Study Reveals Link Between Increased Nursing Care, Better Patient Outcomes In Hospitals

5/29/2002

From: Cindy Price, 202-651-7038; or Joan Meehan-Hurwitz, 202-651-7020, both of ANA e-mail: [email protected] Web site: http://www.nursingworld.org/rnrealnews/

WASHINGTON, May 29 -- Findings from a study on nurse-staffing levels and the quality of care in hospitals published in today's New England Journal of Medicine provide "strong, reinforcing evidence" of the need for better nurse staffing systems, along with the need for further research, according to the American Nurses Association (ANA).

The study, conducted by the Harvard School of Public Health, Vanderbilt University School of Nursing and Abt Associates, concluded that a higher proportion of hours of nursing care correlate with better patient care in hospitals. Specifically, the study, which examined RNs only, found that a higher proportion of hours of care per day and a greater absolute number of hours of care per day provided by RNs were associated with shorter lengths of stay; fewer urinary tract infections and incidences of upper gastrointestinal bleeding; and lower rates of pneumonia, shock and cardiac arrest. In addition, longer hours of care resulted in fewer "failure-to-rescue" deaths from pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis and deep venous thrombosis. And among surgical patients specifically, greater number of hours of care per day by nurses were associated with lower incidences of urinary tract infections and lower rates of "failure to rescue."

"These findings reinforce what we already know: that higher levels of nurse staffing result in better patient outcomes, and that shorter lengths of stay and fewer complications translate into lower hospital costs," said ANA President Mary E. Foley, who pointed to a March 2000 study commissioned by ANA that reached similar conclusions.

In the ANA study, conducted by Network, Inc., several adverse hospital outcomes measures were tracked, including length of stay, pneumonia, postoperative infections, pressure ulcers and urinary-tract infections. The study revealed that hospitalized patients have better health care outcomes in settings with higher staffing levels and higher ratios of RNs in the staffing mix.

As a next step, Foley recommended "conducting further research that examines nurse staffing and patient outcomes not only at the hospital level but also the unit level, where care is delivered, so that nurse-staffing recommendations can be further refined."

In addition, Foley advised more widespread adoption of ANA's Nursing Quality Indicators for acute-care settings. These indicators include such variables as the mix of RNs, LPNs and unlicensed staff caring for patients in acute-care settings; total nursing care hours provided per patient day; patient satisfaction with pain management, educational information, nursing care and overall care; and the relationship between staffing and the number of patient falls, the number of injuries as a result of those falls, and the frequency of hospital-acquired pressure ulcers.

And finally, Foley recommended use of ANA's Principles for Nurse Staffing in more workplaces. These principles advise that patient care be unit-related, staff-related, and organization-related and that certain appropriate staffing factors be considered, including number of patients, levels of acuity, the geographical and architectural setting in which health care is provided (including available technology), and the levels of preparation and experience of all health care providers.

"The relationship between nursing staff and patient outcomes is critical, especially given the nation's growing nursing shortage," Foley concluded. "That is why ANA will continue to press for more research and for more solutions from Congress, including passage of the Nurse Reinvestment Act, which will provide much-needed scholarships and other funding necessary for bolstering the image of nursing and recruiting more nurses into the profession.

"In addition, ANA will continue to push for legislation that improves nurses' working conditions -- so that we can retain practicing nurses at the bedside."

------ ANA is the only full-service professional organization representing the nation's 2.7 million Registered Nurses through its 54 constituent associations. ANA advances the nursing profession by fostering high standards of nursing practice, promoting the economic and general welfare of nurses in the workplace, projecting a positive and realistic view of nursing, and by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.