As new models of care delivery arise in the wake of health care reform, and as U.S. nurses continue the battle for safe-staffing regulations, three new studies add to the significant body of evidence that better work environments, reasonable workloads, and better-educated nursing staff equal better outcomes for patients.
Cardiac events were the focus of one study, which examined the relationship between nurse staffing and survival of in-hospital cardiac arrest (IHCA). The researchers, noting that fewer than a quarter of patients who experience an IHCA survive to discharge, wondered why some hospitals had significantly better outcomes than others. Few previous studies have sought to determine whether this disparity might be related to nurse staffing and nurses’ work environments.
Examining data from the American Heart Association's Get with the Guidelines–Resuscitation database, the University of Pennsylvania Multi-State Nursing Care and Patient Safety Survey, and the American Hospital Association's annual survey of hospitals, the study authors found that on medical–surgical units (where nearly half of all IHCAs occur), each additional patient per nurse was associated with 5% lower odds of surviving to discharge. Additionally, a 16% lower likelihood of surviving to discharge was seen in hospitals with poor nurse work environments, even after the researchers controlled for possible confounding factors.
Similar associations were found in the pediatric setting. The second of the new studies examined the relationships of work environment, staffing, and education levels of neonatal ICU (NICU) nurses to the percentage of very-low-birth-weight infants who were receiving human milk—a source of essential nutrition and immunologic protection—at discharge. Although NICU nurse staffing has been linked to breastfeeding support by nurses, this large, multihospital study was the first to look at optimal nutrition (defined as human milk from any source) and how NICU staffing and work environment relate to it.
The researchers found that in an average NICU, an improvement in work-environment scores by one standard deviation was associated with an additional 4% of very-low-birth-weight infants receiving human milk at discharge. Similarly, increasing the staffing ratio by 0.15 nurse per infant was associated with an additional 3% of very-low-birth-weight infants receiving human milk at discharge. The study also found modest positive correlations between the percentage of nurses with at least a baccalaureate and receipt of human milk at discharge, and the authors speculate that “the effect of education may be related to better critical thinking and clinical judgment skills associated with [attainment of a bachelor's degree in nursing].”
The benefits of higher education levels in nurses were also shown in the third report, a study of the cost-effectiveness of NPs in primary and specialized ambulatory care. In examining 11 randomized controlled trials, the authors found that NPs in “alternative provider ambulatory primary care roles” achieve patient outcomes equivalent to or better than those achieved by general practitioners; there was also evidence—albeit mixed—that primary care provided by NPs can be less costly.—Laura Wallis
McHugh MD, et al. Med Care
2016;54(1):74-80; Hallowell SG, et al. Int J Nurs Stud
2016;53:190-203; Martin-Misener R, et al. BMJ Open