(Herald-Tribune) Manatee Memorial Hospital’s leaders say they have been working since March to hire 45 more nurses. But the recruitment did not happen fast enough to avert a state inspection in April, which uncovered nurse staffing levels considered too low for patient safety, especially at night, state records show.
According to an Agency for Health Care Administration report released this month, nine nursing units in the hospital had one less nurse on duty than required on most dates during a 12-day period in early April, with night shift shortages most frequent. Manatee Memorial responded in writing that it would “recruit additional full-time and part-time staff.”
The state visit was prompted by one or more complaints to the agency. Reviewing patient records, AHCA found failures to give proper medications and prevent falls, leading to an investigation into whether the hospital had enough nurses for its workload.
Manatee Memorial now has 564 nurses on staff, with 26 of them newly hired, said Vernon DeSear, the hospital’s vice president of marketing. Efforts to add 19 more will continue, reflecting a deliberate move away from trying to save money with temporary workers.
DeSear said that patient numbers — and corresponding demand for nurses — once fluctuated widely between winter and summer, and the hospital handled peaks in demand by drawing from a pool of “on-call” nurses. But the pattern has recently shifted to a more stable year-round demand, he said, and hospital leaders had decided to address this new reality when the state inspection occurred.
“The team is important,” he said. “We knew at the time that this was what we wanted to do. But do you ramp up during winter season?”
In one case cited in the AHCA report, a congestive heart failure patient did not receive a dose of Lasix — a medicine that combats fluid retention — that a doctor had ordered. In another, a cardiac patient received medication five hours later than scheduled. And a patient admitted for chest pain fell while alone in the bathroom; the state found the patient had not been properly assessed for a risk of falling.
Such incidents occur at most hospitals. But Lynn Y. Unruh, a professor of health services administration at the University of Central Florida who has studied the links between nurse staffing and patient safety, said it is unusual for the state to cite a hospital for understaffing.
“That is very rare,” she said. “It doesn’t mean there aren’t staffing problems at Florida hospitals. But for AHCA to get involved in that way, it would signify that there are real issues there.”
Unruh said it is easy for researchers to look at hospital staffing levels and patient safety data, and see correlations. But cause-and-effect can be difficult to prove. She and a colleague recently published a study of Florida hospitals, and found two measures where a lack of sufficient nurses clearly made a difference: post-surgical infections, and “failure to rescue” — inadequate patient monitoring for complications.
She said other, less drastic patient safety issues — like giving the proper medication on time — are more difficult to tie to the data on staffing levels. But as a former nurse, she knows the connections exist.
“A medical error is defined as giving the wrong medication to the wrong patient, or not giving the proper dose within an hour of when it should be given,” she said.
When she had to care for six or seven patients at once, “I rarely gave my medications on time. I was committing medical errors every day that I practiced. I worked the evening shift, and I could not get the 4 o’clock meds delivered by 5 p.m.”