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Higher Nurse Staffing Levels Benefit Some Hospitals More Than Others

Friday March 25, 2011
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Higher nurse staffing levels improve patient outcomes in ICUs and other units, according to a new study, but the impact is muted in “safety net” hospitals for low-income, uninsured and other vulnerable populations.

The study, published in the April 2011 issue of Medical Care, is the second major report in recent weeks on the effects of nurse staffing levels on patients. The other study, for the New England Journal of Medicine, focused on the link between staffing shortages during shifts and patient mortality risk (http://bit.ly/i8L8hx).

For the Medical Care study, a team including nurse administrators, health service researchers and health economists reviewed data from the University HealthSystem Consortium. It includes details on 1.1 million adult patients who received care in 872 units, 285 of which were ICUs, in 54 hospitals. It also breaks down the hours of care nurses provided to the patients.

Mary Blegen, RN, PhD, FAAN, professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing, and colleagues found that while staffing levels were similar in safety net and other hospitals, patient outcomes were worse in safety net hospitals.

In non-safety net hospitals, higher nurse staffing rates and a larger number of RNs were associated with fewer deaths from heart failure; fewer incidents involving failure to rescue; lower rates of infection, including postoperative sepsis; and fewer patients who had to stay in the hospital longer than expected.

“Higher levels of nursing skill and more nurses providing more hours of care, overall, are correlated with better care — shorter hospital stays, fewer infections and lower rates of failure to rescue,” said Blegen. “We suspect that the increase in mortality rates due to congestive heart failure in safety net hospitals are a function of patients’ overall health, rather than staffing rates, but more research needs to be done. We also need to know more about how non-RNs affect patient care.”

The study was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Care Initiative, which supports interdisciplinary teams of nurse scholars and scholars from other disciplines to enhance knowledge about the relationship between nursing and healthcare quality.


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