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Background It is uncertain whether lower
levels of staffing by nurses at hospitals are associated with an
increased risk that patients will have complications or die.
Methods We used administrative data from 1997 for 799 hospitals
in 11 states (covering 5,075,969 discharges of medical patients
and 1,104,659 discharges of surgical patients) to examine the
relation between the amount of care provided by nurses at the
hospital and patients' outcomes. We conducted regression analyses
in which we controlled for patients' risk of adverse outcomes,
differences in the nursing care needed for each hospital's patients,
and other variables.
Results The mean number of hours of nursing care per patient-day
was 11.4, of which 7.8 hours were provided by registered nurses,
1.2 hours by licensed practical nurses, and 2.4 hours by nurses'
aides. Among medical patients, a higher proportion of hours of
care per day provided by registered nurses and a greater absolute
number of hours of care per day provided by registered nurses were
associated with a shorter length of stay (P=0.01 and P<0.001,
respectively) and lower rates of both urinary tract infections
(P<0.001 and P=0.003, respectively) and upper gastrointestinal
bleeding (P=0.03 and P=0.007, respectively). A higher proportion of
hours of care provided by registered nurses was also associated with
lower rates of pneumonia (P=0.001), shock or cardiac arrest
(P=0.007), and "failure to rescue," which was defined as death from
pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding,
sepsis, or deep venous thrombosis (P=0.05). Among surgical patients,
a higher proportion of care provided by registered nurses was
associated with lower rates of urinary tract infections (P=0.04), and
a greater number of hours of care per day provided by registered
nurses was associated with lower rates of "failure to rescue"
(P=0.008). We found no associations between increased levels of
staffing by registered nurses and the rate of in-hospital death or
between increased staffing by licensed practical nurses or nurses'
aides and the rate of adverse outcomes.
Conclusions A higher proportion of hours of nursing care provided
by registered nurses and a greater number of hours of care by
registered nurses per day are associated with better care for
hospitalized patients.
Source
Information
From the Department of Health Policy and Management, Harvard School of Public Health, Boston (J.N., S.M., M.S., K.Z.); the Vanderbilt University School of Nursing, Nashville (P.B.); and Abt Associates, Cambridge, Mass. (S.M.).
Address reprint requests to Dr. Needleman at the Harvard School of Public Health, Department of Health Policy and Management, Rm. 305, 677 Huntington Ave., Boston, MA 02115, or at needlema@hsph.harvard.edu.
Related Letters:
The Nursing
Shortage and the Quality of Care
Ulrich C. M., Wallen G., Grady
C., Foley M. E., Rosenstein A. H., Rabetoy C. A. P., Miller B. H.
N Engl J Med 2002; 347:1118-1119, Oct 3, 2002.
Correspondence
This article has been cited by other articles:
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