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Experienced Nurses Are Less Expensive Than You Think

 |  By Alexandra Wilson Pecci  
   January 07, 2014

Healthcare leaders now have data to back up what many already know: More clinical nursing experience means better pediatric patient outcomes.

By now, it's well established that nurse staffing affects patient outcomes. Among those who helped prove that was Linda Aiken, PhD, RN, whose 2002 research revealed that every additional general surgical patient added to a nurse's workload represents a 7% higher patient mortality rate.

"The big 'ah-ha' in the industry was that [Aiken] found the numbers of nurses taking care of patients was associated with outcomes," says Patricia A. Hickey, PhD, MBA, RN, FAAN, Vice President of Cardiovascular and Critical Care Services at Boston Children's Hospital.

But Hickey was "struck by the fact that none of her studies were done in children's hospitals." Why does that matter? Because children's hospitals are already better staffed than adult hospitals.

In the adult patient world, the number of nurses makes a difference in outcomes, but "we think in children's hospitals, the staffing is already at a level where you won't see the difference," Hickey says. Hickey wanted to dig beyond basic numbers by examining the granular nursing attributes that make a difference in hospitals that are already well-staffed.

The result of that digging is research data that's the first to link clinical nursing experience with pediatric patient outcomes. Hickey's study, published in the December 2013 issue of Journal of Nursing Administration, shows that it's not just the number of nurses that's important: Their experience and education matters a lot, too.

The study aimed to determine which pediatric critical care nursing and organizational factors impact in-hospital mortality for cardiac surgery patients across the United States.

Nurse leaders from 38 children's hospitals that contribute data to the Pediatric Health Information System data set completed an organizational assessment for years 2009 and 2010. These data were linked with patient-level data. The study found that:

  • The odds of death increased as the institutional percentage of pediatric critical care unit nurses with two years' clinical experience or less increased.
  • The odds of mortality were highest when the percentage of RNs with two years' clinical experience or less was 20% or greater.
  • The odds of death decreased as the institutional percentage of critical care nurses with 11 years' clinical experience or more increased and for hospitals participating in national quality metric benchmarking.

"Nursing experience and education does matter in pediatrics," Hickey says. But she's careful to point out that she's not disparaging new grads.

"I don't want nurses to feel like we don't support new graduates," Hickey says. In fact, she calls for quite the opposite, arguing that new graduates need to be supported and mentored for two years. That includes a six-month orientation, as well as a mentor to talk to, have classes with, and constantly learn from. She also says that nurses with less than two years experience should make up no more than 20% of a unit's staff.

Hickey says another takeaway for nurse leaders is at the other end of the experience spectrum: That it's critical to retain experienced nurses. Poor pay, poor schedules, no flexibility, limited advancement, and lack of educational opportunities are common reasons that experienced nurses leave their jobs, but as this study shows, it pays in outcomes to improve these workplace factors in order to keep the most experienced nurses, who can also mentor younger nurses as well.

Hickey says older nurses aren't expensive; they're "priceless."

"There is nothing more expensive than turnover… [the hiring process] is far more expensive than the salary that you're going to pay to a senior nurse, and all nurse leaders know that," Hickey says.

"I think we now, for the first time, have illustrated why nurses deserve the salaries that they get—because they are saving lives and they are rescuing patients from bad outcomes."

Alexandra Wilson Pecci is an editor for HealthLeaders.

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