National Survey Reveals Serious Concerns among Americans about Cost-Cutting Trends in Patient Care (5/9/96)

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CONTACT: Joan Meehan [202/651-7020]; Sara Foer [202/651-7023]

National Survey Reveals Serious Concerns among Americans about Cost-Cutting Trends in Patient Care

WASHINGTON, DC -- May 9, 1996 -- Americans are worried about many of the changes in our health care delivery system and how they affect the quality of patient care in health care institutions, warns a survey released in Washington today. As many as three-quarters of the adults polled indicate serious concern that the quality of patient care is being diminished by some cost-cutting practices -- a concern that has increased significantly since 1994.

Seventy-five percent of the survey respondents believe that reducing the number of registered nurses who provide bedside patient care in hospitals lowers the quality of care, and 67% said that increasing the use of unlicensed health care workers for care traditionally performed by registered nurses has the same quality-diminishing effect. Unlicensed health care workers, often called nurse's aides, nursing assistants, and patient care technicians, usually have about 40 hours or less of hospital-based training. Whereas the duration and content of training for unlicensed health care workers are determined by the hospital that employs them and varies widely, registered nurses (RNs) must have between two and four years of higher education and must be licensed by the state in order to practice.

"This survey sends a loud message," says Diane Colasanto, president of Princeton Survey Research Associates, the Princeton-based polling organization that conducted the survey. "Americans are worried about the changes taking place in our health care system. Among the seven cost-cutting options that we investigated, consumers' top two concerns are related to changes in nursing staff. The public fears that changes in hospital nursing staff will substantially lower the quality of patient care.

"Americans are more worried today by the impact changes in nursing staff are having on the quality of patient care than they were two years ago," Colasanto continues. "The percentage indicating the highest level of concern about reductions in the use of registered nurses increased eight percentage points since 1994." Whereas 67% of respondents in 1994 rated the reduction in RN staffing as a key factor leading to deterioration of the quality of patient care in hospitals, that percentage rose to 75% in 1996.

While the recent survey indicates that Americans are concerned about the increased use of unlicensed health care workers, the respondents believe such workers can serve a useful role in assisting RNs with simple tasks. According to those polled, it may be acceptable for certain types of simple tasks, such as feeding and moving patients, to be performed by these personnel. Most Americans (85%) feel, however, that it is inappropriate for unlicensed health care workers to draw blood, insert catheters, IVs, and other tubes, and 74% say unlicensed workers should not give patients medication.

"This survey punctuates Americans' particular concerns about the impact that reducing the number of registered nurses has on the quality of care in hospitals," says Virginia Trotter Betts, JD, MSN, RN, president of the American Nurses Association (ANA). "Care by highly educated, licensed registered nurses is central to the delivery of quality health care in all settings, including our nation's acute-care hospitals. Nurses are a vital ingredient in the formula for quality patient care."

According to the 1996 survey, Americans want information about the level of nursing care in hospitals, but many feel that it would be difficult to obtain. Eighty-two percent of those polled want to know the average number of patients assigned to each nurse, and 80% want to know the hospital's policy on types of care unlicensed health care assistants are allowed to perform.

Clearly, Americans want a wide variety of hospital-specific information available to them in the event they need to be admitted for treatment or surgery, and they are particularly concerned with patient outcomes. Eighty-six percent would be "very" or "somewhat" interested in the survival rate for patients treated for major illnesses; 84% would want to know the number of recent patients who contracted new infections during their stays; and 87% say the satisfaction ratings from recently treated patients are important to them. Interestingly, the number of lawsuits filed against a hospital in the past year is of least importance to the public, but interest is not insignificant -- 77% of those polled said they would want this information.

Cost, surprisingly, is not the most important factor influencing the public's choice of health insurance -- only 17% of those polled who had a choice of insurance plan ranked this as the most important factor in their choice. Americans most value, instead, the ability to choose their own health care provider -- 47% of those polled ranked this as the most important factor in their choice of health insurance. Hospital selection is another important consideration. Ten percent said this is the "most important" factor for them, and 75% said it was "very important" to them.

"This survey focuses the nation's attention on a question that has gone ignored for too long -- how do consumers think cost-driven changes affect their health care services?" Betts questions. "Patients do not see a reduction in their bills, but they most definitely experience a clear decrease in their health care. The safety and quality of the health care they have depended on is being eroded by short-sighted attempts and quick-fix solutions to save money, such as cutting RNs, at the expense of safe, quality patient care."

A decade of research demonstrates that when there are more nurses, there will be lower mortality rates, shorter lengths of stay, fewer complications, and even lower costs.

To make hospital data available to the public, Rep. Maurice Hinchey (D-NY) introduced "The Patient Safety Act of 1996," H.R. 3355. This bill, the first of its kind and developed with ANA's support, mandates public disclosure by hospitals of staffing levels and outcomes -- some of the data which the survey shows the public wants to know. It also calls for "whistle blower" protections for nurses who speak out on behalf of patient care issues, and review of the impact of proposed mergers and acquisitions of health care institutions on patient health and safety.

The survey, "Nursing and the Quality of Patient Care," was conducted by Princeton Survey Research Associates and was commissioned by ANA. The national survey of 1,001 American adults, 18 years and older, was conducted from April 3, 1996 through April 13, 1996 and probes public reaction to seven cost-cutting practices in the health care system. The margin of error for the sample is plus or minus 3%.

The seven cost-cutting options probed in the survey include (1) reducing the number of registered nurses who provide bedside patient care in hospitals; (2) reducing spending on new buildings or hospital renovations; (3) reducing spending for new technology such as magnetic resonance imaging or MRI equipment; (4) reducing salaries and expenses for hospital administration; (5) reducing the number of days patients stay in the hospital after surgery or after delivering a baby; (6) changing ownership of hospitals either through mergers or through purchase by a large corporation; and (7) increasing the use of unlicensed health care workers to perform some types of care registered nurses used to perform.

ANA released the results of this survey today at a press conference in Washington, and underscored the need for increased scrutiny of hospitals and other health care organizations that implement cost-cutting methods which undermine quality patient care. The press conference was one of several events organized by ANA for National Nurses Week, which began a few days earlier with the April 30 introduction of The Patient Safety Act of 1996.