Nurses: More Important Than Doctors.

I’m just kidding. The study is really about whether more patients die in the hospital when nurses are on strike, and the findings suggest that they do.

Now, is it just that only really sick people go to the hospital during a nurse’s strike, driving up the mortality rate, or are nurses actually an integral part of the hospital? This is the question asked yesterday by Freakonomics co-author and University of Chicago Economics Professor Steven Levitt on the New York Times Freakonomics Blog.

Despite mentioning that in Superfreakonomics Levitt and his co-author, journalist Stephen Dubner, wrote that when doctors go on strike patients tend not to suffer, or even fair better, Levitt writes that the statistic might be driven by the type of patients that show up at the hospital. If only very sick patients went to the hospital during strikes, then one would expect the mortality rate to increase during any kind of hospital strike, not just during nurses’ strikes.

Well, unless the population at large sees nurses as the most crucial part of the hospital and only change their medical care-seeking behaviour when the all-important nurses go on strike.

That seems unlikely. People seem to be more afraid that we are heading into a doctorless world then a nurseless one. Anyway, this is all a moot point, because the authors of the study say expressly in the abstract that they controlled for “patient demographics and disease severity.”

Using a variety of observable characteristics, the authors of the study determined that patient demographics don’t change during a strike.

So maybe I’m not kidding. Maybe nurses are more important than doctors.

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3 thoughts on “Nurses: More Important Than Doctors.

  1. I can hardly imagine all the doctors going on strike, leaving those who are in need of emergency care to bleed to death in ER thus having a strong negotiation tool for their union representatives. A more plausible manner to strike would be for a small number of them to go on strike, leaving enough doctors to ensure that ER is running smoothly. Those who do go on strike could be responsible for non emergency treatment, this in turn could postpone the performance of non-emergency but nonetheless life threatening surgeries, thus temporarily decreasing the mortality rate. Here it is also important to look at the way the researchers calculated the mortality rate, is it a sheer number of deaths in the hospitals or is it a relation between the number of deaths and the number of patients treated. The former would grant credence to the aforementioned hypothesis, the latter would suggest that we do not need so many doctors in our hospitals, which seems unreasonable in light of the time people have to wait in order to receive treatment. Good point Katherine.

  2. I think it’s actually kind of interesting that this finding would be all that surprising. I am somewhat surprised there was no increase in mortality during a doctor’s strike, but I’m not at all surprised that a nurses strike has a bigger impact. I think they’ve also done research about how nurse to patient ratios affect patient mortality rates and found similar outcomes (i.e. higher ratio, higher mortality).
    If you think of how a hospital is set up, the nurses are the ones that are providing round the clock care and administering all the medications. If the medications are provided properly and in a timely fashion, there’s a problem. If there isn’t someone around throughout your time at the hospital to notice any changes in your status, you’re also in trouble – it might not be caught until it’s too late. Nurses are also often responsible for the majority of patient teaching, particularly before discharge, so if that wasn’t covered as well during a strike, one would imagine it would definitely affect patient outcomes.
    Going off the other commentator’s note, as long as there were enough doctors to cover emergency and immediately life threatening surgeries and procedures, as well as make sure the other patients orders were in, patients could still have good outcomes.
    Interesting post…

  3. Wow, I wish the whole world could read this!
    As a nurse, I have experienced the incredible sense of responsibility of having someone’s life in my hands, and at the same time experienced the incredible sense of feeling unacknowledged and not important. I often think about the times when I was managed ventricular drains, or administered some really heavy drugs, IV push, all alone as a new grad at the tender age of 23. If my loved one ends up in the ICU I really hope that his/her nurse is not only competent but feels that he/she has an incredible responsibility to keep my loved one alive. I think we need to acknowledge the work that nurses do and their importance in health care. All too often it is the doctors that are acknowledged, as they should be, but let’s not forget about nurses too šŸ™‚
    Thank you Katherine for posting this !

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