Nurse Staffing, Quality of Care/Patient Safety

staffing issues - RN

Surgical patients fare better at hospitals with a higher proportion of registered nurses who have bachelor's degrees

Physicians and the public rank nurse understaffing as one of the greatest threats to patient safety in U.S. hospitals. Several studies have shown that patients fare better when hospitals have a higher proportion of registered nurses (RNs) on their staff. A new study goes a step further. It reveals that surgical patients fare better at hospitals with a higher proportion of RNs with a baccalaureate or higher degree. Generally, RNs receive their education either in 3-year diploma programs in hospitals, associate degree programs in community colleges, or baccalaureate nursing programs in colleges and universities.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (NR04513), researchers led by Linda Aiken, Ph.D., R.N., of the University of Pennsylvania, examined medical record outcomes data for 232,342 general, orthopedic, and vascular surgery patients discharged from 168 general hospitals in Pennsylvania in 1998 and 1999. They linked these data to administrative and survey data on nurse educational composition, staffing, and other hospital characteristics. The proportion of hospital RNs holding a bachelor's degree or higher ranged from 0 to 77 percent across the hospitals studied.

After adjusting for patient and hospital characteristics, nurse staffing, nurse experience, and whether the patient's surgeon was board certified, a 10 percent increase in the proportion of nurses holding a bachelor's degree was associated with a 5 percent decrease in both the likelihood of patients dying within 30 days of admission and the odds of failure to rescue (deaths in surgical patients with serious complications). The researchers conclude that recruiting and retaining baccalaureate-prepared nurses in bedside care and investing in further education of nurses may improve quality of care.

See "Educational levels of hospital nurses and surgical patient mortality," by Dr. Aiken, Sean P. Clarke, Ph.D., R.N., Robyn B. Cheung, Ph.D., R.N., and others, in the September 24, 2003, Journal of the American Medical Association 290(12), pp. 1617-1623.

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/dec03/1203RA2.htm

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