Nurse staffing issues - RN staffing
Over the past decade, many U.S. hospitals reduced the number of
registered nurses (RNs) and substituted licensed practical nurses
(LPNs) for RNs to reduce costs. In response to these
cost-containment measures, there has been a call for government
regulation of minimum staffing levels to protect the quality of
care received by hospitalized patients.
A new study supported by the Agency for Healthcare Research and
Quality (HS08843 and HS09446) found that higher RN staffing levels
were associated with fewer deaths among elderly Medicare patients
hospitalized for first-time heart attack. The researchers suggest
that more astute RN clinical assessments and early identification
of heart attack complications by RNs, such as congestive heart
failure or pulmonary edema, may explain the survival advantage of
patients treated at hospitals with higher RN staffing.
For the study, researchers from the University of Alabama at
Birmingham and the Birmingham Veterans Affairs Medical Center
reviewed the medical records of 118,940 elderly, fee-for-service
Medicare patients hospitalized for heart attack during 1994-1995
from nearly all U.S. acute care hospitals included in the
Cooperative Cardiovascular Project. They linked these data with
American Hospital Association data on participating hospitals and
used Medicare data to determine patient deaths.
The survival advantage for the highest RN staffing levels was
not large (on the order of 2 percent), but it persisted after
adjusting for patient and hospital characteristics. From highest
to lowest quartile of RN staffing, in-hospital mortality was 17.8
percent, 17.4 percent, 18.5 percent, and 20.1 percent,
respectively. Conversely, from the highest to lowest quartile of
LPN staffing, mortality was 20.1 percent, 18.7 percent, 17.9
percent, and 17.2 percent, respectively. These findings suggest an
important effect of nurse staffing on in-hospital mortality. The
researchers call for further investigation of how nurse staffing
affects patient outcomes.
More details are in "Nurse staffing and mortality for Medicare
patients with acute myocardial infarction," by Sharina D. Person,
Ph.D., Jeroan J. Allison, M.D., M.S., Catarina I. Kiefe, Ph.D.,
M.D., and others, in the January 2003 Medical Care 42(1),
pp. 4-12.
Reprints available from the AHRQ Publications Clearinghouse.
These are excerpts from the AHRQ Research Activities,
you can read the full report at
http://www.ahrq.gov/research/mar04/0304RA23.htm |