The Importance of a Healthy Nurse Workforce

Maridav – Fotolia.com

Nurses make up the largest group of health care providers, working in many different venues, from doctors’ offices to biotech firms. They regularly score very high on trustworthiness, and they have a huge impact on how health care is delivered and defined.

But it’s a tough job. Especially when they are working in a hospital setting, with its many intellectual, emotional, and physical demands and the frequently long and grueling shifts. Not surprisingly, nursing is an especially injury-ridden profession, with studies showing that in any given year, about half of all nurses are struggling with lower back pain.

This article in the New York Times poses what it calls “the obvious question”: If the nurses are dealing with all of these injuries, what is the effect on patients?

The answer, according to recent research, is what you would expect — when nurses suffer, so do their patients. One study analyzed more than 1,000 responses from RNs working at hospitals, and found that about 20% of them experienced depression, and about 75% of them experienced some level of physical pain from a muscle sprain or strain that happened at work. The researchers then discovered that risks of a patient fall or medication mistake increased by about 20% when the nurse was in pain or depressed.

Extrapolating the individual costs of these lapses in care to a national level, the researchers estimate that medication errors and patient falls that occurred as a result of nurses’ health issues incurred as much as $2 billion annually on the health care system.

“We have money bleeding out the back door because we don’t have a healthy work force,” said Susan Letvak, the study’s lead author and a registered nurse who is an associate professor of nursing at the University of North Carolina at Greensboro.

Nurses work in an increasingly stressful work environment, particularly within hospitals. Patients are sicker than before, and nurse-to-patient staffing ratios are not always standardized. Over the course of a 12-hour shift, nurses can find themselves in the potentially devastating situation of caring for more patients than is comfortable. When ill, many nurses feel pressure to show up for work because their absence means even more work for their colleagues and even spottier care for their patients.

They may also feel compelled to work because of an ethos that pervades the profession. “Nothing is supposed to stop a nurse,” Dr. Letvak noted. “We are supposed to care for everyone else and soldier on.”

Unfortunately, there are few work-based resources for nurses who are ill or depressed. Few hospitals have preventive programs that mandate, for example, safe patient lifting practices or policies that support nurses who may be temporarily disabled. Nurse managers often have little training in how to handle nurses with health problems, and many staff nurses themselves are unaware of how they might recognize and help a colleague whose work is impaired by illness.

Some nurses are also hesitant to disclose how they feel for fear of losing their jobs. “We have a system of penalizing nurses instead of early recognition and treatment,” Dr. Letvak said.

While the predicted nursing shortage will likely exacerbate many of these issues, Dr. Letvak believes there are several initiatives that could strengthen the current work force. These include measures like standardizing the nurse staffing ratios, providing the option of working shifts shorter than 12 hours and creating more health screening programs. She and her colleagues already have plans to study how helping nurses who are in pain and making shift lengths more flexible might improve patient outcomes and help experienced nurses practice for as long as they can.

“The only way to ensure the best quality for our patients is to have an expert staff of qualified nurses who are healthy enough to offer that kind of care,” Dr. Letvak said. “We can’t ignore nurses’ health anymore.”

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