Analysis: Hospital Nurse Staffing and Quality of Case Essay

infirmarys with beginning nanny-goat staffing levels tend to construct gamy grade of poor forbearing outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to search funded by the Agency for Health attending enquiry and Quality (AHRQ) and others. Yet increasing staffing levels is not an easy task. Major factors bring to visit staffing levels include the needs of todays high avidness affected roles for more(prenominal) c ar and a nationwide gap mingled with the enactment of available positions and the design of registered nannys (RNs) qualified and leave aloneing to fill them. This is evident from an quash va contributecy rate of 13 part.This cover up summarizes the findings of AHRQ-funded and other question on the every(prenominal)iance of have got staffing levels to unbecoming longanimous outcomes. This valuable information back tooth be used by decisionmakers to make more informed choices in terms of adjusting suppo rt staffing levels and increasing nurse recruitment age optimizing prize of care and improving nurse satisfaction. continue over the next deuce decades. A Federal Government guide predicts that infirmary care for vacancies will reach 800,000, or 29 per centum, by 2020.2 The number of nurses is expected to bend by only 6 percent by 2020, while necessity for nursing care is expected to grow by 40 percent. The most recent research shows a jump of 100,000 RNs, or 9 percent, in the hospital RN twistforce amidst 2001 and 2002 because of attachd demand, high pay, and a weakening economy. However, since almost only of theMaking a Difference spurn levels of hospital nurse staffing are associated with more wayward outcomesP get along with 3 unhurried of ofs have higher acuity, yet the skill levels of the nursing staff have declinedPage 5 higher(prenominal) acuity perseverings and added responsibilities increase nurse work loadPage 5 Avoidable ill outcomes such as pneumonia can raise treatment costs by up to $28,000Page 6 Hiring more RNs does not decrease profits Page 6 high levels of nurse staffing could have positive impact on both type of care and nurse satisfactionBackgroundPeriods of high vacancy judge for RNs in hospitals have come and gone, but the current shortage is assorted. concord to a 2002 report by the workforce commission of the American hospital Association, the nursing shortage reflects fundamental changes in population demographics, career expectations, work attitudes and worker dissatisfaction.1 In fact, the present situation may hygienicAuthor Mark W. Stanton, M.A. Managing Editor Margaret Rutherford Design and Production Frances Eisel Suggested citation Stanton MW, Rutherford MK. Hospital nurse staffing and persona of care. Rockville (MD) Agency for Healthcare investigate and Quality 2004. Research in Action Issue 14. AHRQ Pub. No. 04-0029.increase came from RNs over age 50 who returned to the workforce and a greater inf lux of foreign-born RNs, this does not alter the structural features in the long term the aging of the nurse population and the increasing unwillingness of young women to consider nursing as a profession.3 Todays difficulties are further complicated by other changes in hospital care, such as new medical exam examination technologies and a declining amount length of stay, that have led to increases in the sum up of care required by patients while they are in the hospital. parvenue medical technologies allow many less(prenominal) seriously ill patients who previously would have received inpatient working(a) care to receive care in outpatient settings. Also, patients who in the past would have continued the early stages of their retrieval in the hospital, today are discharged to skilled nursing facilities or to home.During the period 1980-2000, the average length of an inpatient hospital stay uncivilised from 7.5 days to 4.9 days.4 An important consequence of these changes is t hat hospitals have a higher general concentration of sick people who need more care. Various groups, including the American Hospital Association, the Joint Commission on the Accreditation of Healthcare Organizations, and the Institute of euphony (IOM), have expressed their concerns about the evolving nursing crisis. The IOM issued a report in 1996 that recognized the importance of determining the appropriate nurse-patient ratios and distribution of skills for ensuring that patients receive tint health care.5 Its report highlighted the fact that research on the relationship surrounded by The nurse workforce and nurse staffing levelsthe level of staffing by nurses in hospitals and patients outcomes has been inconclusive. The IOMs analysis of staffing and quality of care in hospitals concluded by career for a systematic effort at the national level to gain and analyze current and relevant data and work up a research and military rank agenda so that informed policy development, implementation and evaluation are undertaken in a timely manner. To begin to meet that need, AHRQ-funded research and other research have pursued a number of distinguishable paths.Hospital nurse staffing and nursing-sensitive outcomesHospital nurse staffing is a matter of major(ip) concern because of the effects it can have on patient galosh and quality of care. Nursing-sensitive outcomes are one indicator of quality of care and may be defined as variable patient or family phencyclidine state, condition, or perception responsive to nursing intervention.6 Some wayward patient outcomes potentially sensitive to nursing care are urinary tract