Nursing Staff Increase Can Improve Outcomes, Study Shows

Higher nurse staffing levels in both intensive care units and in non-ICUs improve patient outcomes but not to the same extent in safety net hospitals that serve more vulnerable populations, according to a study published in the current issue of Medical Care.

The University HealthSystem Consortium study reviewed data from 1.1 million adult patients from 872 units (285 of them ICUs) in 54 hospitals, plus the hours of care that nurses provided to those patients. The study was funded by the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative.
An interdisciplinary team of nurse administrators, health service researchers, and health economists found that while the staffing levels were similar in safety net and non-safety net hospitals, patient outcomes were worse in safety net hospitals.

In non-safety net hospitals, higher nurse staffing rates and a larger number of registered nurses were associated with:

• Fewer deaths due to congestive health failure
• Fewer incidents in which nurses did not note or initiate treatment in life-threatening situations (failure to rescue)
• Lower rates of infection, including infection after operations (postoperative sepsis)
• Fewer patients who were required to stay in the hospital for 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,” says lead investigator Mary Blegen, RN, 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,” Blegen says.

Earlier this month, a study published in The New England Journal of Medicine found that inpatient mortality goes up significantly when a hospital has greater patient turnover and when it fails to meet its own nurse staffing targets by at least eight hours.

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