When It Comes to Cost and Quality of Hospital Care, Nurse Tenure and Teamwork Count

This post originally appeared on the Robert Wood Johnson Foundation Human Capital Blog.

The largest study to examine the relationship between nurse staffing and patient care reveals that patients get the best care when they are treated in hospital units staffed by teams of nurses who have extensive experience in their current jobs. The study, conducted by an interdisciplinary team including Patricia Stone, PhD, RN, FAAN, Centennial Professor of Health Policy at the Columbia University School of Nursing and Ciaran Phibbs, PhD, research economist at the Health Economics Resource Center at the Palo Alto Veterans Administration Health Care System, was funded by the Interdisciplinary Nursing Quality Research Initiative (INQRI).

The research team reviewed more than 900,000 patient admissions over four years (from 2003 through 2006) at hospitals in the Veterans Administration Health Care System. They analyzed nurses’ payroll records and patients’ medical records to see how nurse staffing affected patients’ length of stay. Longer hospital stays tend to be associated with delays and errors in care delivery, so shorter stays indicate better care. Shorter stays also reduce the cost of care.

Researchers found that a one-year increase in the average tenure of registered nurses (RNs) on a hospital unit was associated with a 1.3 percent decrease in the average length of stay.

The study also found that patients’ length of stay was longer when a member of a team of experienced RNs was missing or a new member was added to the team. Stone, one of the principal investigators, notes that “when the same team of nurses works together over the years, the nurses develop a rhythm and routine that lead to more efficient care.”

The researchers note that their findings suggest that hospital executives should consider policies that will help them retain experienced nurses and that encourage nurses to remain on their current units.

The paper, “Human Capital and Productivity in a Team Environment for the Healthcare Sector” was published in the April 2014 issue of American Economics Journal: Applied Economics.

The Robert Wood Johnson Foundation created INQRI to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality.