Increased RN Staffing Hours Are Correlated with Higher Quality Patient Care

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 (LPN) or nursing assistant (NA) 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 new research brief on the Robert Wood Johnson Foundation website.

INQRI in the News

HealthLeaders Media highlighted the INQRI program, and the importance of nurses to quality of care, in its recent article “Interdisciplinary Care Starts with Respect for Colleagues.” Managing editor Alexandra Wilson Pecci writes that it is time to upend the hospital hierarchy, where power starts with physicians and flows down to nurses, particularly within interdisciplinary care. “Instead of this top-down hierarchy, I believe all branches of health care should function as equals,” Pecci said. “The responsibilities of nurses, physicians, pharmacists, and other members of the clinical care team are certainly different, but none is more or less important to patient care. All members of the team are needed for their own, particular skills.”

The new INQRI-funded study “Scope-Of-Practice Laws For Nurse Practitioners Limit Cost Savings That Can Be Achieved In Retail Clinics,” continues to receive media coverage, most recently on the Reuters Health Globalpost website.  The study is led by Joanne Spetz and Stephen Parente.

New Survey Shows Nurse Practioners Spending More Time on Patient Education and Medication Adherence

A survey of nurse practitioners (NPs) and physician assistants (PAs) conducted by Manhattan Research reveals that NPs are playing a central role in helping patients adhere to their medication regimens and also spending more time on patient education - both of which are crucial in improving quality of care and patient outcomes.

According to the survey of 909 NPs and PAs, nearly nine in ten NPs provide resources to patients that help them with medication adherence (including three in ten who have referred patients to digital tools to help with adherence, and almost half of NPs report spending more time on patient education in the last two years.

The survey findings are highlighted in a new infographic.

Several INQRI research teams have examined the role of nurses in medication management, including ways home healthcare nurses can help with adherence; the impact of nursing processes on medication errors; and ways nurses and pharmacists can collaborate on medication reconciliation. And an INQRI research team led by Marianne Weiss and Olga Yakusheva identified the impact of nurses' discharge teaching on patient outcomes, discharge readiness, and readmission rates. A brief on that study was recently posted.

Hospitals' Approach to Quality Care

Kaiser Health News recently reported that the Joint Commission has released their annual report announcing which hospitals have excelled at meeting basic requirements for treating common illnesses.  The report recognizes the accomplishments of 620 hospitals, with 18% of them listed as "top performers," having followed recommended protocols at least 95% of the time.

This announcement comes at the same time that USA Today has published an interview with

Marty Makary, a surgeon at Johns Hopkins Hospital.  Dr. Makaray has recently written a new book, Unaccountable: What Hospitals Won't Tell You and How Transparency Can Revolutionize Health Care, in which he suggests that hospitals aren't forthcoming about medical errors, readmission rates and other quality issues.

What do you think about these two sides of the quality discussion?  Comment below.

Click here to read the story about the Joint Commission's announcement.
Click here to read the interview with Dr. Makaray.

Op-Ed In The Huffington Post Highlights the Significance of Nurses

Earlier this morning Brian Secemsky, M.D., a resident physician in internal medicine at UCSF Medical Center, emphasized the importance of recognizing nurses' integral role in the delivery of team-based care. Dr. Secemsky highlighted just a few of the roles that nurses play in the delivery of care, and how these roles improve the patient and provider experience.

To read Dr. Secemsky's full Op-Ed, click here.

The Importance of Wellness In the Workplace

For those of you who follow the INQRI blog, you may be familiar with our coverage of issues addressing the health of the nursing workforce. Earlier this summer, a group of health care, human service, and education providers in Northeast Ohio created an innovative nursing initiative, which is currently undergoing rigorous external evaluation, to support health, satisfaction and the quality of care delivered by front-line nurses. Pamela A. Maidens, MA, CPM wrote a fantastic summary of how this initiative came about, why it is important, in addition to describing how the educational program works.

To read more about this wellness initiative, click here.

California Nurses' Union Advocates for Setting Minimum Charity Care Levels for Non-Profit Hospitals

Over the past few decades, many health care professionals have expressed their concern regarding non-profit facility's tax-exempt status and the amount of charitable care they deliver. To this point, the California Nurses Association has called for California legislatures to institute a minimum level of charitable care non-profit institutions must deliver if they are to continue receiving government financed subsidies and benefits. With much of the charitable care delivered in California falling on financially restricted public hospitals, the CNA has requested for stringent requirements for non-profit hospitals to utilize at least 8% of their revenue for the delivery of charitable care.

To read more about the CNA's efforts, click here.

Ohio Medicaid Program Incentivizes High Quality Care For Nursing Homes

Starting last month, Ohio' Medicaid program altered its payment procedures to reflect the current trend of moving slowly away from a fee-for-service scheme to adapt to pay-for-performance reimbursement schemes. Ohio's new payment policy links approximately 10% of all Medicaid reimbursements for nursing homes to a wide range of quality measures including, patient satisfaction, rate of errors and nurse staffing levels.

