A recent Washington Post article analyzing the impact of nurse staffing minimums provides insight from two INQRI advisors.
“There’s plenty of evidence that there’s a shortage of nursing care, and it’s not solved by anything to do with the hospital supply,” Linda Aiken, INQRI research manager and National Advisory Committee member, tells the Washington Post. “All the shortage of care at the bedside has to do with how much hospitals want to pay nurses, and whether they want to use their resources on something else.”
Aiken’s recent research, published in the Lancet in February 2014, found that patients are more likely to die after common surgical procedures when they are cared for in hospitals with heavier nurse workloads and fewer nurses with bachelor's degrees. The study found that every extra patient increased the chance of surgical patients dying within 30 days of admission by 7 percent.
A California law requiring mandatory minimum nurse staffing has shown benefit for nurses, with studies showing that patient loads and rates of occupational injury decreased in the state, while job satisfaction among nurses increased. The Post reports, however, that there is conflicting evidence as to whether legislating mandatory minimum staffing improves patient outcomes. Lori Melichar, a labor economist for RWJF and program officer for INQRI, tells the Post that the question is complicated. “And when you layer on ‘Is this policy going to be effective,’ as a researcher and an economist, I can’t make that determination,” she says.
An INQRI-funded study on the impact of nursing staffing on hospital performance revealed that increasing the number of registered nurse (RN) hours per patient day increased the quality of patient care. The study looked in particular at patients who were being treated for acute myocardial infarction, pneumonia or heart failure.) For all three conditions, increasing the number of RN hours increased the quality of care. This did not hold true for increasing the number of licensed practical nurse or nursing assistant hours.
The study's authors—Gestur Davidson, Ira Moscovice, and Kathy Belk—posited that RNs are involved in and directly affect procedures, practices and processes that directly influence patient outcomes. This was the first study into how nurse staffing affects hospital performance on quality metrics used in the Premier Hospital Quality Demonstration project. It is reviewed in a 2013 research brief on the RWJF website.