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Citations for ILW.COM's Seminar
Current Nurse Immigration Issues
(In Cooperation With CGFNS)
Session 2 held on December 13, 2007

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From Donna Richardson

New ANA Study Provides More Proof of Link Between RN Staffing and Quality Patient Care (5/02/00)



May 2, 2000

Washington, D.C. - The American Nurses Association (ANA) today released the results of a study documenting that hospitalized patients have better outcomes in hospitals with higher staffing levels and higher ratios of RNs in the staffing mix. The study was done by Network, Inc., a hospital and healthcare research organization.

"Patients fare better when RNs play a significant role in their care," said Mary Foley, MS, RN, president of the American Nurses Association (ANA). "The study confirms what we have known experientially for years and what a decade of various studies has shown: RN care makes the difference in reducing complications and allowing patients to be discharged from the hospital on time and on the path to recovery. However, when RN care is reduced, patients suffer. This study comes at a time when hospitals are struggling to address concerns about health care errors. It is clear that the skill and expertise RNs bring to patient care are critical to addressing these issues."

Today's pressures for hospitals to control costs make it all the more important to determine the value RN care adds to the measurable differences in patient outcomes. This study tracks five adverse outcomes measures that can be mitigated if adequate nursing care is given. Those measures include: length of stay in the hospital, pneumonia contracted while in the hospital, postoperative infection, pressure ulcers (bed sores) and urinary tract infections contracted while in the hospital.

Using hospital and Medicare data from nine states, the study correlates these five adverse outcomes measures with RN staffing levels and overall hospital staffing levels. All five measures are markedly decreased with higher levels of RN involvement in patient care.

"Shorter lengths of stay and fewer complications translate into lower hospital costs," said Foley. "Not only do patients fare better, but hospitals can actually save money by using highly skilled nurses in adequate numbers. It makes no sense for hospitals to cut RN staff or replace RNs with unlicensed assistive personnel who lack the education and judgement of RNs. For years, hospitals have tried to cut corners in this way, but the data keep disproving that approach. RNs are the best value in health care - the best care is also the most economical."

ANA released the study's findings at the Nurse Staffing Summit, held in Washington, DC, May 1-2. The Summit examined the critical issues of inappropriate RN staffing, the impact on quality care and nursing practice, as well as strategies to address staffing issues. During this meeting, a comprehensive plan to tackle insufficient staffing was developed.

"Many hospitals are experiencing a shortage of nurses which affects the quality of patient care," continued ANA President Foley. "Hospitals in part created that shortage by trying to cut costs by reducing their RN staffs, through attrition or lay-offs, in the mid-90s. What many hospitals are doing now to address the staffing situation is mandating overtime - forcing RNs to work extremely long hours. But forcing RNs to work excessive over time is unsafe for both nurses and patients. In reality, mandatory overtime is often a business strategy to cut costs, since hospitals pay fewer benefits and do not have to keep a reserve of RNs available to address a fluctuating patient census."

"We also are seeing hospitals use a variety of recruitment strategies to address the shortage they helped create. While incentives like signing bonuses may attract nurses, employers must make a fundamental commitment to creating a safe and professional environment in which nurses can provide quality care to patients in order to retain them and realistically address staffing issues."

The study is part of ANA's Safety and Quality Initiative, a multi-phasic effort to promote the use of objective measures to demonstrate relationships between nurse staffing and patient outcomes. Another component of that Initiative was the development by ANA of its Principles for Nurse Staffing. Those principles maintain that the number, mix and competencies of nurses must be considered in light of patient census and acuity when determining the best blend of professional care in hospitals and other settings. The principles have been instrumental in helping individual nurses advocate for appropriate staffing levels and participate in designing patient care systems, which result in improved quality patient care. In addition, ANA's constituent member associations (CMAs) have succeeded in having them included in collective bargaining agreements with hospitals such as Howard University Hospital in Washington, DC.

"This study adds even more backing to the thinking that grounds our Principles," said Foley. "Through solid research, workplace advocacy, collective bargaining, and work in the legislative and regulatory arenas, ANA will continue to speak out strongly for all nurses - and the patients for whom they care."

For more information on the study, please see here

Mary McNamara, 301-628-5198
Mary Stewart, 301-628-5038