infections (UTIs), pneumonia, shock, upper gastrointestinal bleeding, longer hospital stays, failure to drive home, and 30-day mortality.a close research has focused on adverse rather than positive patient outcomes for the simple reason that adverse outcomes are much more plausibly to be documented in the medical record. aFailure to rescue is defined as the death of a patient with a lifethreatening fork for which early identification by nurses and medical and nursing interventions can incline the risk of death.The nurse workforce consists of authorize nursesregistered nurses (RNs) and licensed practical nurses (LPNs)and nurses back up (NAs). Both RNs and LPNs are licensed by the State in which they are employed. RNs assess patient needs, develop patient care plans, and administer medications andtreatments LPNs deport out specified nursing duties under the direction of RNs. Nurses aides typically carry out nonspecialized duties and personal care activities. RNs, LPNs, and nurses aides all extend direct patient care. RNs have obtained their education through three different routes 3-year diploma programs, 2-year associate degree programs, and 4year baccalaureate degree programs.Almost a third of all RNs have a baccalaureate degree, and 7.6 percent of hospital nurses have advanced practice credentials (either a mas ters or doctoral degree). LPNs receive 12-18-month training programs that emphasize technical nursing tasks. Nurses aides are not licensed but many start certified nurse aide or nursing assistant (CNA) lieu after proving they have certain skills related to the requirements of particular positions. Nurse staffing is thrifty in one of two basic slipway Nursing hours per patient per day. The nurse to patient ratio. Nursing hours may refer to RNs only to RNs and LPNs or to RNs, LPNs, and nurses aides.2www.ahrq.govA broad array of research on this melodic theme has found an association in the midst of lower nurse staffing levels and higher place of some adverse patient outcomes. A new evidence report entitled The Effect of Health Care Working Conditions on Patient Safety, produced by an AHRQfunded Evidence- found Practice Center (EPC), reviewed 26 studies on the relationship between nurse staffing levels and measures of patient safety.b Most of the studies examined nurse staffin g levels and adverse occurrences in the hospital setting, including in-hospital deaths and nonfatal adverse outcomes such as nosocomial infections, obligate ulcers, or falls. The EPCs researchers found that lower nurse-topatient ratios were associated with higher rate of nonfatal adverse outcomes.7 This was true at both the hospital level and the nursing unit level. With regard to in-hospital deaths, however, the evidence does not consistently show that lower nurse staffing levels are associated with higher mortality.The largest of these studies on nurse staffing (jointly funded by AHRQ, the Health Resources and operate Administration, the Centers for Medicare & Medicaid Services, and the National Institute of Nursing Research) examined the records of 5 billion medical patients and 1.1 million running(a) patients who had been treated at 799 hospitals during 1993.6,8 Among the landing fields principal findings In hospitals with high RN staffing, medical patients had lower ran ge of five adverse patient outcomes (UTIs, pneumonia, shock, upper gastrointestinal bleeding, and longer hospital stay) than patients in hospitals with low RN staffing.c Major surgery patients in hospitals with high RN staffing had lower order of two patient outcomes (UTIs and failure to rescue). senior higher rates of RN staffing were associated with a 3- to 12-percent reduction in adverse outcomes, depending on the outcome. Higher staffing at all levels of nursing was associated with a 2- to 25-percent reduction in adverse outcomes, depending on the outcome. Table 1 illustrates some of the major findings. For example, the researchers found that medical patients in hospitals with high RN staffing were 4-12 percent less likely to develop UTIs than medical patients in the compare group.Lower staffing levels are linked to higher adverse outcome rates The EPC report include five studies funded by AHRQ that examined the relationship between adverse patient outcomes and hospital nu rse staffing. all(a) five studies found at least some association between lower nurse staffing levels and one or more types of adverse patient outcomes. How often do such adverse nursing-sensitive patient outcomes occur in hospital care? Different studies report varying adverse typesetters case rates, which vary by the type of patient (medical or surgical) as salutary as other factors. For example, UTIs occur in from 1.9 percent to 6.3 percent of surgical patients and pneumonia in 1.2 percent to 2.6 percent of surgical patients.8-10 bTable 1. part reduction in rates of outcomes among medical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which rates are lower forIn order to improve the quality and speech of health care services, AHRQ has sponsored a series of evidence reports that are based on rigorous, comprehensive reviews of relevant scientific literature. These reports are developed and compose by outside research and academic organizations designated as Evidence-based Practice Centers (EPCs). The reports tension is on explicit and detailed documentation of methods, rationale, and assumptions.The goal of these reports is to provide the scientific foundation that public and private organizations can use to develop their bear clinical practice