Jewish World Review Oct. 25, 2002 / 19 Mar-Cheshvan, 5763

Hospital nurse staffing & patient mortality

By Robert A. Wascher, M.D., F.A.C.S. | Almost every hospital in the United States is struggling to recruit new nurses. The nursing profession has seen its ranks decline substantially over the past 10 years due to ever decreasing numbers of nursing student applicants, as well as the increasing numbers of trained nurses who are fleeing the profession. Long shifts, low pay, and excessive patient loads all contribute to the very high burnout rate among hospital nurses these days. The impact of inadequate nurse staffing is evident to many physicians (and patients), including myself. The dispensing of important medications is often delayed, patients who require assistance often must wait a very long time before their nurses are available to respond to a call for help, and important cues relating to early complications are often missed by harried nurses who are simultaneously caring for more patients than they can safely handle.

A study in this week's Journal of the American Medical Association puts this problem into sobering perspective. The authors reviewed patient outcome at 168 hospitals in Pennsylvania, and studied more than 230,000 surgical patients and more than 10,000 nurses at these hospitals. The study determined that for each additional patient assigned to a hospital ward nurse, there was a corresponding 7 percent increase in the risk of death among patients assigned to the same nurse.

The risk that a nurse would fail to respond promptly when a patient signaled that a serious problem was occurring also increased by 7 percent for each patient added to his or her care. Doubling a nurse's patient caseload from 4 to 8 patients resulted in a a very significant 31 percent increase in the risk of patient death.

This study merely confirms what most health care professionals already know: inadequate staffing of hospitals with nurses seriously degrades patient care, and results in a higher risk of complications, including patient death. At the same time, overwhelming caseloads of seriously ill patients increase the likelihood that nurses will develop job-related burnout. As it stands now, there are not enough new graduating nurses from American nursing colleges to fill all of the empty nursing slots.

Therefore, hospitals are recruiting large numbers of nurses from other countries. (The Philippines is a particularly rich source of foreign-trained nurses for hospitals throughout the United States.) This study adds further evidence that the chronic shortage of trained nurses in the United States is having a deleterious effect on the health of hospital patients.

More needs to be done to transform Nursing into a better-paying and more highly respected profession. As anyone who has ever been a patient in the hospital knows, few things are more comforting in the middle of the night than a concerned and well-trained nurse who is readily available if the need arises. Now, according to this new study, it appears that One's recovery from surgery or a major illness hinges upon patient access to a nurse who is not constantly overwhelmed by an excessive number of patients under his or her charge.


Like many avid runners, I occasionally develop knee pain associated with osteoarthritis and soft tissue strain. After several episodes of severe knee pain occurred about two years ago, as well as two herniated discs in my spine, I started taking glucosamine sulfate on a daily basis. While I cannot attest that all of my joint pain has miraculously resolved since I started taking glucosamine, I have experienced a gradual but significant improvement in my symptoms.

In the current issue of the Archives of Internal Medicine, 202 patients with known knee osteoarthritis were randomized to receive either glucosamine sulfate (1500 mg per day) or a placebo ("sugar pill"). The patients were all followed for three years, and underwent periodic knee joint x-rays and symptom questionnaires. The study found that the patients who took the placebo pill experienced a gradual and sustained reduction in the thickness of the cartilage lining the knee join, while the patients taking the glucosamine sulfate pills experienced virtually no loss of protective cartilage in the joint during the 3-year study.

Moreover, the symptoms associated with arthritis of the knee improved by 20 to 25 percent among the patients taking glucosamine. Knee joint pain, function, and stiffness all improved significantly among the group of patients who took glucosamine.

Based upon this new information, I think that I'll continue taking glucosamine on a daily basis!


Heart surgeons have been relatively shy about prescribing aspirin to patients who have just undergone coronary artery bypass grafting (CABG). Aspirin shuts down the function of platelets in the blood, increasing the risk of abnormal bleeding after surgery.

A total of 5,065 patients who were scheduled to undergo CABG participated in an international study that involved 70 medical centers in 17 countries, the results of which are reported in this week's issue of the New England Journal of Medicine. Among the patients who received aspirin within 48 hours of their CABG surgery, 1.3 percent of such patients died during the course of the study.

On the other hand, mortality was 4.0 percent after surgery among the patients receiving a placebo pill. Postoperative aspirin therapy was associated with 48 percent reduction in the incidence of heart attack, a 50 percent reduction in the risk of stroke, a 74 percent reduction in the risk of developing kidney failure, and a 62 percent reduction in the risk of a loss of blood supply to the intestines ("intestinal stroke"). Based upon this study, it appears that aspirin therapy following CABG surgery may significantly reduce the risk of serious post-CABG complications, including death.

JWR contributor Dr. Robert A. Wascher is a senior research fellow in molecular & surgical oncology at the John Wayne Cancer Institute in Santa Monica, CA. Comment by clicking here.


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02/26/02: The continuing controversy regarding screening mammography
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© 2002, Dr. Robert A. Wascher