Researchers estimate that each additional nurse-hour per patient day is associated with 10% lower odds of receiving penalties under The Patient Protection and Affordable Care Act's Hospital Readmissions Reduction Program.
The better staffed a hospital is with nurses, the lower its odds of being slapped with readmission penalties. And hospitals with higher nurse staffing had 25% lower odds of being penalized compared with similar hospitals with lower staffing finds a study published in the October issue of Health Affairs.
Researchers matched hospitals that were similar in all respects except nurse staffing, lead author Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, associate professor at the University of Pennsylvania School of Nursing, Center for Health Outcomes and Policy Research.
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"They were twins in all respects, except one was really well staffed and one wasn't," says McHugh, who's also a Robert Wood Johnson Foundation Nurse Faculty Scholar.
In addition to being less likely to be penalized for readmissions in general, the study found that hospitals with higher nurse staffing levels also have 41% lower odds of receiving the maximum penalty for readmissions.
In addition, researchers estimate that each additional nurse-hour per patient day is associated with 10% lower odds of receiving penalties under The Patient Protection and Affordable Care Act's Hospital Readmissions Reduction Program.
Researchers examined nurse staffing levels and data readmissions penalties for 2,826 U.S. hospitals.
A supplementary analysis found that "a greater proportion of patients in better-staffed hospitals rated their hospital highly and would recommend it to friends and family—factors associated with readmissions and better staffing," the study said. McHugh says that patients at poorly staffed hospitals were more likely to report that they didn't get as good information to prepare for recovery at home.
It's not surprising that nurses with excessive workloads are unable to perform "little" tasks such as properly preparing patients to care for themselves at home.
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"The work that nurses do is directly linked to the kinds of things we associate with readmissions," such as discharge planning and care coordination, McHugh says. "Things like patient education get a little bit of a short shrift" when hospitals don't have enough nurses, he adds.
Although hospital leaders might feel gung-ho about new technologies and programs that the PPACA is focusing on, McHugh says all that attention will be for naught without a good foundation of nurses who can actually implement those programs and tools. For instance, "the EHR itself doesn't do anything in terms of care delivery… it requires both the input of the care providers and the uptake of the care providers in order to make it reach its potential," he says.
Another example is discharge prevention programs that call for a focus on high-risk patients. Those programs might be well-intended, but "if there aren't enough nurses to go around to begin with, you're adding this onto the daily work that the nurses already have to do," McHugh says.
"All of those things depend upon having an adequate number of nurses at the bedside to deliver them," he says. "If that foundation isn't there, none of these other kinds of things have a good chance of success."
In other words, hospitals can invest heavily in new programs and technologies, but without skilled professionals there to run them, to interpret the information, and to implement interventions, that investment will be undermined.
"I think these [programs] are all essential and important. I just think there's a higher level of their success in the real world if there's enough staff to implement them," McHugh says. "You can't ignore the delivery process, and that delivery process is people."
Alexandra Wilson Pecci is an editor for HealthLeaders.
