Where I Stand — Mike O’Callaghan: Yes, nurses are important

Friday, Dec. 11, 1998 | 12:29 p.m.

"STUDY: NURSES ARE IMPORTANT" was the headline of a recent newspaper story. So, what's new I thought. The great value of nurses in all health services has always been taken for granted by those of us who have spent time in hospitals. My hospital experiences from the 43rd M.A.S.H. and several military and VA hospitals to Sunrise Hospital have given me more than a little knowledge needed to appreciate nurses. This has encouraged me to speak up whenever there is any question about the value of nurses.

Now researchers at the U.S. Agency for Health Care Policy and Research have come to the same conclusion and published their findings in the nursing journal Image. A press release told us: "Studies like this demonstrate that it is critical to study the outcomes and effectiveness of changes in the organization and delivery of health care services," AHCPR Administrator John M. Eisenberg, M.D., said. "This information is as important to improved health care quality as is information about the outcomes and effectiveness of medical treatments. AHCPR is dedicated to providing the scientific evidence that clinicians, health care systems leaders and policymakers need to correct quality problems, such as avoidable complications and medication errors."

So what did the study find? Hospitals that provide one more hour of nursing care per patient day had almost 10 percent fewer patients with urinary tract infections and 8 percent fewer patients with pneumonia. This conclusion was drawn after analyzing data from 506 hospitals in 10 states. Nevada was not one of the states. In addition to this, they found "that the fewer full-time equivalent nurses per inpatient day a hospital has, the greater is its incidence of urinary tract infection, pneumonia, thrombosis -- formation of blood clots -- pulmonary congestion and other lung-related problems following major surgery."

It doesn't take a genius to figure out that the higher level staffing of nurses makes for better medicine. That's at least the view consumers or patients should draw from the study. What is not as clear are some of the other findings of the study. "In addition to the relationship between nurse staffing and these adverse events, population and hospital-level variables were related to adverse events. Large hospitals had significantly lower urinary tract infection rates than did small hospitals, while large- and medium-sized hospitals had higher pulmonary-compromise rates than small hospitals. Bed size was not related to either of the two other complication indicators. Not-for-profit hospitals had significantly lower postoperative pneumonia and pulmonary compromise rates than did for-profit hospitals. Hospitals with nursing schools had significantly lower postoperative pneumonia and pulmonary compromise rates than did hospitals without nursing schools."

The researchers believe that what they have learned should be used when making hospital regulations. It should also be given special attention by cost-conscious managers of health care agencies. They point out that "declaring adverse events is good for patients, good for a hospital's reputation, and -- depending on the cost-effectiveness analysis -- may be fiscally good for hospitals as well." Then they ask, "What is the level of adverse events at which hospital management is satisfied?"

Six years ago, during President Clinton's first year in the White House, the American Medical Association came unglued when his wife advocated a wider and more important role for nurses. That's when I pointed out that nurses are very special people, and most Americans see them in this light. It's time for the AMA politicians to share this view and show their fellow professionals the courtesy and respect they have earned. Just as important is a willingness to promote and recognize their professional use in broader roles as our country struggles to keep from total fiscal bankruptcy and/or shrinking health programs. Neither is acceptable to the people of the United States.

Here in Nevada, during recent years, I have noticed a very close working relationship between our leading physicians and the nurses. I'm not referring to the kind of relationship appearing in that somewhat tacky advertisement for the 40th anniversary being celebrated by Sunrise. What has been noticeable is the support large numbers of local physicians have given to nurses seeking better working conditions and higher pay. It has been a real team effort, which is exactly what a patient should expect when in the care of these unselfish professionals.

Yes, as the study points out, nurses are important. Very important to every patient who comes under their care. I've always said that good doctors make it possible to live and good nurses make you want to live. Several of us are alive today because of the care nurses provided during those long nights in military hospitals. It didn't take a technical study to convince us that nurses are important, but it's good that it was made so that health care agencies and hospitals will treat them with the professional respect they have earned over many generations.