About 14 percent of U.S. hospitals are suffering from a severe shortage of nurses, with over 20 percent of nursing positions unfilled. To handle this shortage, many health care facilities have increased nurses' patient loads or expanded the use of nonpermanent staff, such as float pool and agency nurses. Extended work shifts and overtime for nurses also have escalated. Overwork and fatigue among nurses have been associated with medication errors and falls, increased deaths, and spread of infection among patients and health care workers.
Improving the working conditions of registered nurses (RNs) can potentially decrease the incidence of many infectious diseases among staff and patients, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS13114). For the study, researchers conducted a review of published research on the nursing workforce and nursing as it relates to infectious diseases. Their review revealed that a higher ratio of pool staff to regular nursing staff tends to increase health care-associated infections, while greater RN skill mix decreases the incidence.
Without adequate numbers of trained hospital employees to implement effective infection control procedures, such as hand hygiene and proper isolation procedures, emergency departments and hospital wards can easily become venues for the spread of epidemics. For example, in a study of over 1,500 nurses working in 40 units in 20 hospitals, poor organizational climate and high workloads were associated with 50 to 200 percent increases in the likelihood of needlestick injuries (which can transmit infectious blood pathogens) and near-misses among hospital nurses.
Nurses are concerned about their exposure to infection, and their perception of unsafe working conditions may hinder their recruitment and retention. This perception may constrain the ability of hospitals to deal with future infectious disease threats, caution the researchers.
See "Nurses' working conditions: Implications for infectious disease," by Patricia W. Stone, Ph.D., M.P.H., R.N., Sean Clarke, R.N., Ph.D., C.R.N.P., C.S., Jeannie Cimiotti, R.N., and Rosaly Correa-de-Araujo, M.D., M.Sc., Ph.D., in the November 2004 Emerging Infectious Diseases 10(11), pp. 1984-1989.
Reprints (AHRQ Publication No. 05-R006) are available from the AHRQ Publications Clearinghouse.
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