hospital staffing issues - RN
Having more registered nurses (RNs) on staff substantially
decreases the likelihood that hospitalized patients will develop
pneumonia, according to the findings of a recent study that was
supported by the Agency for Healthcare Research and Quality
(HS11397). The study was led by Sung-Hyun Cho, Ph.D., M.P.H.,
R.N., of the Korea Institute for Health and Social Affairs, Seoul,
and formerly of the University of Michigan at Ann Arbor.
Dr. Cho and colleagues examined the impact of nurse staffing on
adverse events that, according to an expert panel, could be
minimized or prevented by adequate nurse staffing: fall/injury,
pressure ulcer, problematic drug reaction, pneumonia, wound
infection, and sepsis (blood infection). They examined the impact
of patient and hospital characteristics and nurse staffing on the
incidence of these events among 124,204 surgery patients at 232
acute care California hospitals. Surgeries ranged from coronary
artery bypass surgery and rectal resection to hip procedures.
Most surgery patients (93 percent) did not suffer from any
adverse events. However, when adverse events did occur, pneumonia
occurred most frequently (nearly 3 percent of adverse events), and
falls/injuries occurred least often. An increase of 1 hour worked
by RNs per patient day was associated with an 8.9 percent decrease
in the odds of pneumonia. Similarly, a 10 percent increase in the
proportion of RNs to overall nursing staff was associated with a
9.5 percent decrease in the odds of pneumonia.
Overall, the occurrence of pneumonia was associated with an
increase of 5.1-5.4 days in hospital length of stay, an increase
of 4.67 to 5.55 percent in the probability of death, and a jump of
$22,390-$28,505 in costs. Postoperative patients are at
particularly high risk of pneumonia due to collapsed lung,
retained secretions, and pain. Attentive lung care provided by RNs
may allow these patients to avoid postoperative pulmonary
infections, note the researchers. Patient characteristics had a
great impact on the occurrence of adverse events, while hospital
characteristics had minimal influence.
See "The effects of nurse staffing on adverse events,
morbidity, mortality, and medical costs," by Dr. Cho, Shake
Ketefian, Ed.D., R.N., F.A.A.N., Violet H. Barkauskas, Ph.D.,
R.N., F.A.A.N., and Dean G. Smith, Ph.D., in the March 2003
Nursing Research 52(2), pp. 71-79.
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/jul03/0703RA18.htm |