This country has a serious nursing shortage: The American Health Care Assn.'s most recent estimates from July 2008 show 116,000 open hospital nursing positions and more than 19,000 vacancies in long-term care settings.
A March 2008 report by Dr. Peter Buerhaus of Vanderbilt University Medical Center and colleagues predicted that national nursing shortages could balloon to 500,000 by 2025. Predictions from the U.S. Department of Health and Human Services are more dire: It anticipates a shortage of 1 million nurses by 2020.
A lack of faculty at nursing schools across the country is preventing many people from entering the profession, thereby exacerbating the shortage. Nearly 50,000 qualified applicants were turned away from professional nursing programs in 2008, according to the American Assn. of Colleges of Nursing.
In California, the outlook may be slightly less grim. It's the only state with legislation requiring minimum nurse-to-patient ratios in acute-care hospitals. The law, which went into effect in 2004, limits the number of patients a nurse can care for on shifts depending on the type of medical unit and the patients' degree of illness.
A nurse working on an intensive-care unit, for example, cares for no more than two patients per shift. A medical and surgical unit nurse cares for a maximum of five.
Linda Aiken, professor of nursing at the University of Pennsylvania, is studying effects of the legislation. She has found that nurses participating in the survey reported overwhelmingly that the ratio law has had a positive effect on their day-to-day work life.
The California Nurses Assn., which sponsored the legislation, credits the ratio law with helping to mitigate the effects of the nursing shortage and points to statistics that show an increase of 100,000 actively licensed registered nurses in California since the law was adopted.
Three nurses talk about what it's like to be a hospital-based nurse today:
RN, 59 years old, medical diabetic unit at Long Beach Memorial Medical Center; nurse for 21 years
Fifteen years ago, with a six- or seven-patient assignment, probably four of them could get up and about. A typical patient [today] has totally restricted movement, so we have to keep turning them as much as possible [to prevent] blood clots.
At the same time, this person can require IV medications every six hours and can be taking three different antibiotics every two to three hours and pain medicine every two hours. We are monitoring all of their lab results, making sure any tests that have been ordered have been followed through, and prepping patients for tests.
That's just one patient -- and I can have up to five.
It would be a good day if I had one patient who could get up and walk around and get to the bathroom and take care of washing up [on their own]. More often than not, I have at least three that require total care, meaning that everything has to be done for them.
It's pretty hefty -- a day with four patients is OK, five is pushing it. It only takes one extra person to push you over the edge in terms of trying to manage your day. They don't get into the hospital easily nowadays. Insurance companies won't cover the cost of hospitalization unless the patient is pretty ill.
About 20 years ago, I had nine patients. I think the ratios, by allowing us to only care for a certain number of patients depending on their acuity [degree of illness], has helped immensely. We have more time to see our patients and to do our job adequately.