Nurses Concerned Over Working Conditions, Decline in Quality of Care, ANA Survey Reveals (2/06)

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February 6, 2001

CONTACT: ANA Communications Department
301 628-4ANA

Respondents cite reduced time for patient care, concern for patient safety

Washington, DC -- America's registered nurses (RNs) feel that deteriorating working conditions have led to a decline in the quality of nursing care, according to findings of a national survey released today at a press conference hosted by the American Nurses Association (ANA).

Specifically, 75 percent of nurses surveyed feel the quality of nursing care at the facility in which they work has declined over the past two years, while 56 percent of nurses surveyed believe that the time they have available for patient care has decreased.

In addition, more than 40 percent of nurses surveyed said they would not feel comfortable having a family member or someone close to them be cared for in the facility in which they work. And over 54 percent of nurse respondents would not recommend their profession to their children or their friends.

"The responses we have received from nurses who took this survey are alarming," said ANA President Mary Foley, MS, RN. "With over three-quarters of respondents believing that the quality of nursing care has declined and more than half saying their time for patient care has decreased, consumers should be concerned about the quality of health care they are receiving. And if four in 10 nurses would be hesitant for a family member to be cared for in their own facility, that sends a red flag to the American public that something is definitely amiss in our nation's health care facilities.

"If we hope to maintain the quality of care in our health care facilities, we must improve nurses' working conditions, which have deteriorated over the last decade. To help achieve that end, ANA is actively calling for legislation that protects patients and nurses, and ensures better care," Foley added.

In the survey, which involved 7,299 respondents, 5,067 nurses cited inadequate staffing as a chief way in which the quality of care declined, followed by decreased nurse satisfaction (4,445) and delays in providing basic care (4,262).

The relationship between inadequate staffing and quality of care correlates with a March 2000 study, conducted by hospital and health care research organization Network, Inc. for ANA, which found that patients have better health-care outcomes in hospitals with higher staffing levels and higher RN ratios in the staffing mix.

The ANA Staffing Survey also reflects similar findings in a 1996 American Journal of Nursing (AJN) survey, which revealed that nearly 9 out of 10 nurses polled expressed serious concerns that the safety and quality of patient care was being diminished by "cost-saving" nursing-staff cutbacks.

The ANA Staffing Survey further found that nurses are putting their patients and their patients' safety ahead of their own personal and professional needs. When asked about what they have been experiencing in their workplace, a significant number of respondents indicated they are "skipping meals and breaks to care for patients" (5,711); feel "an increased pressure to accomplish work" (5,340); are "pressured to work voluntary overtime" (4,258); are not able to "attend continuing education programs due to an increased workload" (4,210); and suffer from "increased stress-related illness" (3,762).

In addition, 3,617 respondents said they feel "exhausted and discouraged" when they leave work, with an additional 3,222 recognizing that they are "discouraged and saddened by what they couldn't provide for their patients." And, 2,928 of those questioned said they feel "powerless to effect change necessary for safe, quality patient care."

"Nurses know that they can't provide the best quality of nursing care under their current working conditions, or without being able to obtain continued training and education when they need it," said Foley. "Both patients and nurses deserve better."

The survey findings are even more alarming when combined with the respondents' demographics. Of the nurses who took the survey, 43.4 percent ranged in age from 41 to 50 years old, and 22.5 percent were 51 to 60 years old, indicating that the majority of respondents (65.9 percent) will likely retire within the decade. These older nurse demographics reflect the findings of a study completed by Peter Buerhaus of Vanderbilt University School of Nursing and published in the June 14, 2000, Journal of the American Medical Association (JAMA), which found the bulk of the nation's nursing workforce is aging significantly, with the number of full-time equivalent RNs per capita forecasted to fall 20 percent below demand by 2010. Part of the problem, according to the Buerhaus study, is that younger women now have more lucrative career opportunities in other fields and are not attracted to nursing in the numbers they once were.

"These findings reinforce what we already know," said Foley, "that today's nurses not only are frustrated, but that many soon will be retiring, and that younger people will not choose nursing as a career unless we improve working conditions and compensation, and address health and safety concerns."

Bolstered by the survey's findings and other indicators, ANA and its Constituent Member Associations (CMAs) have outlined a national state legislative agenda to address staffing problems, and have identified the following priorities for 2001:

  • Restrictions on mandatory overtime -- which establish that no employee of a health care facility can be required or forced to accept work in excess of a predetermined schedule. Any employer who violates the provisions would be subject to sanctions. Nurses do not want to be forced to work overtime when they are tired or when they have other commitments.
  • Increased whistleblower protections -- including legislation that would protect health care workers against retaliatory or punitive actions from employers for reporting safety and quality concerns. Nurses want to know they can report unsafe conditions to the appropriate agency without fear of reprisal, especially when those concerns have already been voiced in their facility and no action has been taken.
  • Mandated collection of workforce and nursing-sensitive quality data – as a means of making health care facilities publicly accountable for the quality -- not just the cost -- of care delivered to patients, and for the staffing levels used to deliver that care. Included would be a mandate to incorporate nursing research, nursing workforce data and other findings into agencies' reports.
  • Establishment of patient classification systems -- requiring health care facilities to develop and utilize valid and reliable tools to calculate the appropriate level and mix of nursing staff (RN, LPN, unlicensed assistants) needed to deliver safe, quality care.

Legislative efforts designed to improve health care facility working conditions are already underway in many states. For example, legislation to prohibit mandatory overtime has been introduced in Connecticut, Hawaii, Nevada, New York and Washington state in the 2001 legislative session. And additional bills are expected to be introduced in many other states.

Armed with the ANA Staffing Survey findings, many CMAs are mobilizing nurses to educate the public and state legislators regarding the issues and to offer nursing's solutions.

"This survey provides valuable insights into the perceptions of nurses regarding their working conditions and the impact that changes in the health care system are having on patient care and safety," said Foley. "This is important data that ANA and its CMAs can take to state legislatures throughout the nation -- to let legislators know the changes that need to be made in nurses' work environments, in order to protect patients and address the current crisis in health care.

"The bottom line," Foley concluded, "is that we have to improve working conditions in order to enable older nurses to stay in nursing longer, and so that young people will be attracted into the profession."

The 2001 ANA Staffing Survey was conducted by Cornerstone Communications and commissioned by ANA. The findings released today are based on the responses of 7,299 RNs. The survey was conducted Dec. 7, 2000, through Jan. 19, 2001, via ANA's Web site, and was designed to measure nurses' perceptions of their working conditions and the safety and quality of patient care. Reporters may request a copy of the full ANA Staffing Survey by calling Cindy Price or Hope Hall at 202-651-7038 (Price) or 202-651-7027 (Hall).

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The American Nurses Association is the only full-service professional organization representing the nation's 2.6 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.