Hospitals with Higher Proportions of Registered Nurses Have Better Patient Outcomes, Study Finds
Patients in hospitals with low numbers of registered nurses are more likely to have complications, stay in the hospital longer and die from treatable conditions than patients in hospitals with more registered nurses, according to a study released today, the New York Times reports. Researchers from the Harvard School of Public Health and the Vanderbilt School of Nursing analyzed the discharge records of more than six million patients at 799 hospitals in 11 states during 1997. Five million of the patients had medical problems and one million underwent surgery (Grady, New York Times, 5/30). Researchers divided the hospitals into four categories based on the number of patients per registered nurse. Hospitals with the highest number of registered nurses had an average of 2.7 patients per registered nurse, while hospitals with the lowest number of registered nurses had an average of 3.8 patients per registered nurse (Johannes, Wall Street Journal, 5/30). The study, published in today's issue of the New England Journal of Medicine, found that:
- Patients in the highest-staffed hospitals experienced cardiac arrest and shock 9.4% less often than patients in the lowest-staffed hospitals.
- Patients in the highest-staffed hospitals had 9% fewer urinary tract infections, 6.4% fewer cases of hospital-acquired pneumonia and 5% fewer episodes of stomach or intestinal bleeding than patients in the lowest-staffed hospitals.
- Patients in the highest-staffed hospitals spent on average four hours less in the hospital than those in the lowest-staffed hospitals.
- Surgical patients in the highest-staffed hospitals were 6% less likely to die from surgical complications, including shock and sepsis, than surgical patients in the lowest-staffed hospitals (Pelton, Baltimore Sun, 5/30).
- The "failure to rescue" death rate -- patients who died from conditions that might have been reversed, including pneumonia, shock, cardiac arrest, upper gastrointestinal bleeding, sepsis or a blood clot -- for medical patients in the lowest-staffed hospitals was 2.5% higher than for patients in the highest-staffed hospitals (New York Times, 5/30).
The study, which was funded by the Agency for Healthcare Research and Quality, also analyzed patient outcomes based on care provided by licensed practical nurses, who generally have a year of formal training, and nursing aides, who usually have "minimal training," as compared to registered nurses, who have college degrees in nursing (AP/Arizona Republic, 5/30). The study found that on some measures, only the number of registered nurses impacted patient outcomes (Wall Street Journal, 5/30). In hospitals with higher numbers of registered nurses, for example, patient hospital stays were 3% to 5% shorter and complication rates were 2% to 9% lower that hospitals with fewer registered nurses. The level of practical nurses and nurses aides did not affect patient outcomes, the study found (New York Times, 5/30).
Peter Buerhaus of the Vanderbilt School of Nursing, one of study's lead researchers, said, "This research clearly shows that we need more and better-educated nurses to ensure that hospital patients don't suffer needlessly from complications" (AHRQ release, 5/29). American Hospital Association Senior Vice President for Policy Carmela Coyle added, "The study suggests that registered nurses are key and critical to insuring good patient care." However, Coyle expressed concern that the study could lead some people to conclude that mandated nurse-staffing ratios -- opposed by hospitals -- would solve the problem. She said, "What you really need to look at is much more than the number of nurses and the number of patients. How many of the nurses have 20 years of experience or more, and how many are right out of school? What technology is there to support them? How sick are the patients?" About 12% of nursing jobs nationwide, or 126,000 positions, are unfilled, according to the AHA (New York Times, 5/30). Buerhaus called for more research to "understand the factors influencing nurse staffing levels and the mix of different types of nurses" in hospitals (AHRQ release, 5/29).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.