To read more about this initiative, head over to Kaiser Health News for a more thorough explanation of this, and similar programs.

Inside an Award-winning ED's Nursing Department

Yesterday, Alexandra Wilson Pecci, reporting for HealthLeaders Media, gave a glimpse of specific programs and initiatives being implemented in one of the most innovative nursing department within an emergency department at Boston Children's hospital. One such program focuses on improving the assessment of pain among children, a topic area that has also been focused on in previous INQRI research.

To read more of Ms. Pecci's description of the fabulous care being provided at Boston Children's hospital, click here.

How to Better Motivate Nurses and Cut Costs

Yesterday, Karen Minich-Pourshadi, Senior Editor for HealthLeaders Media, published a fascinating piece that discussed innovative ways for hospital systems to cut costs while motivating their nursing workforce. Ms. Minich-Pourshadi recommends that hospitals take a cue from airline companies and utilize a point system, similar to 'travel miles', that rewards nurses for covering their colleagues shifts or providing exemplary care. The case study presented by Ms. Minich-Pourshadi demonstrates how hospitals are looking at other industries to solve some of their workforce issues that previously was viewed as unfeasible.

To read more about this innovative program, click here.

A Quick Round Up of Nurses Responses to The Supreme Court's Ruling on Health Care Reform

With the Supreme Court ruling to uphold the entire Patient Protection & Affordable Care Act (ACA), we thought it would be fitting to share with you some responses by nursing organizations across the country in response to this landmark ruling.

Ohio Nurses Association Questions Impact of Issue 3 with the Supreme Court's Decision to Uphold Health Care Reform

Last November, the citizens of Ohio voted in support of legislation (Issue 3) that said no law can force someone to have insurance, thus negating the individual mandate included in the ACA. The Ohio Nurses Association is now left wondering how will Ohio implement the provisions in the ACA and what effect will this have on the nursing workforce?

Nurse leaders happy with ruling on ACA

The ANA has touted the law’s potential to increase the profile of RNs in the healthcare system through new models such as accountable care organizations and medical homes. These models would rely on RNs’ expertise in care coordination, the ANA has said.

ANA Lauds Supreme Court Decision Upholding Health Care Reform Law

The American Nurses Association (ANA) lauds the U.S. Supreme Court's decision today to uphold the Affordable Care Act (ACA), including the "minimum coverage provision," hailing it as a victory for all patients and their families.

Nurses: 'Court Ruling Does Not End Healthcare Crisis Or the Need to Continue the Campaign for Reform'

The Supreme Court decision should not be seen as the end of the efforts by health care activists for a permanent fix of our broken healthcare system, said National Nurses United. The union pledged to step up a campaign for a reform that is not based on extending the grip of a failed private insurance system, but "on a universal program based on patient need, not on profits or ability to pay.

More Videos From The INQRI 2012 National Conference

We are pleased to share with all of you the final three recordings from our National Conference, which convened in Washington, DC at the end of April. Below you will see a video from Dr. Susan Hassmiller discussing the role of INQRI in the development and implementation of the Future of Nursing and the Campaign for Action. The two videos following Dr. Hassmiller's comments are panel discussions on "Dissemination & Implementation" and "The Business Case for Changes Nursing". Feel free to share these videos and comment on them either on the blog or their respective Youtube pages.

INQRI and the Future of Nursing



In this session from the 2012 INQRI national conference, RWJF's advisor for nursing, Susan Hassmiller shares her thoughts about INQRI's role in the Future of Nursing and the Campaign for Action.


INQRI Panel: Dissemination and Implementation - INQRI's Potential Impact 




Presented by INQRI grantees: Marita Titler, Deleise Wilson, Barbara Resnick and Leah Shever. Moderated by Polly Pittman. At INQRI's national conference (April 26-27, 2012), a select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

INQRI Panel: The Business Case for Changes in Nursing To Improve Quality and Value



Presented by INQRI grantees: Olga Yakusheva, Doug Wholey and Kevin Frick. Moderated by INQRI Co-Director Mark Pauly. At INQRI's national conference (April 26-27, 2012), a select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

Newly Released Videos From The INQRI 2012 National Conference

We are pleased to share with all of you three few videos from the INQRI National Conference that took place on April 24-25th of this year. Continue to keep an eye on our blog as we will continue to upload new material from this wonderful and highly successful conference.

“INQRI Leadership Team”

In these clips from the 2012 INQRI national conference, leadership team members Lori Melichar (senior program officer), Mary Naylor (program director), and Mark Pauly (program co-director) share their reflections about INQRI's beginnings, its impact and the stage it has set for the future.





