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Study Examines Link Between Nurse Staffing, Patient Outcomes

Thursday April 28, 2011
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Better working conditions and better staffing of nurses can significantly improve the care of patients with serious conditions, according to the latest nurse labor study by the University of Maryland School of Nursing.

Several noteworthy trends surfaced as researchers analyzed survey data concerning patient outcomes from 633 nurses in 71 hospitals in North Carolina and Illinois, said lead investigator Alison Trinkoff, RN, ScD, FAAN.

For example, pneumonia deaths were significantly more likely in hospitals where nurses reported increased psychological demands and more adverse work schedules. Trinkoff said researchers measured high psychological demands by very fast pace of work, lack of time to complete work, excessive required work, being delayed by other workers and frequent interruptions.

Patients also were more likely to develop deep vein thrombosis after surgery in hospitals where nurses reported high psychological demands. The researchers controlled for variances in staffing levels in their analysis.

“We selected outcomes that have been reported as nursing-sensitive and that have sufficient rates of occurrence to generate reporting data for over 90% of the hospitals,” Trinkoff said.

The researchers calculated the association between job demands on nurses, both psychological and physical, and work schedules against outcomes of patients with myocardial infarction, heart failure, stroke, and craniotomy.

They discovered that deaths from heart failure were also significantly associated with long shifts and with nurses continuing to work while sick. Deaths from MI were associated with nurses frequently working with awkward postures and heavy weekly burdens.

Patients were more likely to experience postoperative hemorrhaging when their nurses were frequently interrupted. Where nurses reported a lack of time away from the job, patients were significantly more likely to develop respiratory failure and infections.

Previous studies had shown a link between intense demands or heavy schedules and adverse effects on nurses, but this study showed those issues can affect patient outcomes.

Positive aspects of the practice environment, such as peer and supervisor support, did not offset or balance the adverse impact of these demands.

Hospitals where nurses reported a focus on patient safety were less likely to have such complications or adverse patient outcomes than hospitals where patient safety was not a stated focus.

Details on those trends and others appear in the study “Linking Nursing Work Environment and Patient Outcomes,” which runs in the April issue of the Journal of Nursing Regulation.


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