August 16, 2002

Accreditation organization seeks to curb nursing shortage

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Vanderbilt University School of Nursing’s Peter Buerhaus, Ph.D., is a leader in the national awareness of the critical problem associated with a nursing shortage.

Accreditation organization seeks to curb nursing shortage

The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) last week released an urgent call for action to combat the rising shortage of nurses in the United States and the associated health care risk. The private organization that inspects and accredits hospitals linked the nursing shortage to a rise in patient deaths, complications and lengths-of-stay.

The organization’s release comes more than a year after a study by Vanderbilt University School of Nursing’s Peter Buerhaus, Ph.D., explaining the critical role nurses play in preventing adverse patient outcomes. More than 126,000 nursing positions nationally are unfilled today. Buerhaus predicts a shortage of 500,000 registered nurses by 2020.

Buerhaus, Valere Potter Professor of Nursing and senior associate dean for Research, consulted with the national organization before the release last week. Buerhaus’ study, appearing in the May issue of the New England Journal of Medicine, was co-authored by Harvard’s Jack Needleman. The study showed that low nurse staffing directly impacts patient outcomes, including urinary tract infections, shock and bleeding.

When the study was first released in 2001 the pair sought to provide evidence that nursing staff is related to what happens to patients. This was part of an effort to highlight the need for a change in public policy that would enable hospitals to enrich staffing levels to the point where adverse patient outcomes can be reduced.

The Vanderbilt-Harvard study showed higher R.N. staffing was associated with a 3 percent to 12 percent reduction in certain adverse outcomes, and higher staffing at all levels of nursing was associated with a 2 percent to 25 percent reduction in adverse outcomes.

In the report, the JCAHO concurred with Buerhaus’ and Needleman’s findings, offering a paradigm shift in the way nurses are trained, hired and perceived in the workplace.

“This represents the first time that JCAHO has seriously embraced the nursing shortage and the impact it has on quality of health care,” Buerhaus said.

Buerhaus is excited about the increasing awareness of nursing’s role in quality of health care. “What used to be a trickle of evidence has now turned into a stream of evidence,” he said.

The three-tiered strategy outlined by JCAHO includes transforming the workplace, creating a clinical foundation for nursing educational preparation and advancement, and providing financial incentives for health care organizations to invest in high-quality nursing care.

“Hospitals need to take into account that JCAHO will now be including data on how nurses affect the health care industry,” Buerhaus said.

In transforming the workplace, JCAHO suggests that hospitals and other medical facilities give nurses the independence and support needed to perform their jobs well, creating a culture of professional satisfaction and encouraging retention. The accreditation organization is also calling for the creation of standardized post-graduate nursing residency programs to improve nursing education.

“The need for solutions to this problem is particularly urgent,” said Dr. Dennis S. O’Leary, JCAHO president. “We must as a country understand not simply what needs to be done, but who specifically is responsible for getting each task done. Otherwise, we face a future in which patient safety and health care quality will be significantly compromised.”

“This report is about accountabilities,” said Sally Ann Sample, R.N., moderator of the JCAHO Expert Roundtable committee. “Hospital CEOs, public policy makers, nurse executives, schools of nursing, physicians, accreditors and private industry must all come together to take definitive steps to radically change the calamitous course we are on now.”