Posted on February 11, 2004 at 12:40 p.m.
BIRMINGHAM, AL — Heart attack patients treated in hospitals staffed by more registered nurses (RNs) are less likely to die than patients treated in hospitals staffed by fewer RNs, according to a recent study led by Sharina Person, Ph.D., assistant professor of preventive medicine at the University of Alabama at Birmingham (UAB). Details of the study were published in the January 2004 issue of Medical Care.
“Over the last decade, many hospitals in the United States, in an attempt to increase efficiency and reduce costs, have reduced the number of RNs and increased the number of less educated ‘nurse extender’ personnel,” Person said. “This raises serious concerns about quality of care and patient outcomes. This study, which shows a direct association between the number of RNs and patient deaths, validates these concerns.”
The study surveyed patient records of 118,940 Medicare patients hospitalized from February 1994 through July 1995 following a heart attack. “This was a national study,” Person said. “Randomly selected patient records represented care provided at 4,401 hospitals in 50 states.”
Although other studies have drawn similar conclusions, UAB’s study went a step further, adjusting for numerous variables not accounted for in previous studies. “We took into consideration many variables, including hospital volume, teaching status, nursing skill mix and quality of care based on administration of appropriate therapies for heart attack patients,” Person said. “Even after adjusting for all variables, the association between nurse staffing and patient mortality remained significant.”
The study suggests higher skill levels of RNs may account for the finding. “Because physicians have limited time to spend with patients, they often rely on RNs to alert them to evidence of complications,” Person said. “Also, RNs are critical in implementing standard orders and clinical assessments that may trigger further physician evaluation and action.”
Further study is needed but researchers caution: “Although hospital staff restructuring often carries the admirable goal of increased efficiency, care must be given to how this goal is achieved,” Person said. “The goal should not be achieved by reductions in nurse staffing without careful and complete examination.”