March 6, 2003

LETTER TO THE EDITOR

MARYLAND’S DANGEROUS NURSE SHORTAGE

There are actually enough nurses, according to Mary Foley, President of the American Nurse Association. The problem is that 41% of them choose not to work in a hospital setting. Hospital nurses are generally overworked and overstressed with huge patient caseloads that defy good standards of patient care.

Maryland’s nursing shortage is not about income as much as it is about working conditions. The U. S. Bureau of Labor Statistics reports that Maryland’s registered nurses earn the highest median wage in the nation. They earn $27.14 an hour, compared to the nationwide median hourly wage of $21.56.

Nationwide, 13% of nursing jobs in hospitals remain vacant. In Maryland, the shortage is worse, with 2,000 or 15.6% of nursing jobs unfilled. George Benjamin, Secretary of the State’s Department of Health and Mental Hygiene noted that for every eight nurses, who retire, three nursing school graduates enter the field. The U.S. Department of Health and Human Services statistics show that there are 856 nurses for every 100,000 Maryland residents. The ratio of nurses per 100,000 population is 1,010 in Pennsylvania, 936 in Delaware and 1,675 in Washington, D.C.

The Maryland Commission on the Crisis in Nursing reports that the shortage of nurses has forced half the hospitals in the state to close down beds and units, limit emergency room admissions and postpone some surgeries.

Obviously, the critical shortage of nurses impacts on patient care. A 2002 study, published in the New England Journal of Medicine, documents the consequences of the nurse shortage. The study, which surveyed 799 hospitals in eleven states, including Maryland, notes that the shortage hits hardest on the nation’s hospitals. It has resulted in increased patient deaths and illnesses from heart attacks, infection, shock and internal bleeding. Specifically, patients suffer cardiac arrest and shock 9.4% less often in hospitals with one nurse for every 2.5 patients per day than with one nurse for every four patients per day.

Dr. Peter Pronovost, co-chairman of the Patient Safety Committee at Johns Hopkins Hospital, is involved in a web-based reporting system that is tracking mistakes in intensive care units of 30 hospitals. An analysis of the first 350 cases showed that about 40% of the errors stemmed from workload.

LETTER TO THE EDITOR

Page Two

The Statewide Commission on Nursing has identified nurse recruitment and retention problems and offered solutions. They are virtually the same recommendations contained in the 1982 Governor’s Commission on Nursing Issues.

Legislation to provide tax incentives and low interest mortgage loans to nurses in return for their agreement to continue working were rejected by the 2001 General Assembly. With the exception of a minimal increase in annual nursing scholarship aid from $2,400 to $3,000, the 2001 Assembly opted for still more study.

In order to improve working conditions for nurses, the 2002 General Assembly enacted legislation to require hospitals to make efforts to develop predetermined schedules to protect nurses from working involuntary overtime, except in unanticipated emergency situations. To date, in this 2003 session, no major nursing legislation has even been introduced.

Quality health care demands enough hospital nurses to take care of patients. The continuing and deepening shortage of nurses weakens a critical link in the health care chain. We dare not continue to address the growing nurse shortage with weak half measures. If we do, we shortchange our ability to deliver quality health care.

Sincerely,

Eric Bromwell

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