More TLC Better for Hospital Patients

And registered nurses are preferred source of that care, study says

WEDNESDAY, May 29, 2002 (HealthDayNews) -- Tender loving care in the hospital is more than a nicety -- it's key to your health.

People who get more contact with registered nurses do better across a wide range of measures than patients in hospitals with smaller staffs, a new study has found. They have fewer serious infections, such as pneumonia and sepsis, less gastric bleeding and even fewer heart attacks and bouts of shock.

However, the effect is limited almost entirely to highly trained registered nurses (RNs), and not to more junior nurses and aides.

A report on the findings appears in tomorrow's The New England Journal of Medicine.

By many accounts, the nation is facing a nursing shortage whose worst years are coming. American hospitals will experience a shortage of 400,000 nurses by the year 2020, according to a recent study.

What's more, the average age of nurses is rising as younger men and women leave the field or reject it for other professions. According to a 2001 report from the General Accounting Office, four in 10 registered nurses will be over age 50 by the year 2010.

The new study was led by Jack Needleman, of Harvard University's School of Public Health, and Peter Buerhaus, senior associate dean for research at Vanderbilt University's School of Nursing.

It compared patient outcomes and nurse staffing in 799 hospitals in 11 states -- Arizona, California, New York, Maryland, Massachusetts, Missouri, Nevada, South Carolina, Virginia, West Virginia and Wisconsin.

It looked at 25 outcomes for both medical and surgical patients, including length of stay, risk of urinary tract infections, hospital-acquired pneumonia and blood infections, leg clots, heart attacks and death.

The researchers also tracked a catch-all category called "failure to rescue," which included deaths from particular complications -- shock, cardiac arrest, upper gastrointestinal bleeding, pneumonia, sepsis and deep vein clots. These conditions can be caught by registered nurses, but failure to identify them in time can be deadly.

On average, patients received 11.4 hours of nursing care, nearly 70 percent of which was provided by RNs. The rest was split between licensed practical nurses (LPNs) and nurses' aides.

Hospitals that provided more RN care had between a 3 percent and 12 percent reduction in adverse outcomes, while higher staffing levels across the board were linked to a 2 percent to 25 percent drop, the researchers found.

The link between patient welfare and staffing was strongest for the hospitals with the highest share of RNs.

Although the level of skilled nursing care didn't reduce a patient's overall risk of dying, more RN hours did cut the chances of a "failure to rescue" death, the researchers found.

"Those complications could easily get away from the team and the patient could die," says Buerhaus, who notes the death rate for these conditions in low-staffed hospitals was 18 percent to 20 percent.

"The nurse who picks up on these complications and acts quickly to intervene rescues that patient, whereas when you are in a hospital with low staffing, there's less of a chance that a nurse will be able to do so," Buerhaus says.

Patricia Rowell, a policy specialist for the American Nurses Association, says the study is consistent with earlier work linking nurse-staffing levels to healthier patients. However, it's not simply a question of more bodies on the ward.

"There is a difference in who you're providing, not just in the numbers but in the knowledge they bring to the work that they're doing," Rowell says. Registered nurses are better able than nurses' aides and nurse practitioners to identify patient conditions that need immediate medical attention, she says.

Yet for the last decade or so, hospitals have been substituting these more junior staffers for better paid RNs to cut costs, she says.

The new study met with little surprise at one big-city hospital.

"There's a direct relationship" between patient health and the number of registered nurses on hand, says Dawn Bloch, an RN at Columbia-Presbyterian Medical Center in New York City. "We love people, and we want the best for them."

What To Do

For more on the nursing shortage, visit the American Association of Colleges of Nursing or NurseWeek.

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