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Numerous studies have established the overall impact of nurse staffing levels on patient outcomes, but those studies have rarely focused on specific hospital units. Little is known about whether higher staffing levels in intensive care units (ICUs) or in non-intensive care units can improve care. It is also unclear whether the impact of nurse staffing is the same in safety net hospitals, which provide care to low-income, uninsured and vulnerable populations and tend to have poorer patient outcomes overall. A new study, published in the current issue of Medical Care, finds that higher staffing levels in both intensive care units and in non-intensive care units improve patient outcomes but not to the same extent in safety net hospitals.
Mary Blegen, PhD, RN, FAAN, professor in Community Health Systems and director of the Center for Patient Safety at the University of California San Francisco School of Nursing is one of the lead investigators of the study, which was funded by the Robert Wood Johnson Foundation Interdisciplinary Nursing Quality Research Initiative (INQRI). She led an interdisciplinary team with nurse administrators, health service researchers, and health economists that reviewed data from the University HealthSystem Consortium (UHC), which included details on 1.1 million adult patients cared for in 872 units (285 of them ICUs) in 54 hospitals, and the hours of care that nurses provided to those patients.
Researchers 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 (RNs) 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); and lower rates of infection, including infection after operations (postoperative sepsis); and 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 careshorter hospital stays, fewer infections and lower rates of failure to rescue," says Blegen. "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."
INQRI supports interdisciplinary teams of nurse scholars and scholars from other disciplines to address the gaps in knowledge about the relationship between nursing and health care quality. It is helping to advance the recommendations of the Institute of Medicines landmark report, The Future of Nursing: Leading Change, Advancing Health, which include fostering interprofessional collaboration and preparing and enabling nurses to lead change. By requiring research teams to include a nurse scholar and at least one scholar from another health care discipline, INQRI not only fosters interprofessional collaboration, the Initiative also ensures that diverse perspectives are brought to bear in research.
The Interdisciplinary Nursing Quality Research Initiative is funded by the Robert Wood Johnson Foundation.