Failing Health

Managed care has seriously thinned nurses' ranks, says SON's Shindul-Rothschild, and patients suffer

By Sandra Howe
Staff Writer

Managed health care has resulted in fewer nurses working longer hours and caring for more patients, trends which are setting the stage for disaster, according to Asst. Prof. Judith Shindul-Rothschild (SON), who recently conducted a major study on the state of nursing in America.

Shindul-Rothschild surveyed 7,560 nurses from across the country on their perceptions of their profession and the quality of care their hospital or institution provides. The results, to be published in the November issue of the American Journal of Nursing , strongly suggest that managed care has not improved the quality and continuity of health care, Shindul-Rothschild said. Based on her analysis, nurses feel they and their patients are enduring hardships for the sake of increased profits and productivity.


Asst. Prof. Judith Shindul-Rothschild (SON)-"When health care reform failed in the first years of the Clinton Administration, business intervened and nurses became a primary target to lower costs in the health care industry. As a result, patients and nurses are in worse shape now than before."

"When health care reform failed in the first years of the Clinton Administration, business intervened and nurses became a primary target to lower costs in the health care industry," said Shindul-Rothschild in a recent interview. "As a result, patients and nurses are in worse shape now than before."

In Shindul-Rothschild's survey, the largest ever conducted concerning nurses' views on health care and nursing practice, 66 percent of the respondents said they are taking care of more patients than before the recent industry cut-backs. Fifty-five percent reported an increase in patient and family complaints about the quality of care provided and only 43 percent said the quality of care at their workplace over the past year met their professional standards.
As managed care has forced hospitals to close unprofitable units, increase efficiency and lower costs, says Shindul-Rothschild, many nurses have felt the effects of downsizing. Forty-five percent said their workplace had trimmed nurse-manager positions and 38 percent reported cuts in top level nurse administration positions.

The number of registered nurses working full time dropped in every region of the country, the survey found. Sixty-four percent of nurses in the Northeast and the East-North Central regions reported reductions in the number of registered nurses on staff; on the West Coast, 56 percent of the respondents said their hospital or institution had replaced full-time registered nurses with part-time registered nurses.

Nurses in all regions said these factors have contributed to added responsibilities, leaving them less time to spend with patients. Fifty-five percent said they were unable to provide continuous care to patients and 73 percent reported having less time to comfort and talk to patients in the last year.

"Health care organizations are unlikely to change the practice of forcing fewer nurses to do more until the long term costs, such as increased worker compensation, disability or legal settlements, exceed the short-term savings," Shindul-Rothschild wrote in her study.

Furthermore, the survey found that unlicensed personnel, some with no more than a high school degree, are increasingly taking on the duties of registered nurses. This trend, said 87 percent of the respondents, has resulted in a deterioration of the quality of care.

In general, nurses felt that patients often do not receive sufficient treatment through managed care, Shindul-Rothschild found. Psychiatric and geriatric nurses reported higher re-admission rates, while the rates of complications secondary to initial illnesses have skyrocketed in all areas, with the highest reports of unexpected re-admissions - 68 percent - reported in the Northeast.

Shindul-Rothschild's study found that patients are not the only ones getting hurt. More than 70 percent of nurses are injured on the job, she found, and 43 percent of the respondents said nurses suffered more work-related injuries last year than in years past.

"What this study suggests to me is, before we start seeing bad things happen to patients, you're going to see nurses themselves suffering, taking the toll physically for the inordinate demands that have been put on them to care for seriously ill patients," she said.

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