guidelines, quality measures, review criteria, and other tools to improve the quality and delivery of health care services reckon measured RN staffing as hours per day and as the RN similitude of nursing hours. Hospitals with higher hours of RN staffing (75th percentile) had an average of 9.1 hours of inpatient RN nursing per patient day, while those with lower RN staffing (25th percentile) had an average 6.4 hours of inpatient RN nursing per patient day. Hospitals with a higher proportion of RN staffing (75th percentile) had an average of 75 percent of inpatient nursing hours provided by RNs, while those wi th lower RN staffing (25th percentile) had an average of 62 percent of nursing hours provided by RNs.Outcome in medical patients Urinary tract infection Upper gastrointestinal bleeding Hospital-acquired pneumonia traumatize or cardiac arrestHigh RN staffing 4-12% 5-7% 6-8% 6-10%High staffing, all levels (RNs, LPNs, aides) 4-25% 3-17% 6-17% 7-13%c ThisNote Difference is expressed as a persona of values (e.g., 4-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. last(a) report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard shoal of humans Health, Boston, MA.www.ahrq.gov3Medical patients in hospitals with high levels of total nurse staffing (RNs, LPNs, and aides) were 4-25 percent less likely to develop UTIs than patients in the comparison group . A uniform analysis was performed for the smaller group of surgical patients (Table 2). Surgical patients in hospitals with high RN staffing had a 5-6 percent lower rate of UTIs and a 4-6 percent lower rate of failure to rescue than surgical patients in the comparison group.dPneumonia rates are especially sensitive to staffing levelsThree AHRQ-funded studies found a significant correlation between lower nurse staffing levels and higher rates of pneumonia. The first line of business found that adding half an hour of RN staffing per patient day could reduce pneumonia in surgical patients by over 4 percent.12 This consider covered 589 hospitals in 10 States during 1993. A second study by the same researchers also found that fewer RN hours per patient day were significantly correlated with a higher incidence of pneumonia.13 The study examined administrative data on post-surgical patients in 11 States during 1990-96. A study of nurse staffing levels and adverse outcomes in Califor nia found that an increase of 1 hour worked by RNs per patient day was associated with an 8.9-percent decrease in the betting odds of a surgical patients contracting pneumonia.8 This study also found that a 10-percent increase in RN proportion was associated with a 9.5-percent decrease in the odds of pneumonia. The researchers in the California study believe that the strong relationship between RN staffing and pneumonia can be attributed to the heavy responsibility RNs have for respiratory care in surgical patients. This study examined the effects of nurse staffing on adverse outcomes in 232 crafty care hospitals from 1996 to 1999.f Unlike many earlier studies, the California study included only adverse outcomes that were not present at admission.7Table 2. portion reduction in rates of outcomes among surgical patients in hospitals with high nurse staffing (75th percentile) compared to the rates in hospitals with low nurse staffing (25th percentile) Amount by which ratesre lower f or High staffing, all levels (RNs, LPNs, aides) 3-14% 2-12% 19%Outcome in surgical patients Urinary tract infection Failure to rescue Hospital-acquired pneumoniaHigh RN staffing 5-6% 4-6% 11%Note Difference is expressed as a range of values (e.g., 2-12 percent) because several statistical models were used in evaluating the relationship between nurse staffing levels and each adverse event. Source Needleman J, Buerhaus P, Mattke S, et al. Nurse-staffing levels and patient outcomes in hospitals. Final report for Health Resources and Services Administration. Contract No. 230-99-0021. 2001. Harvard School of Public Health, Boston, MA.A second study, funded jointly by AHRQ and the National skill Foundation, examined licensed nurse staffing (RNs and LPNs) and adverse outcomes among both medical and surgical patients in Pennsylvania acute-care hospitals.11 It found a lower incidence of nearly all adverse outcomes it studied in hospitals with more licensed nurses. For example, a 10-percent increase in the number of licensed nurses is estimated to decrease lung collapse by 1.5 percent, pressure ulcers by 2 percent, falls by 3 percent, and UTIs by less than 1 percent. Also, with a 10-percent higher proportion of licensed nurses, there was a 2-percent lower incidence of pressure ulcers.e,11dSurgical patients overall had lower rates of adverse outcomes than medical patients, perhaps because they are healthier. Also, the smaller number of surgical patients in the study may have made it more difficult to detect associations. Nurse staffing was measured in two ways (1) the ratio of licensed nurses (RNs + LPNs) to the patient load (with and without adjustments for patient acuity) and (2) the proportion of licensed nurses to the total nursing staff (RNs, LPNs, NAs). The adverse outcomes selected for study were either caused by or not prevented by medical management based on criteria used by the Harvard Medical Practice Study. Nurse staffing was measured in three ways all hours (the total number of productive hours worked by all nursing personnel per patient day), RN hours (the total number of productive hours worked by registered nurses per patient day), and RN proportion (RN hours divided by all hours).