Better nursing working environment means better outcomes for surgery patients

While it sounds logical, a recent study published Jan. 20 in JAMA Surgery reported that hospitals with the better nursing departments had fewer patients die after a surgical complication. What makes a good hospital nursing environment? The two criteria used by the study included a magnet designation and one nurse for every hospital bed. In summary, the study included about 25,000 geriatric general surgery Medicare patients in Illinois, Texas, and New York, who were treated at hospitals designated as having good nursing environments and another 62,000 similar patients treated at hospitals which did not have good nursing environments as defined by the criteria above. There was a one percent difference between the hospitals. In the “good nursing environment” hospitals, 4.8% of patients died within 30 days of arriving at the hospital, while 5.8% of patients died at the other hospitals. The least healthy patients were the least likely to die at the hospitals with good nursing environments, with nearly a 3% drop in the death rate.

Pick a hospital, any hospital

In a recent Reuters article about the study, lead author Jeffrey Silber, MD, said, “This study is for the person, referring doctor, or health policy analyst asking, ‘Would I be better off at this hospital or that hospital?’” But what does this higher level of care actually cost? One of the more surprising facets of the study was that the hospitals with better nursing care weren’t costing patients more money. “A surprising finding was that better nurse staffing throughout the hospital does not have to be more costly,” stated Professor Linda Aiken, director of the Center for Health Outcomes and Policy Research at the Pennsylvania University’s school of Nursing. She added, “Indeed, we found that Magnet hospitals achieved lower mortality at the same or lower costs by admitting 40% fewer patients to intensive care units and shortening length of hospital stay.”

No Surprises

Ask any nurse who has worked an understaffed floor, and he or she will tell you that their patients aren’t receiving the best possible care. Other studies have backed up anecdotal reports and this new study as well.

• Researchers looking at mortality rates in England indicated that a higher ratio of nurses per hospital bed has been linked to a lower risk of death following emergency general surgery.
• US researchers found that having more nurses was one of the five key factors that help overcome the “weekend effect” in hospitals when patients are more likely to die or experience negative outcomes.
• Hospitals with higher nurse staffing are less likely to be penalized for excessive readmission rates by the Centers for Medicare & Medicaid Services (CMS) than similar hospitals with lower nurse staffing ratios. In fact, each additional nurse hour per patient day is associated with 10 percent lower odds of receiving penalties under the Hospital Readmissions Reduction Program.

What’s in it for me?

For the nurses looking at where to spend their careers, they may find higher job satisfaction and better patient outcomes working at a hospital that is committed to supporting a strong nursing staff.