Matthew McHugh, PhD, JD, MPH, RN
For practicing nurses, this may seem like a no-brainer, but a new study is offering even more evidence that quality nursing improves patient outcomes. The research found that patients having surgery at hospitals distinguished by better nursing environments and above-average nurse staffing levels had lower mortality.
Furthermore, these facilities—designated “Magnet” for their nursing excellence and a nurse-to-bed ratio ≥1—achieved their results without costing more.
The study, published online in JAMA Surgery
found that the advantage in magnet hospitals was greater for all patients, but even more so for those who are sicker and have more complex needs.
“Magnet designation for nursing excellence offers a way for patients to easily identify hospitals where they are more likely to have good outcomes following surgery,” explained study coauthor Matthew McHugh, PhD, JD, MPH, RN, Associate Director, Center for Health Outcomes and Policy Research, at the University of Pennsylvania School of Nursing in a statement.
For their study, researchers at PennNursing and The Children’s Hospital of Philadelphia compared 25,076 matched pairs of Medicare general surgery patients treated between 2004 and 2006 at 328 hospitals, of which 35 were Magnet (focal) hospitals, and the remaining 293 hospitals served as controls. The patient pairs were identical in terms of surgical procedure, and similar in age, gender, severity of illness, demographics, and chronic illness.
The mean nurse-to-bed ratio at the focal hospitals was 1.51 versus 0.69 at the control hospitals. The study’s primary outcomes were 30-day mortality and costs reflecting resource utilization.
Thirty-day mortality in focal hospitals was 4.8% whereas in the control hospitals it was 5.8% (P
<.001). The cost-per-patient for the two institution groups were similar but indicated better value in the focal group.
“A surprising finding was that better nurse staffing throughout the hospital does not have to be more costly,” said Linda Aiken, PhD, RN, Director of the Center for Health Outcomes and Policy Research at PennNursing, in a statement. “Indeed, we found that Magnet hospitals achieved lower mortality at the same or lower costs by admitting 40% fewer patients to intensive care units and shortening length of hospital stay.”
One factor hypothesized as being complicit in postoperative mortality is “failure to rescue” (death following a major complication), explained the authors of a companion commentary2
“First, hospitals with better nursing environments (termed focal hospitals) have a nearly 20% lower failure-to-rescue rate than control hospitals. Interestingly, even larger benefits were observed in the sickest patient group. While causation cannot be assumed, the quality and quantity of nursing care likely enables early recognition and management of these complex patients.”
“Successful rescue likely requires teamwork, communication, and leadership skills from frontline nurses,” they continued. “Yet these attributes are hard to measure, and researchers continue to work toward gathering pertinent and reliable data in these important domains.”
Study authors cautioned that while “these results do not suggest that improving any specific hospital’s nursing environment will necessarily improve its value, they do show that patients undergoing general surgery at hospitals with better nursing environments generally receive care of higher value.”
A list of Magnet-designated hospitals can be found at www.nursecredentialing.org
1. Silber JH, Rosenbaum PR, McHugh MD, et al. Comparison of the value of nursing working environments in hospitals across different levels of patient risk [published online January 20, 2016]. JAMA Surg.
2. Ghaferi AA, Friese CR. Revisiting nursing’s effect on surgical quality and cost [published online January 20, 2016]. JAMA Surg