Registered nurses make a difference in patient outcomes

Evidence is mounting that the number of registered nurses and the hours per day that they provide care in hospitals can improve patient outcomes. “Nursing leaders and researchers acknowledge that if nursing units are understaffed or the skill mix is inappropriate (not enough registered nurses), nurses are at risk for missing early warning signs of a problem or potentially missing the problem entirely.” (1) hours of nursing care, urinary tract infection, Foley catheter related infections

In 2004, California was the first state to implement a system to create fixed staffing ratios for different types of nursing units. For example, as of 2009, a California hospital medical surgical nurse was to have no more than 5 patients. A critical care nurse, neonatal or labor and delivery nurse was assigned to no more than 2 patients.

Did this type of mandated ratios make a difference in patient care? Researchers studied 253 California hospitals to see if 2006 staffing data revealed changes in patient outcomes. Over 2 million patient stays were analyzed.
The data showed:

1. As the total number of registered nursing care hours increased, the odds the patient would develop a urinary tract infection decreased by 4.25 times.
2. As the number of nursing hours increased, the length of stay at the hospital decreased.

Both a reduction in urinary tract infections, which are costly to treat, and length of stay create quality and financial benefits for a hospital. A single episode of a hospital acquired urinary tract infection can create an additional cost of $1,046. Care associated with a hospital acquired Foley catheter related infection is not reimbursed by the Centers for Medicare and Medicaid Services and many private insurers. Further, hospitals have an incentive to get a patient discharged as soon as possible because of the current system of a fixed amount of reimbursement per diagnosis.

The goal is to remove Foley catheters as soon as possible, particularly after surgery. This study shows the benefits of having registered nurses involved in the care of patients. See the post on preventing urinary tract infections to see what you can do as a patient or family.

(1) Salvadore Esparza, James Zoller, Andrea Weatherby White and Martha Highfield, “Nurse staffing and skill mix patterns: Are there differences in outcomes?” Journal of Healthcare Risk Management, Vol. 31, No. 3, 2012

Patricia Iyer MSN RN LNCC is president of Avoid Medical Errors. She has inserted many Foley catheters in patients over her clinical career and taught genitourinary nursing care in a diploma school of nursing.

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