WASHINGTON (ASRN.ORG)- Many hospitals and nursing homes are endangering patients by allowing or requiring nurses to work more than 12 hours a day.

Such long hours cause fatigue, reduce productivity and increase the risk that the nurses will make mistakes that harm patients.

Donald M. Steinwachs, chairman of the health policy department at Johns Hopkins University, said fatigue was a ''major cause of mistakes and errors'' in hospitals and nursing homes. 

The report said many nurses and nursing assistants worked more than 12 consecutive hours, with some working double shifts of 16 hours. 

To reduce ''error-producing fatigue,'' the report said, state officials should prohibit nurses from working more than 12 hours in any 24-hour period or more than 60 hours a week. 

In one study for the government, 27 percent of nurses at hospitals and nursing homes reported that they worked more than 13 consecutive hours at least once a week. 

The report said, ''Long work hours pose one of the most serious threats to patient safety, because fatigue slows reaction time, decreases energy, diminishes attention to detail, and otherwise contributes to errors.'' 

Many hospitals and nursing homes have too few nurses to take proper care of patients, the panel said. 

Intensive care units at hospitals should have one licensed nurse on duty for every two patients, the report said. Nursing homes, it said, should have one registered nurse for every 32 patients and one nursing assistant for every 8.5 patients. 

The Bush administration said last year that it had no plans to set minimum staffing levels for nursing homes, in part because such requirements would generate billions of dollars in additional costs for Medicaid, Medicare and nursing homes.

But the National Academy of Sciences said the administration should do what it declined to do last year: set ''minimum standards for registered and licensed nurse staffing in nursing homes.'' 

The academy found overwhelming evidence that as levels of nurse staffing rose the quality of care improved, because nurses had more time to monitor patients and can more readily detect changes in their conditions. 

''Studies show that increased infections, bleeding and cardiac and respiratory failure are associated with inadequate numbers of nurses,'' the report said. ''Nurses also defend against medical errors. For example, a study in two hospitals found that nurses intercepted 86 percent of medication errors before they reached patients.'' 

Senator Charles E. Grassley, an Iowa Republican who has been investigating nursing homes since 1997, said he saw no need for the government to specify the proper number of nurses. 

''If we mandate minimum staffing levels, the nursing home industry will want more money,'' Senator Grassley said. ''It seems nursing homes already receive plenty of money to do the job'' -- more than $58 billion a year from Medicare and Medicaid. Senator Grassley recently secured a promise from the industry to use $4 billion in Medicare money to improve services to patients in the next decade. 

Dr. Andrew M. Kramer, a panel member who is a professor of medicine at the University of Colorado, said nursing assistants ''work double shifts on a fairly regular basis'' at some nursing homes. 

The academy said the nation's 2.8 million licensed nurses and 2.3 million nursing assistants accounted for 54 percent of health care workers. Thus, said Dr. Harvey V. Fineberg, president of the Institute of Medicine, ''It is nurses who deliver most of the care we receive.'' 

Pamela Thompson, chief executive of the American Organization of Nurse Executives, a subsidiary of the American Hospital Association, said it was ''an accepted practice'' for nurses to work 12-hour shifts. 

Alan E. DeFend, vice president of the American Health Care Association, which represents nursing homes, said: ''The shortage of nursing assistants has reached crisis proportions. Sometimes there's just no alternative to overtime.''

The panel did not distinguish between voluntary and mandatory overtime. 

Ada Sue Hinshaw, a panel member who is dean of the School of Nursing at the University of Michigan, said: ''The fatigue effects are the same. Medical errors start climbing after 12 hours of work.'' 

To reduce such errors, the panel said, nurses should be more involved in the day-to-day management of hospitals and nursing homes..

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