“INQRI Panel: Trends in Interdisciplinary Collaboration”
Presented by INQRI grantees: Cindy Corbett, Linda Costa and Michele Balas
Moderated by David Krol from the Robert Wood Johnson Foundation.

A select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

INQRI Panel: Measuring Nurses' Contribution to the Quality of Health Care

Presented by INQRI grantees: Susan Beck, Marianne Weiss, Nancy Ryan-Wenger, Nancy Donaldson.
Moderated by INQRI NAC Member Shelley White-Means.

At INQRI's national conference (April 26-27, 2012), a select group of INQRI grantees used their findings as the basis for discussions about the relationship between their research and trends in interdisciplinary collaboration, methodology and implementation science, quality measurement, dissemination and implementation, and the business case for nursing.

Nursing Excellence Improves Outcome for High-Risk Infants‎

We are pleased to share with you a recently published study in JAMA conducted by INQRI cohort 2 grantees Dr. Eileen Lake, Dr. Jeannette Rogowski and colleagues, which found hospitals designated by the American Nurses Credentialing Center as a "RNE" hospital provide high quality care in three quality measurement areas. These hospitals, who have obtained the "RNE" designation by achieving exemplary practice or leadership in five areas, had significantly better outcomes than hospitals without this designation in rates of hospital infection, severe intraventricular hemorrhage, and death after seven day. Surprisingly, this study found no significant difference in the death rate of low birth weight infants after 28 days of birth between those hospitals with "RNE" designation and those that did not receive this credential.

Click here to read more about this study.

Click here to read the actual study (subscription required). 

Pediatric Advance Care Discussions Difficult for Nurses and Physicians

Yesterday, Larry Hand, of medscape.com, detailed a newly published study in this month's Pediatrics that surveyed physicians and nurses at intensive care units (ICUs) and oncology wards at Children's Hospital Boston and Dana-Farber Cancer Institute in Massachusetts to identify barriers to advance care discussion and planning for children. The survey identified the top 3 barriers for ACD discussions regarding children: unrealistic parent expectations, differences between the way physicians and parents understand a prognosis, and lack of parent readiness to have the discussion.

Click here to read Mr. Hand's summary of the article.

Click here to read the study as it appears in Pediatrics.

Educating The Nursing Workforce

We are pleased to share with all of you two initiatives seeking to bolster nurses' education and training so that they may continue to provide evidence-based, high-value care.

Earlier this morning, Wolters Kluwer Health announced that they would be expanding Lippincott's Professional Development Programs for hospitals and other health care facilities. These bolstered educational tools are designed to optimize nursing performance, increase clinical knowledge, ensure staff competence, and improve patient outcomes.

Click here to read more about WKH's Professional Development Programs.

Similarly, the American Association of Colleges of Nursing (AACN) has announced the extension of their Quality and Safety Education for Nurses (QESN) initiative, thanks to additional funding from the Robert Wood Johnson Foundation. The QESN provides educational resources and training to enhance the ability of faculty in master's and doctoral nursing programs to teach quality and safety competencies.

Click here to read more about the AACN's extension of the QESN initiative.

Please Thank Your Nurse This Holiday Season

Yesterday, Anthony Youn, M.D., wrote a heart warming blog piece about the importance giving thanks to nurses who provide quality care during the holiday season.

Click here to read the Op-Ed.

New Nursing Program Promises to Advance Patient Care Quality and Safety

Yesterday, the Johns Hopkins University School of Nursing announced the acceptance of a new grant, funded by The Helene Fuld Health Trust of New York, that will prepare 200 new clinical nurses over the next five years in quality improvement and patient safety that is firmly grounded in leadership development. This initiative will specifically focus on the vulnerable elderly population, who are the responsibile for a high percentage of redadmissions in hospitals nationwide. This education intiative aligns with recommendations to bolster the nursing workforce made in IOM's Future of Nursing: Leading Change, Advancing Health report.

Click here to read the news article.

Click here to read other blogposts related to the IOM's report.

Nursing homes: A Caring Staff Makes All The Difference

Earlier today, Robin Erb and Kristi Tanner, of the Detroit Free Press, published the final article of their three piece series focusing on the quality of care in nursing homes. The article gave a personalized view of how caring, compassionate staff can positively effect the quality of life experienced by nursing homes' residents.

Click here to read the article.

Click here to read the first article in the series.

Click here to read the second article in the series.

Publish Post

Reflecting On Dr. Berwick's Tenure As CMS Administrator

In this month's edition of Health Affairs, Harris Meyer wrote a fascinating piece reflecting on Dr. Don Berwick's short tenure as the head of the Center for Medicare & Medicaid Services (CMS). In the article, Ms. Meyer discussed the praise Dr. Berwick's body of work at the CMS received from numerous professional organizations and highly respected health leaders.

Click here to read the Health Affairs article (freely available to all).