leave in an effort to save money. More work for fewer nurses. There is a lower demand for elective care and procedures so hospital revenues are down. This also leads to fewer new employees being added into the mix and easing some of the demands on the current nursing population.
Other studies in recent years support the University of Maryland School of Nursing findings. The consequences of these high demands and adverse work conditions can have a significant impact on individual nurses and the ability to accomplish tasks; specifically, poor decision making, lack of concentration, apathy, decreased motivation and anxiety may impair job performance, possibly resulting in lethal threats to patient safety.