A recent study published in The American Journal of Medicine looked at the amount of time nurses spend with patients versus the assigned physician. The study determined, unsurprisingly, that nurses spend nearly double the amount of time with patients than physicians. For physicians, 14% to 18% of their time was dedicated to actual patient interactions, while nurses consistently spent 33% of their time directly interacting with patients. While this statistic won’t be a surprise to many nurses, it is important to look beyond the statistics and consider what benefit the additional time could have on improving patient diagnosis and outcomes.
The primary benefit of patient/nurse interactions is the building of trust. Patients, especially sick and vulnerable patients, build a relationship with their nurses. They speak, they share, and likely, they share more openly and truthfully. But what impact could this have on patient diagnosis and outcomes? The impact is likely significant and impacts both patient length-of-stay and the financial resources needed to get well.
How? Let’s look at a real-life scenario. A patient presents with muscle weakness and partial paralysis, with an array of seemingly unrelated symptoms, including skin rashes, enlarged nerves in the neck, and thinning eyebrow hair. Endless tests commence as the usual suspects are ruled out one by one. Frustrated, the patient casually mentions to her nurse that she needs to get the issues resolved quickly because “it is baby season”. Confused, the nurse stares blankly at her patient, waiting for further explanation. The patient goes on to relay she is a wildlife rehabber, trying to get through the busiest time of the year, and the vague symptoms are progressively making that more difficult. Suddenly, a thought occurs to the nurse, and she quickly asks if the patient has had contact with armadillos, and the answer is a resounding yes.
The tests that follow confirm Hansen’s disease, more commonly known as leprosy. No intake paperwork goes so far as to ask patients what they do in their spare time, typically intake paperwork is limited to the type of employment and family medical history. In this case, the patient’s hobby was the culprit, something highly unlikely to have been shared outside of the casual conversation that so often occurs between patients and those who provide their direct daily care.
It is hard to overestimate the impact nurse relationship-building has on patient outcomes. As in the patient above, likely thousands of dollars in needless testing, days of additional hospitalization, and delayed treatment for the actual underlying issue were only a fractional amount of the impact. Nurses and doctor exposure to a debilitating illness and decreasing length of stay not only help the patient being treated but opens up beds to both increase the hospital's ability to care for more patients and increases the hospital's profitability.
But what other gains come from increased nurse/patient contact times? Patient satisfaction, for one. While in some markets, there may only be a single option for hospitalizations, in other areas, patients may have a choice of hospital providers. To that end, word of mouth, especially in today’s highly charged social media environment, can be critical to attracting new patients and retaining previous patients. Because nurses spend a significant amount of their on-shift time directly interacting with patients, perhaps no other role will have a greater impact on satisfaction than that of a nurse.
Perhaps looking at the juxtaposition of increased patient/nurse interactions proves the critical nature of adequate staffing and time management related to outcomes even more profoundly. According to the National Institutes of Health, National Library of Medicine, the national nursing shortage, which would obviously impact patient/nurse interaction time, is cause for substantial concern.
Why is there a national shortage? A wide variety of factors, both preventable and not preventable, have combined to create a crisis within nursing. These factors include:
But how does the national nursing shortage impact patients? According to the NIH “Nursing shortages lead to errors, higher morbidity, and mortality rates. In hospitals with high patient-to-nurse ratios, nurses experience burnout, dissatisfaction, and the patients experienced higher mortality and failure-to-rescue rates than facilities with lower patient-to-nurse ratios. Some states have begun to pass legislation to limit patient-to-nurse ratios. Despite this, when staffing is short, ratios go up to meet the need.”
So, the ever-decreasing number of nurses not only helps to contribute to burnout for those who remain but also increases mortality rates for hospitalized patients as well. By reducing the amount of time nurses can spend tending to their patients, we are creating a circular firing squad that not only negatively impacts our own lives and the lives of our loved ones but contributes to the dissatisfaction of those working within the nursing profession, making them more likely to turnover or leave their noble calling.
What can we do? The unfortunate answer is there are no simple solutions to complex problems. However, legislative initiatives are making it easier for nurses licensed in their current state to move to a different state, hopefully helping to address the geographical nursing shortages. Employers are offering substantial sign-on bonuses and higher rates of pay for experienced nurses, which should hopefully drive additional interest in pursuing the profession. More flexible hours and on-site daycare options are becoming more popular, hopefully reducing turnover. But each of these solutions isn’t enough, considering the enormity of the problem at hand and the negative impact patients experience every day due to reduced interactions with their nurses.
We know unequivocally, that there is a direct correlation between patient outcomes and adequate nursing levels. While it may not be easy to find additional time for dedicated nurse/patient interactions, it must be a priority for those within the profession, patient lives depend on it.