PHILADELPHIA In one of the most ambitious studies of hospital nurses ever undertaken, researchers at the University of Pennsylvania have found widespread concern about quality of patient care and discontent in the ranks of hospital nurses and have identified trends that bode ill for a quick resolution to the current nurse shortage.

The study documented widespread nurse dissatisfaction and growing concern for patient well-being in the survey of 43,329 registered nurses in 711 hospitals in five countries. Fundamental problems with management of care in hospitals and working conditions for nurses are international in scope and may contribute to medical errors and other undesirable consequences for patients, concluded the investigators in the May-June issue of the influential healthcare journal Health Affairs.

"Nurses report they are unable to provide quality of care consistent with professional standards in today hospitals," said Linda Aiken, Penn professor of nursing and sociology. "Hospital executives should take a hard look at management practices and move away from quick fixes."

Specifically, the researchers found across the U.S., Canada, the United Kingdom and Germany:

• As many as half of the registered nurses reported a decline in the quality of patient care provided in their hospital within the previous year and no more than one-third judged the care provided on their units as excellent.
• Two-thirds of nurses say there are insufficient nurses in their hospitals to provide adequate quality of care to patients.
• In the U.S. and Canada, where length of stay is shortest and home-based services are weakest, only about one-third of nurses feel confident that their patients can take care of themselves after being discharged.
• In four of the five countries, including the U.S., approximately 40 per-cent of the hospital nurses reported being dissatisfied with their current jobs; the comparable statistic for professional workers in the U.S. at large is 10 percent.
• Consumer and provider frustration appears high, with over half of the nurses in the U.S. and Canada reporting being verbally abused on a regular basis.
• Burnout levels are high and significant numbers at least one in five of all nurses and one in three nurses under 30 indicated they intended to leave their jobs within the next year.

The team of researchers conducted surveys of 13,471 acute care hospital nurses in the U.S.; 17,450 in Canada; 5,006 in England; 4,721 in Scotland; and 2,681 in Germany in 1998 and 1999 with grants from the National Institutes of Health, National Institute of Nursing Research and other sources.

"Hospital nurses working in very different healthcare systems are experiencing similar strains and have concerns about their patientswelfare that are very much alike. With an aging nursing workforce in western countries and younger nurses reporting greater intentions to leave their jobs than more senior ones, hospitals will face worsening shortages unless working conditions are improved," Aiken said. "There clearly a pressing need to rethink the way nurseswork in hospitals is designed."

Health Affairs, published by Project HOPE, is a bimonthly, multidisciplinary journal devoted to publishing the leading edge in health policy thought and research. Copies of the journal are available at no charge to members of the press. To obtain a copy, contact Jackie Graves at 301-656-7401, ext. 255, or via e-mail at press@healthaffairs.org.