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Medical panel seeks better working conditions for nurses

Improvements would reduce errors, report says

WASHINGTON -- Tired and grumpy nurses forget to wash their hands, give the wrong drugs to patients, and waste hours on paperwork, a panel of experts said in a report calling for shorter hours and better working conditions for the profession.

The changes, including 12-hour limit on their workday, would reduce medical errors and make conditions better for nurses and patients alike, an Institute of Medicine panel said yesterday.

"We need to move ahead urgently with these recommendations," Donald Steinwachs, chair of the committee that wrote the report, told a news conference.

"The benefits go beyond saving lives," he added, saying that changes would make nurses less likely to quit or change jobs and would save money spent treating patients hurt by costly mistakes.

Steinwachs is chairman of the department of health policy and management at Johns Hopkins University School of Public Health in Baltimore.

"No one or two actions by themselves can keep patients safe," Steinwachs added. "Rather, creating work environments that reduce errors and increase patient safety will require fundamental changes in how nurses work, how they are deployed, and how the very culture of the organization understands and acts on safety."

Karen Higgins, president of the Massachusetts Nurses Association, which is promoting safe registered nurse staffing legislation, said: "I couldn't have put it more clearly myself. Fatigue and overwork, brought on by understaffing, are causing errors in patient care."

The nation's 2.2 million registered nurses, 700,000 licensed practical and vocational nurses, and 2.3 million nursing assistants are the front line in caring for patients and protecting them against errors, the report said.

It cited a study in two hospitals that found that nurses intercepted 86 percent of medication errors before they reached patients.

Medication errors include giving the wrong drug, giving the wrong amount, giving it the wrong way -- orally vs. intravenously, for instance -- or giving it at the wrong time, said Ada Sue Hinshaw, dean of the University of Michigan school of nursing.

The IOM, which advises the federal government on medical matters, found in a 1998 report that medical errors cost up to $29 billion each year and kill as many as 98,000 people.

State regulators should ban nursing staff from working more than 12 hours a day and more than 60 hours per week, the committee said.

"Every safety-sensitive industry . . . sets some sort of boundary on hours," said Hinshaw, referring to regulations affecting truckers, train crews, pilots, and a variety of other industries.

The recommendations echo groundbreaking changes made by the Accreditation Council for Graduate Medical Education, which set new standards in July that limit hospital work by residents, or physicians-in-training, to 80 hours a week.

The report said regulations setting minimum standards for staffing in nursing homes need to be updated. The report says the US Department of Health and Human Services should require nursing homes to have at least one registered nurse in the building at all times.

Intensive care units need to aim for one nurse for every two patients. Better conditions may often mean shifting nurses' work to others, the panel said.

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