Behind America’s chronic health care inadequacies is a dramatic back story of nurses fighting to improve patient care at the bedside despite a system so preoccupied with costs that nurses are shunted aside to fold linens, find lost medication and chase down doctors.

The nation’s penny-wise, pound-foolish approach flies in the face of hard evidence that nurses are essential to preventing hospital infections, reducing medication errors and keeping patients alive.

As a result, virtually every patient – and that means all of us, sooner or later – risk not receiving the medical care we need when we need it.  The consequences are serious and may even be fatal.

A definitive New England Journal of Medicine study revealed that about half of all patients do not get the care that is specifically recommended for their medical condition. The Centers for Disease Control reports that 90,000 hospital patients die from health care associated infections each year.  At least that many more die in hospitals from medical errors.      

Often, nurses are the only fail-safe professional protection patients can count on, which isn’t surprising when you consider that half of all health care providers are nurses.  Since they spend the most time with patients, they are the ones who first spot and address patients’ problems before they become critical.

Recent research reports that higher levels of hospital nurse staffing are associated with fewer adverse outcomes—as much as 25 percent fewer.  That means fewer patients with pneumonia or intestinal bleeding, fewer pressure ulcers and fewer heart attacks.  The risk of surgical patients dying within their first 30 days in the hospital improves with adequate nurse staffing.   

The vigilance of nurses may well be the most important defense any patient has against medical error. We believe much of the quality job starts and ends right here.  But too often, nurses are blocked from performing this core mission – which is what called many of them to the profession in the first place.

Instead, to save money, many hospitals divert nurses from patient care to paperwork, patient transport, running for lab results and picking up meds from the pharmacy.  This strategy is driving droves of nurses out the door – many after less than two years on the job—ironically without saving anyone any money. Short-sighted hospital cost-cutters don’t realize that the high cost of adverse events far exceeds what it costs to recruit and retain well-trained nurses.  The Institute of Medicine found that nurses are the health care professionals most likely to intercept medication errors, which cost hospitals $3.5 billion annually or prevent hospital-acquired pneumonia which can add 84 percent to the cost of that patient’s care, including nearly an extra week in the hospital. 

Nationally, nursing also should take its rightful seat at the health care improvement table with the rest of the major players – hospitals, doctors, drug companies, health plans, insurers, government.  Despite their expertise, when it comes to fixing problems, nurses are rarely asked for their opinion.

Locally, hospitals and health plans need to make sure nurses are on their boards and in their executive suites.  That’s the only way nurses will have the power to be change agents and advocates for higher quality care.

The challenge for hospitals, physicians and health care executives is to shed the old health care stereotypes of the past and recognize that nurses are absolutely essential to keeping patients safe, improving the quality of care and securing the bottom line.