Research Brief: Nurse Presenteeism

A team at the University of North Carolina, Greensboro, led by Susan Letvak and Christopher Ruhm, evaluated the influence of presenteeism (decreased productivity due to health problems) on hospital registered nurses' (RNs) quality of patient care. This study focused on presenteeism among RNs suffering musculoskeletal pain and/or depression. In addition, they assessed the economic costs to the health care system associated with presenteeism. Using a mixed methods approach, including a survey and focus groups of RNs in North Carolina, researchers documented a depression prevalence of 18% in hospital nurses. Seventy-one percent of nurses interviewed reported working with some pain and the majority of nurses interviewed reported that a health problem had negatively affected their productivity on the job in the previous two weeks. The team found that pain and depression were significantly associated with presenteeism and that presenteeism was significantly associated with patient falls, medication errors and the perceived quality of care. Finally, the team found that the productivity loss due to pain and/or depression was $14,339 per nurse and $876.9 million for the state of North Carolina. If these numbers were extrapolated to the nation, the productivity loss would be $22.7 billion.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Quality of Nursing Care on Acute Inpatient Units

Does the composition of hospital nurse staffing levels matter when it comes to preventing costly complications and death following those complications? A team at the University of California, led by Mary Blegen, Tom Vaughn (from the University of Iowa) and Colleen Goode (from the University of Colorado), 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 in intensive care units and in general units will lead to better patient outcomes, information that can guide states considering regulation of nurse-patient staffing ratios to address patient safety gaps.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Supplemental Nurse Staffing

A team of researchers at the University of Rochester, led by Ying Xue and Deborah Freund, conducted a study to better understand one hospital's use of supplemental registered nurses (SRNs) and examine its impact on patient and nurse outcomes and cost. Using focus groups, interviews, mail surveys, chart reviews and reviewing hospital administration data, the team found that use of SRNs varied greatly by unit and that typically permanent RNs have similar experience and more education (BSN or higher degree). Although, the use of supplemental nurses occurred more frequently in units that were rated as having poor working environments, the team did not find that their use had any negative impact on patient or nurse outcomes. The findings of this project will further understanding of the impact of SRNs on quality and cost outcomes and help hospital administrators make evidence-based strategic plan for nurse staffing.
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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Tailored Plan to Prevent Patient Falls

This week, we present the work of a team led by Patti Dykes and Blackford Middleton which has created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members). The team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.

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Example of a Fall TIPS Bed Poster
Example of a Fall TIPS Plan of Care
Example of Fall TIPS Patient Instructions

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Effect of NQF Safe Practices on Patient Outcomes

Led by Richard Lindrooth and John Welton, an interdisciplinary team at the Medical University of South Carolina examined how adoption of the National Quality Forum safe practices affects nursing sensitive patient safety outcomes. Barriers to adoption of these practices were also explored. This team took a step beyond existing literature by testing whether the implementation of safe practices leads to more effective use of nurses, and whether this leads to better performance on patient safety outcomes.

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Histogram of Adoption of Safe Practices, 2004-2006

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Rural Hospital Collaborative and HF Outcomes

This week, we'd like you to introduce you to a team of researchers at the University of Maryland and Johns Hopkins University, led by Robin Newhouse and Laura Morlock.  This team conducted a study which identified the linkages between processes of nursing care and the quality of patient outcomes, while also addressing the pressing need for mentorship in implementing evidence-based heart failure (HF) care in rural hospitals. The team conducted a randomized control trial with twenty three rural hospitals from five states in the eastern United States. In the course of their project, the team found that heart failure core measures improved significantly between 2007 and 2009, but that nursing support and staffing does not predict core measure improvement. Heart failure core measures are reported by acute care hospitals as a measure of quality care for HF patients. They found that there is no relationship between the smoking cessation core measure, nursing smoking cessation counseling activity, and patient intent to quit smoking. Finally, they found that nurses in better practice environments use more evidence-based smoking cessation interventions. This study is one of the first to focus on linkages between rural nursing and patient outcomes, and has affected the engagement of nurses in 23 rural hospitals in improvements in heart failure care. Qualitative evidence suggests profound changes in the uptake of evidence and the formation of multidisciplinary teams.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Impact of Nurse Characteristics and Practices on Patient Outcomes

