As discussed previously in the Tuesday Briefing (see Related Items), the nursing shortage is one of the most formidable problems currently facing the healthcare industry. According to a 2001 report by First Consulting Group (sponsored by the American Hospital Association), vacancy rates are 13% for registered nurses (RNs), 12.9% for licensed practical nurses (LPNs), and 12% for nursing assistants. Sixty percent of hospitals report an increase in RN vacancies since 1999.
It is natural to assume that nurse staffing shortages would impact nursing behavior and satisfaction with nursing care. Overworked nurses may be restricted to cursory interaction with patients just to accomplish their basic clinical duties. Further, the stress of working extended shifts could result in decreased morale among nurses. Gallup research indicates that nurses have relatively low employee engagement compared to other healthcare workers and to the U.S. working population as a whole. (See "Shift Change: Where Did All the Nurses Go?") Is the staffing shortage also impeding nurses' ability to provide compassionate care to their patients?
Gallup's patient satisfaction/loyalty data indicate that the answer to this question is an emphatic no. According to Gallup's research, patient satisfaction with nursing care and compassion (a core measure on Gallup's patient satisfaction questionnaire) was remarkably stable between 1999 and 2001 for both inpatient and emergency departments. At worst, a slight decline (from 3.52 to 3.50) in the percentage of patients who were very satisfied with the caring and compassion they received occurred between 1999 and 2000.
Gallup data indicate that the era of nurse staffing shortages has not yet affected patients' ratings of the care and compassion they receive from nurses. This finding may be testament to the strong sense of mission (see "Nursing: The Rules of Engagement") typically found among nurses. In many cases, their need to provide the best possible care to their patients drives them to rise to the challenge posed by staff shortages, often working longer hours to compensate.
Furthermore, the American public continues to hold the nursing profession in high esteem. When Gallup asked Americans to rate the honesty and ethical standards of people in 23 different fields, nurses were ranked at the top of the list in both 1999 and 2000, and were second only to firefighters in November 2001. Thus, where care falls short, the patient may be more likely to place the blame on the hospital or the system, not their personal nurse caregiver. Still, with as many as 126,000 registered nursing positions vacant, and the gap projected to get worse, all healthcare has to wonder whether nursing will be able to maintain such lofty patient satisfaction scores.