Becky Hartman will tell you how crucial it is for a hospital to have enough nurses.

When she rushed her mother to a Wichita, Kan., hospital, an ER doctor quickly sized up the older woman as another pneumonia case. Her breathing was labored, and pneumonia patients filled the emergency room.

But 61-year-old Shirley Keck didn't have pneumonia. As she lay in a hospital room all but ignored, she was suffering from a common type of heart failure that filled her lungs with fluid.

As Keck deteriorated over several hours, Hartman begged Wesley Hospital nurses for help.

"It was total chaos. Everybody was tired. Everybody was totally overworked," Hartman recalls. "As the breathing got worse, I'd ring the button. Nobody came."

It was Feb. 8, 1998 — a Sunday night, when hospital staffs are leanest. There were just two registered nurses and two nurse aides for 42 patients on Keck's floor, fewer than half the staff the hospital's own guidelines required.

"I'm going to die," Shirley Keck told her daughter.

She did, but was resuscitated and lingered for four years — depressed, paralyzed except for one arm and unable to talk because a stroke during the ordeal had caused brain damage.

Her family sued and won a $2.7 million malpractice settlement from Wesley Hospital in July 2000. Two years later, Keck died.

The hospital and Keck's attorney, Bradley Prochaska, say it's the first malpractice decision specifically pinned on inadequate nurse staffing. He has filed a similar suit involving a 38-year-old quadriplegic woman.

At first, Hartman was furious with the nurses. Now, she's joined their cause, speaking out about the need for more nurses at the bedside.

"If another family doesn't go through this, the nightmares I've had," she says, "that's all I can ask for."

Across the country, nurses unions are pushing hospitals and lawmakers for limits on patient loads. And hospitals are trying to recruit and keep more nurses, all with good reason: Too few nurses can cost patients their health and sometimes their lives, study after study shows.

• A shortage of nurses is a factor in about one-fourth of patient injuries or deaths in hospitals, according to the Joint Commission on Accreditation of Healthcare Organizations' 2002 report.

• The prestigious Institute of Medicine says long work hours and fatigue contribute to errors. Its November 2003 report recommends a ban on nurses working longer than 12 hours a day.

• A 2002 study by Harvard and Vanderbilt university researchers, examining millions of 1997 hospital cases, found preventable deaths and patient complication rates were up to nine times higher in hospitals where most of the care was given by licensed practical nurses and aides, not better-trained RNs.