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Study quantifies link between RN experience, length of stay

Tuesday April 15, 2014
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Patients get the best care when they are treated in units that are staffed by nurses who have extensive experience in their current job, according to a study.

The review of more than 900,000 patient admissions over four years at hospitals in the Veterans Administration Healthcare System is described as the largest study of its kind to link nurse staffing to patient outcomes. Researchers at Columbia University School of Nursing and Columbia Business School in New York City analyzed payroll records for each nurse and medical records for each patient to see how changes in nurse staffing affected the length of stay for patients.

Because length of stay is increased by delays in delivery of appropriate care and errors in care delivery, the researchers noted, a shorter length of stay indicates that the hospital provided better treatment. A shorter length of stay also makes care more cost-effective.

As published in the April issue of the American Economics Journal: Applied Economics, the researchers found that a one-year increase in the average tenure of RNs on a hospital unit was associated with a 1.3% decrease in length of stay.

“Reducing length of stay is the holy grail of hospital management because it means patients are getting higher-quality, more cost-effective care,” senior study author Patricia Stone, RN, PhD, FAAN, Centennial Professor of Health Policy at Columbia Nursing, said in a news release.

“When the same team of nurses works together over the years, the nurses develop a rhythm and routines that lead to more efficient care. Hospitals need to keep this in mind when making staffing decisions — disrupting the balance of a team can make quality go down and costs go up.”

Although many hospitals rely on temporary staffing agencies at least some of the time to fill RN vacancies, the researchers found paying staff RNs overtime is more cost-effective. RNs working overtime resulted in shorter lengths of stay than hours worked by nurses hired from staffing agencies.

Nursing skill also mattered, the researchers found. Length of stay decreased more in response to staffing by RNs than by unlicensed assistive personnel. Furthermore, the study showed that length of stay increased when a team of RNs was disrupted by the absence of an experienced member or the addition of a new member.

“This rigorous econometric analysis of nurse staffing shows that hospital chief executives should be considering policies to retain the most experienced nurses and create a work environment that encourages nurses to remain on their current units,” the senior economist on the study team, Ann Bartel, PhD, Merrill Lynch Professor of Workforce Transformation at Columbia Business School, said in a news release.

The researchers used the VA’s Personnel and Accounting Integrated Data for information on each nurse’s age, education, prior experience, VA hire date, start date at the current VA facility and start date with his or her current unit at that facility. To assess patient outcomes, the researchers used the VA’s Patient Treatment File for information on each patient including dates of admission and discharge for each unit and for the overall hospitalization, as well as age and diagnoses. The final sample accounts for 90% of all acute care stays in the VA system for the fiscal years 2003 to 2006.

Study access (via subscription or purchase): http://www.aeaweb.org/articles.php?doi=10.1257/app.6.2.231


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