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RENEE MONTAGNE, HOST:

This is MORNING EDITION from NPR News. Good morning. I'm Renee Montagne. Nurses are the backbone of hospitals; pretty much any patient or doctor will tell you that. Still, a new poll by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health finds that one-third of hospitalized patients say nurses weren't available when needed, or didn't respond quickly to requests for help.

As part of our series "Sick in America," NPR's Patti Neighmond looks at what's behind this finding.

PATTI NEIGHMOND, BYLINE: Nurses provide most of the hands-on patient care, so we were surprised when our polls showed in many cases, nurses weren't available. We wanted to find out what's going on from nurses themselves. We put a call out on Facebook and got hundreds of responses - nurses telling us they get no breaks, no lunches, barely time for the bathroom.

UNIDENTIFIED NURSE: We're always afraid that something will happen to our patients during the time that we're off the floor. And I, personally, don't feel comfortable leaving my patients unless I know that a co-worker is actually looking after them during the time that I'm off the floor.

NEIGHMOND: This nurse responded to our call-out. And like nearly all we talked to, she didn't want her name used because she's worried about retaliation from her employer. She says she rarely stops - not for 12 hours. She's an emergency room nurse in a busy, urban hospital.

The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more - often eight, if she's covering for a colleague taking a lunch break.

UNIDENTIFIED NURSE: There are times that I've been with a patient where I, literally, could not leave their bedside because maybe I was injecting a medication that you have to push slowly over five to 10 minutes so that it doesn't harm them. And I can see a call bell going off down the hallway, and there's no way I can go and respond to that.

NEIGHMOND: The only option: Yell down the hallway, and hope another nurse hears and responds to the patient call bell.

UNIDENTIFIED NURSE: There have been shifts where I've driven home at the end of 12 hours, and I'm gripping the steering wheel, and all I can think of is, what happened during my shift? Did I miss anything? I've run ragged; I didn't get a break; my knuckles are white. And what can we do to make this situation better for both the patients and the nurses?

NEIGHMOND: Stories like this suggest there's a shortage of nurses. But there isn't.

LINDA AIKEN: We have a shortage of nursing care, but not a shortage of nurses.

NEIGHMOND: Linda Aiken's a researcher and professor of nursing at the University of Pennsylvania. There was a shortage about a decade ago, she says, but today that's changed. The number of RNs graduating has increased dramatically over the past decade, but many can't find jobs.

Nancy Foster is a vice president with the American Hospital Association. She says hospitals are facing big financial challenges.

NANCY FOSTER: In part, it's because our patients are sicker. They are coming to us with many more intense diseases and disorders than they would have 25 years ago. In part, that's because there are so many more medications and devices and other interventions at our fingertips, we can help many more people than we could have 25 years ago - and restore them to health.

NEIGHMOND: Nurses, says Foster, aren't alone in feeling the crunch. But nursing researcher Aiken says any reductions in nurse staffing, at a time of increasing patient demand, jeopardizes care.

AIKEN: Nurses are the surveillance system in hospitals for the early detection and intervention, to save a patient.

NEIGHMOND: And if there's not enough time with patients, early detection may not happen. Our nurse says that's her biggest fear.

UNIDENTIFIED NURSE: You know, you might walk into a room, and they're breathing and they look OK and they answer your questions. But if you look at their neck and their jugular vein is just slightly distended, or you check their nail beds and they're a little bit dusky - you know, taking the time to pick up on the small details like that, those are the early warning signs that somebody is getting sicker fast.

NEIGHMOND: In our poll, half of Americans who were hospitalized overnight in the past year said they were very satisfied with their care. Another third said they were somewhat satisfied, but some things could have been better. Only 16 percent said they were dissatisfied - so it's not all bad news.

But with a rapidly aging population, the fear is that the nursing staff will be stretched even more thinly. And for our overworked nurse, this takes a toll on a career she's always loved.

UNIDENTIFIED NURSE: I've thought, before, that the day that I come home and look back, and realize that I made a mistake because the demands exceeded any reasonable capacity on the part of a nurse, that's the day that I never want to be a nurse again.

NEIGHMOND: Now, our call-out on Facebook was not scientific. Many nurses may not share the feelings of this overworked nurse. But our poll is scientific, and it does point to significant problems when it comes to the availability of nurses at the bedside.

Patti Neighmond, NPR News.

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