nurse staffing issues - patient complications
Analysis of data on nurse staffing levels confirms that there
is a direct link between the number of registered nurses (RNs) and
the hours they spend with patients and whether patients develop a
number of serious complications or die while in the hospital.
For the study, which was supported in part by the Agency for
Healthcare Research and Quality (HS09958), investigators
reexamined and refined their previous analysis released by the
Health Resources and Services Administration (HRSA) in April 2001
as part of an ongoing collaboration within the Department of
Health and Human Services to improve nursing care in American
hospitals. The partnership also included AHRQ, the Centers for
Medicare and Medicaid Services, and the National Institute for
Nursing Research.
The research described in the original HRSA report and the new
analysis were conducted by Jack Needleman, Ph.D., of the Harvard
School of Public Health, and Peter Buerhaus, Ph.D., R.N., F.A.A.N.,
of the Vanderbilt University School of Nursing. Along with their
colleagues, Drs. Needleman and Buerhaus reviewed their original
discharge and staffing data from 799 hospitals in 11
States—California, New York, Maryland, Virginia, West Virginia,
Arizona, Massachusetts, Missouri, Nevada, South Carolina, and
Wisconsin—to estimate nurse staffing levels for RNs, licensed
practical nurses (LPNs), and aides, as well as the frequency of a
wide range of complications that patients developed during their
hospital stay. These data cover 6 million patients discharged from
hospitals in 1997.
Specifically, they confirmed their initial findings that low
levels of RNs among a hospital's nurses were associated with
higher rates of serious complications such as pneumonia, upper
gastrointestinal bleeding, shock, and cardiac arrest, including
deaths among patients with these three complications, as well as
sepsis or deep vein thrombosis. These complications occurred 3
percent to 9 percent more often in hospitals with lower RN
staffing levels than in hospitals with higher levels of RN
staffing.
Both studies also found that rates for urinary tract
infections, a less serious but common infection among hospital
patients, and length of time spent in the hospital were also
higher in hospitals with lower RN staffing. When comparing
hospitals, the study controlled for how ill patients were in
different hospitals and differences across hospitals in how likely
patients were to suffer these complications.
Researchers again found an association between nurse staffing
and deaths from more serious complications, but they found no
evidence of an association between nurse staffing and overall
deaths among medical or surgical patients. Low RN staffing at
hospitals makes it more likely that some patients will suffer
pneumonia, shock and cardiac arrest, and gastrointestinal
bleeding, and that some patients may die as a result, according to
the researchers. They conclude that more and better-educated
nurses are needed to ensure that hospital patients don't suffer
needlessly from complications. They also call for more research to
identify the factors influencing nurse staffing levels and the mix
of different types of nurses working in a particular hospital.
See "Nurse-staffing levels and the quality of care in
hospitals," by Drs. Needleman and Buerhaus, Soeren Mattke, M.D.,
M.P.H., and others, in the May 30, 2002, New England Journal of
Medicine 346(22), pp. 1715-1722.
Reprints are 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/jun02/0602RA1.htm |