Tuesday, April 26, 2011

Nurse Staffing - Different Models, Different Results

Last week it was announced that the Henry Mayo Newhall Memorial Hospital in Santa Clarita, CA, is abandoning the “team nursing” program they initiated last year (to a "rocky reception").  Instead, they will replace it with a more intimate model which will allow nurses to focus more of their time on fewer patients.  The California Nurses Association has welcomed this change, believing that the team nursing model could be detrimental to patient safety.

This is just one example in which nurses are contributing to the discussion revolving around increasing patient care quality.  All across the country, nurses are leading efforts to understand what drives better nursing care to keep patients safe and the environments that are crucial to making that happen.  For example, an INQRI team at the University of California examined the extent to which nurse staffing levels affected the incidence of complications and the failure to rescue from those complications, (i.e. death following complications). Their examination showed that nursing hours per patient day were strongly associated with lower rates of pressure ulcers and hospital acquired infections, and fewer deaths from complications. Further, more RN hours in the mix had additional benefit with still lower rates of failure to rescue and hospital acquired infections. Their work shows that higher levels of nursing hours per patient day and RN skill mix will lead to better patient outcomes.

Another INQRI team at the University of Pennsylvania conducted the first study to look at the link between nursing and very low birthweight infants in the neonatal intensive care unit (NICU).  Researchers examined care in more than 100 NICUs around the U.S. and found that when babies are treated in units where nurses have less support and less frontline experience they are at higher risk of developing infections. Babies in hospitals where nurses are supported and have  more experience are less likely to have medical complications such as bleeding in the brain, which leads to costly complications. The team has found that higher levels of nurse staffing and the proportion of nurses with bachelor’s degrees in nursing and NICU experience are associated with better infant outcomes. The study results could guide decisions related to setting standards for all hospitals to follow when creating and staffing a neonatal intensive care unit where infants thrive.

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