What’s So Hard to Understand: Patient Safety, Quality Care Linked to Nurse StaffingJanuary 29, 2013
By Maureen Shawn Kennedy, AJN editor-in-chief
The data linking nurse staffing as well as shift length with patient outcomes and satisfaction with care continue to roll in. The latest report on nurse staffing, published in the January 13 issue of Medical Care by McHugh and MA, links higher nurse–patient ratios and good work environments to reduced 30-day readmission rates. Read the abstract here.
Most nurses seem to support better nurse–patient ratios, but there’s continuing ambivalence about reducing shift length, as seen in the comments we received on a recent blog post asking whether it’s time to retire the 12-hour nursing shift.
In August, researchers reported a link between nurse staffing and hospital-acquired infections. Publishing in the American Journal of Infection Control, the authors noted a “significant association” between nurse–patient staffing ratios and both urinary tract infections and surgical site infections. Further, they noted that reducing nurse burnout was associated with fewer infections. (Read our news report on the study here.)
Health Affairs published a report in November called “The Longer the Shifts for Hospital Nurses, The Higher the Levels of Burnout and Patient Dissatisfaction.” The findings were there, loud and clear—researchers Stimpfel, Sloane, and Aiken found that “extended shifts undermine nurses’ well-being, may result in expensive turnover and can negatively affect patient care.”
And in December, we published a CE article (“Staffing Matters—Every Shift”) that looked at data suggesting that not just nurse–patient ratios, but the skill mix and relative experience levels among nurses in a unit, affected patient outcomes. (Here’s the blog post we ran describing the article’s main points.)
But all this shouldn’t be news. In 2004, Health Affairs carried a report by Ann Rogers and colleagues noting the link between long working hours and the risk of error. And in 2002, researchers led by Jack Needleman and Peter Buerhaus reported study findings in the New England Journal of Medicine: in brief, data from 799 hospitals in 11 states showed that more care by RNs (as opposed to LPNs or nurse aides) led to better patient outcomes.
The Institute of Medicine released its own report in 2003, Keeping Patients Safe: Transforming the Work Environments of Nurses, which it recommended the prohibition of working more than 12 hours in 24 hours and more than 60 hours per week. It also recommended that hospitals and nursing homes evaluate mechanisms for determining staffing requirements to ensure patient needs are being met safely.
So what’s changed in the last 10 years as a result of these findings and high-level recommendations? Have hospitals worked to improve staffing? Have hospitals moved away from “12-hour-plus” shifts or refused to let nurses work “double shifts” (back-to-back eight-hour shifts)? We reported on this issue last May, but we’d like to know—is your facility paying attention to the evidence and making changes to ensure patient safety and a healthy work environment for you?