Another study recently added to the growing body of evidence that nurse work environments affect patient outcomes.
Published online in the International Journal for Quality in Health Care, the University of Pennsylvania School of Nursing study found Medicare patients who underwent elective hip and knee surgery in hospitals with insufficient nurse staffing and poor nurse work environments were more likely to be readmitted to the hospital within a month of discharge.
For those familiar with the issue, the connection between inferior nurse working conditions and a higher rate of readmissions isn’t exactly surprising. But this study provides an interesting detail that quantifies the effect of overstretched nurses responsible for too many patients: Each additional patient in a nurse’s workload was associated with an 8 percent increased likelihood of a patient needing to be readmitted within 30 days.
On the opposite end of the spectrum, patients cared for in the best work environments — where nurses reported strong collegial relationships with physicians and autonomy in clinical practice — had 12 percent lower odds of an early readmission, researchers found.
“These study findings are consistent with decades of prior research demonstrating the role hospital nurses play in ensuring safe outcomes for surgical patients," said the study's senior author Matthew McHugh, PhD, JD, MPH, RN, associate director of the school’s Center for Health Outcomes and Policy Research.
"Nurses work around-the-clock providing care to patients before, during and after surgery, making them the likely healthcare providers to identify and intervene on early warning signs that could lead to a negative health outcome."
The study spanned 112,017 Medicare patients undergoing elective total hip or knee replacement in 495 hospitals in California, Florida, New Jersey and Pennsylvania. Overall, almost 6 percent of patients were readmitted to the hospital within 30 days. For more than half, the unplanned readmission occurred within 10 days of discharge.
The most common reason for readmission, the study found, was postoperative infection. The finding makes sense, researchers explained, given nurses’ pivotal role in keeping infection at bay.
“Nurses are involved in many aspects of infection prevention, including: timely initiation of antibiotics prior to surgery, stopping antibiotics at the appropriate time, wound care management, monitoring for signs and symptoms of infection or sepsis and patient education about preventing infection after discharge. Nurses also prevent infection through consistent and thorough hand washing practices,” they wrote.
“When nurses are stressed for time, any and all of these infection prevention measures may be compromised.”
The second most common readmission reason was for packed cell transfusion, indicative of anemia secondary to blood loss. When nurses are too busy to consistently assess lab values, vital signs and physical status for signs of slow blood loss, patient care suffers, the study points out. But when workloads are manageable, nurses are able to keep an eye on potential problems and keep the entire healthcare team aware of important changes.
Adequate nurse staffing and supportive work environments for nurses are crucial for value-based care, the study suggests.
“Our findings provide implications for hospital administrators and policymakers,” researchers warned. “Empirical evidence suggests that when hospital budgets are squeezed, nursing services are often the first resource to be cut; however, doing so may be costly. Hospital administrators should be cautious of reducing investments in nursing in an effort to cut expenses.”
To put it plainly, when money is tight, cutting back on nursing care is an awful idea for both patient outcomes and the bottom line. If you value your patients, you’d better value your nurses.