"There's a lot more that goes into that picture," Sheff says. "You can't just look at nursing for that one metric."
In response to that point, the lead author of the study, Colleen J. Goode PhD, RN, FAAN, NEA-BC, professor at the College of Nursing, University of Colorado, Denver, tells HealthLeaders via email:
"There are many factors that influence the development of each of the outcomes. Sepsis and the others we used have been shown in the past to be influenced by nurse staffing. They are called 'Nursing Sensitive Indicators,'" she says. "By doing the multivariate analyses, we controlled for hospital characteristics such as the average severity of patient's at each hospital. The outcome measures we used adjusted for risk from patient characteristics that are often associated with the development of each of the outcomes such as age, gender and co-morbidities."
But even in light of her findings, Goode says she "absolutely" believes that hospitals should pursue the certification, especially since MRP is increasingly focused on patient outcomes.
"I am big believer in [MRP]," she said in a telephone interview. "I hope people don't think because of this study I am not."
For Sheff and Torosian, the study doesn't sway their choice to pursue MRP certification, mostly because they feel like they've already benefited from the process. In fact, to hear them talk about it, the certification itself seems almost beside the point.
"It's so empowering, so wonderful to be able to give the bedside nurse that voice," Sheff says. "It's been so rewarding and so fulfilling."