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Are nurses too busy to check on patients?

During a recent visit to a hospital to see one of my relatives, it struck me as odd that I sat there for nearly an hour and never saw a nurse come into the room.

I peeked out the door a few times and saw several nurses at the nurses station. They were clearly busy: talking to doctors and charting on computer terminals. But were they too busy to check on the patients they were caring for?

There's no denying that today's nurses are busier than ever. In Western Pennsylvania, we have a large and growing elderly population. Many come to the hospital with chronic diseases such as diabetes and high blood pressure. They sometimes arrive so sick, they require a lot of resources -- and precious time from busy nurses.

That means you're highly unlikely to see a nurse spending too much time in one patient's room, helping them eat or -- gasp -- holding their hand the way nursing pioneer Florence Nightingale did back in the 1800s. They come in, do what they're supposed to do, and go to the next patient.

Like most states, Pennsylvania has no mandates for nursing staffing levels. In fact, the Hospital & Healthsystem Association of Pennsylvania opposes any law dictating how many patients a hospital should assign to one nurse.

"There are too many variables involved with determining staffing levels, and any one-size-fits-all policy/ratio ignores those variables," said Roger Baumgarten, the association's spokesman. The variables include the number of patients, how sick they are and the space and technology in a particular unit.

Jackie Dunbar-Jacob, dean of the University of Pittsburgh's School of Nursing, said nurses are trained to assess and prioritize patients so the very sick get more attention.

I can understand that, to a certain degree. But just because you're not in cardiac arrest and are able to carry on a conversation doesn't mean you shouldn't be continuously monitored. You're in the hospital because you need skilled medical care. And you shouldn't have to hire a private nurse.

A longtime nurse I know who has worked in both UPMC and West Penn Allegheny hospitals told me she supports nurse-to-patient ratios because they ultimately would give her more time with patients.

"Most good nurses want to spend time with their patients," she said. "But if you have a very sick patient, you have no choice but to spread yourself thin."

Pennsylvania should consider taking a cue from California, which became the first state in the nation to mandate minimum staffing levels. The 2004 law requires one nurse for every two patients in intensive care and one nurse for every five patients in medical surgical units.

A study by researchers at the University of Pennsylvania and Arizona State University showed California's law improved staffing levels and -- more importantly -- the quality of patient care. The study found California hospitals hired more skilled registered nurses, not lesser-skilled vocational nurses, as some feared.

If having the right number of nurses can prevent medical errors, improve patient satisfaction and cut medication mistakes, it makes sense for Pennsylvania's health care community to have a serious discussion about this issue.

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