Research: Patients do better when nurses are around
Two recent studies, from separate agencies, document the positive impact of nurses on inpatient outcomes. One study focuses on complications in surgical patients1 while the other analyzes the incidence of adverse outcomes in a general inpatient sample.2
Complications among patients undergoing major surgery
Data from 506 hospitals in 10 states in 1993 show that the fewer full-time equivalent (FTE) registered nurses per inpatient day at a hospital, the greater the incidence of urinary tract infection (UTI), pneumonia, thrombosis, and pulmonary congestion. Those complications are often preventable when nurses have the time to get patients out of bed and walking after surgery, and monitor their other needs.
Further findings disclose that, post-surgically:
Large hospitals have significantly lower UTI rates than smaller ones.Large and medium-sized hospitals have higher rates of lung-related disorders than smaller facilities.
Both public and not-for-profit hospitals have significantly lower UTI rates than do for-profit hospitals.
The presence of FTE nurse practitioners did not have statistically significant relationships to adverse events while hospitals with more physician assistants had higher rates of pneumonia and thrombosis.
Hospitals with high numbers of Medicare patients had higher UTI levels.
Among the benefits of increased nurse staffing:
An increase of .5 RN hours per patient day is related to a 4.2% decrease in pneumonia, 2.6% decrease in thrombosis, and 1.8% decrease in pulmonary problems after surgery.One extra hour of RN care per patient decreased UTIs by 10% and pneumonia by 8%.
The researchers note that the study raises provocative questions for hospitals as well as policy makers: "Should nursing staff be increased? What is the level of adverse events at which hospital management is satisfied?"
They add, "Most important, these findings indicate the importance of evaluating the effect of clinical reorganization on patient care with as much rigor as any clinical intervention."
Nursing care and selected patient outcomes
Using 1992 and 1994 data, the American Nurses Association measured four outcomes in California, Massachusetts, and New York hospitals:
pressure ulcers;pneumonia (not community acquired);
UTIs;
postoperative infections.
Data from all three states show differences from 1992 to 1994 such as:
substantial increases in nurse staffing per patient day;modest increases in RN skill mix;
modest increases in case-mix acuity.
1992 and 1994 findings from New York and California show:
increased RN staffing relates to decreased rates in each of the studied four outcomes;increased RN staffing relates to shorter lengths of stay.
Findings from Massachusetts show:
in 1992, only pressure ulcers decreased with more RN staffing;in 1994, only pneumonia decreased with more RN staffing;
in 1992 and 1994, increased RN staffing relates to shorter lengths of stay.
References
1. Kovner C, Gergen PJ. Nurse staffing levels and adverse events following surgery in U.S. hospitals. Image: J of Nursing Scholarship 1998; 30: 315-321.
2. American Nurses Association. Implementing Nursing’s Report Card: A Study of RN Staffing, Length of Stay and Patient Outcomes. Washington, DC: American Nurses Publishing; 1997.
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