An INQRI team led by Nancy Donaldson and Carolyn Aydin examined individual and collective effects of unit level nurse workload, staff nurse characteristics and selected risk assessment and preventive intervention processes of care on variance in nursing sensitive outcomes of acute care medical-surgical units. The team found that patient outcomes were predicted by combinations of all elements in their model, including: unit/patient characteristics, nursing workload, registered nurse expertise and clinical processes. Interestingly, they found that falls and falls with injury were predicted by patient characteristics and clinical process variables, but not by nurse expertise. However, hospital acquired pressure ulcer prevalence was predicted by a combination of all elements in the model. Finally, the team also found that unit and patient characteristics and workload could predict medication practice errors and that workload and practice errors predicted medication outcome errors. These findings can guide hospitals in efforts to improve staffing effectiveness and patient safety, reducing medication administration errors and understanding prevalence of facility acquired pressure ulcers.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: How Do Nurses Influence Discharge Teaching?

This week, we introduce you to the INQRI project conducted by Marianne Weiss, Olga Yakusheva, and their team.

Improving how patients are discharged from the hospital to reduce unnecessary readmissions is a critical issue now being debated at the national level. With one in five elderly readmitted to the hospital within 30 days at an annual cost to Medicare of $17 billion, policymakers are seeking cost-effective solutions to better transition patients from hospital to home. Researchers at Marquette University, led by Weiss and Yakusheva, have been studying what hospital-based nurses do to influence outcomes after a patient is discharged from a hospital. Specifically, they identified the contributions that nursing staff make to the quality of discharge teaching and the impact of that teaching on patient outcomes, readiness and readmission rates of patients who are discharged home. They have found that when units had more RN hours per patient day, fewer overtime hours and fewer vacancies, the discharge teaching was of higher quality, patients reported greater readiness for hospital discharge, and post-discharge utilization of readmission and emergency room visits was lower.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Reducing Blood Stream Infections

The next grantee project in our series comes from Johns Hopkins University.  Led by David Thompson and Jill Marsteller, the team's goal was to implement a comprehensive safety program including an evidence based intervention to reduce central line-associated blood stream infections (CLABSIs) while examining the context of nursing care delivery on patient outcomes. This interdisciplinary research team used the expertise of nurses to develop and deliver a quality improvement initiative that reflects the positive clinical contributions of nurses in the critical care setting. This study is likely to inform other nurse-led medical error reduction interventions, contribute to the quality improvement literature and to the science of rigorously evaluated evidence based interdisciplinary nursing practice.

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Access a chart on the quarterly number of perceived CLABSI prevention practices during the implementation period.

This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.

Research Brief: Testing Quality Measures with Consumers

At this phase of the program, INQRI is focusing almost completely on dissemination.  To that end, we will be featuring a weekly presentation of grantee findings along with access to a research brief which is targeted to the largest possible audience.

This week, we would like to introduce you to the work of Shoshanna Sofaer and Jean Johnson.  The work of their team at Baruch College and The George Washington University has helped shed light on whether some of the National Quality Forum's (NQF) nursing sensitive measures are perceived as meaningful by consumers. The team designed and conducted focus groups with recently hospitalized patients to understand their perception of the nursing sensitive measures. Consumers found several patient safety measures to be very compelling, and clearly believed that nurses had a significant role in hospital quality. On the other hand, consumers didn't think nurses should be advising patients to quit smoking, arguing that nurses have better things to do with their time. They also found measures of nurse skill mix and turnover rates confusing. The team learned that overall, the public, while valuing nurses highly, has an incomplete understanding of what they do, including what they do based on their own assessments, and to whom they are accountable. Researchers performed a thorough literature review regarding the actions of nurses in care coordination and conducted interviews with nurses in four hospitals and held nine focus groups with recent patients. They found that while consumers clearly recognize the importance of care coordination, their perceptions of the nurses' role differed from the perspective of the nurses. The team found that there are limits to the patients' ability to truly observe many aspects of care coordination, which may explain why nurses see their role as broader and more central than do the patients. This research provides great weight to the importance of seeking public views when creating measures of nurse quality and showed that the public has much to contribute to the process. Findings could influence the process by which NQF endorses measures. In part because of this research, NQF recently dropped smoking cessation counseling for myocardial infarction, heart failure and pneumonia from the nursing sensitive measures.

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This post is part of a series to provide the public with research briefs on INQRI-funded projects across a range of interests.