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New Study Finds Strong Link Between Patient Outcomes and Nurse Staffing

Monday May 7, 2001
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A new Department of Health and Human Services (HHS) study confirms what RNs already know - more nurses translates into better patient care.
The study, Nurse Staffing and Patient Outcomes in Hospitals, found the number and mix of nurses in a hospital make a difference in the quality of care patients receive. "It's not just the level [numbers] of nurses," says Peter Buerhaus, RN, PhD, FAAN, a study coauthor and associate dean for research at Vanderbilt University School of Nursing. "It's also the mix of nursing staff," he adds, referring to RNs, LPNs, and nursing assistants.
What sets this study apart is the volume of source data and its carefully crafted research design. Researchers analyzed 1997 data from more than five million patient discharges from 799 hospitals in 11 states. They found a strong and consistent relationship between nurse staffing and five outcomes in medical patients - urinary tract infection, pneumonia, shock, upper gastrointestinal (GI) bleeding, and length-of-stay. Further, there was a strong and consistent relationship between nurse staffing and "failure to rescue" in major surgical patients. Failure to rescue was defined as a death among patients with shock, sepsis, pneumonia, deep vein thrombosis/pulmonary em-
bolism, or GI bleeding.
In these cases, a higher number of RNs was associated with a 3% to 12% reduction in the rates of adverse outcomes, while higher staffing levels for all types of nurses was associated with a 2% to 25% reduction in adverse outcomes.
The researchers used an extensive review of the literature and insights from experts to identify several "outcomes potentially sensitive to nursing" (OPSNs) for the study. Data for the OSPNs came from hospital discharge records, and the information for nurse staffing levels came from financial reports or hospital staffing surveys.
The study shows quality care is cost-effective for hospitals in light of the substantial costs of adverse outcomes. But hospitals aren't the only ones that benefit: Lower rates of adverse outcomes also reduce psychological costs to patients, their families - and nurses.
Reaction to the study started with the head of the HHS and rapidly spread to the national media. "This study underscores why the Bush Administration budget increases funding for nurse training programs," said HHS Secretary Tommy G. Thompson. "We have to take action to address the emerging nurse shortage to protect the health and well-being of all patients." Results were featured in print and on national broadcast outlets.
What about the long-term impact of the study? Buerhaus says, "There is an urgent need for improvement in data collection." It was difficult to obtain national data because states collect information in different ways. For example, even the definition of FTE (full-time equivalent) differs across states, and only 17 states require reports on nurse staffing data.
Buerhaus adds the spotlight is "shining brightly" on hospitals and nurses and we will continue to see substantial interest in the nursing shortage by the public, media, government, policymakers, and special interest groups.
The bottom line is this could be the definitive study on the nurse staffing numbers game. "We've produced solid evidence that removes any notion that nurses are not important in producing high-quality patient care and in reducing the negative or adverse consequences that sometime happen to people who are hospitalized," says Buerhaus. "It's going to be awfully hard to say we don't need to be concerned about staffing levels or these are just complaining nurses."
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