Mixed Verdict on Level of RN Staffing and Better Patient Outcomes

Elevated levels of nurse staffing can lead to better patient outcomes, though not necessarily in safety net hospitals – which provide healthcare to low-income, vulnerable and uninsured persons — according to a report published by the American Public Health Association. According to a study funded by the Robert Woods Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, researchers examined discharge records for 1.1 million patients in 872 units — including 285 intensive-care units — at 54 University HealthSystem Consortium hospitals and found relationships between patient outcomes and the length of time that nursing care patients received.

Although staffing levels were similar, outcomes were enhanced in non-safety net facilities, where more registered nurses were associated with lower mortality rates from congestive heart failure, infections and bedsores, as well as shorter stays. There were also fewer “failure to rescue” deaths, where nurses did not note or initiate treatment in life-threatening situations.   “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 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.  “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.”

There’s another side to this issue, however.  A study published in the New England Journal of Medicine found that a lack of adequate nurses has a direct correlation to higher patient morality rates.  A study of nearly 200,000 nursing shifts determined that staffing of “RNs below target levels” is linked to increase patient deaths.  Some of the under-staffing is a result of efforts to control costs.  In one finding, when inadequate numbers of nurses were on duty, inappropriate and dangers levels of patient transfers and discharges occurred.  Shortages also lead to higher turnover rates.  According to the study, the risk of death increased two percent for patients cared for by shifts staffed by too few RNs.  The typical patient was exposed to three nursing shifts, which created a six percent increased risk of death.  Elevated levels of shift turnovers resulted in four percent more deaths.  The American Nursing Association believes that policymakers must focus on reimbursement systems that reward hospitals for maintaining adequate nurse staffing.

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