Room: Phillips 203
Time: Tue 10:15 AM-11:45 AM

Nurse Staffing, Nurse Human Capital And The Quality Of Hospital Care

Chair: Frank Sloan (Duke University)

Session Description

An increasing body of evidence demonstrates a relationship between nurse staffing, nurse education and experience, and the quality of patient care in adult acute-care settings. As a result, policymakers have become interested in establishing minimum nurse staffing thresholds for hospital care. In order to formulate public policy, however, it is necessary to obtain precise estimates of the effects of staffing on outcomes. It is equally important to determine the role of characteristics of the nurse workforce on patient outcomes, as these may modify staffing effects. Public reporting can also be used to encourage improvement in the quality of patient care. However, the role of nursing in the adoption of initiatives such as National Quality Forum-endorsed safe practices is not known. In this session, we explore the role of nurse staffing and nurse human capital as determinants of the quality of hospital care and the adoption of safe practices.

The first paper uses longitudinal data for acute inpatient care in the VA to estimate the effect of nurse staffing and nurse human capital (contract labor, tenure on unit, team cohesiveness and stability) on outcomes and length of stay. The study finds that nurse staffing does affect the quality of patient care (measured by patient safety indicators (PSIs)) but that previous studies may have over-estimated these effects. Factors besides staffing levels, such as use of contract nurses and turnover, are also important determinants of patient outcomes. This implies that in setting guidelines for nurse staffing, policy makers should consider the characteristics of the nursing staff in addition to the number of nurses.

The second paper addresses the role of nurse staffing, education and experience on patient outcomes in the NICU for very low birth weight infants. VLBW infants are one of the highest risk pediatric patient populations, with highly nurse-intensive hospitalizations. Yet, there is very little evidence on the role of nursing in determining patient outcomes in this setting. The study finds that the observed-to-expected nurse staffing ratio, percent of nurses with a BSN and nurse experience on the NICU are associated with decreased mortality and the odds of developing severe intraventricular hemorrhage. Further, hospitals with better-educated, more NICU-experienced staff have lower staffing levels. This implies that minimum staffing levels, based on infant acuity, have the potential to improve morbidity and mortality outcomes for these infants. However, the education and experience of nurses should also be taken into consideration in setting NICU nurse staffing guidelines.

Finally, the third paper examines the role of nursing in the hospital adoption of a set of National Quality Forum-endorsed Safe Practices in the context of public reporting by the Leapfrog Group. The study finds that public reporting of Safe Practices helped spur a sizable number of poor performing hospitals to adopt the practices, but only if sufficient RN staff were already in place. The results further demonstrate that patient safety indicators (PSIs) dependent on the quality of nursing care show slight improvement with the adoption of Safe Practices. In contrast, PSIs that are dependent on the performance of multi-disciplinary teams were unaffected by Safe Practice adoption.

Key Terms None listed

Session Organizer: Jeannette Rogowski (University of Medicine and Dentistry of New Jersey)

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Presentations

1. A Longitudinal Study of the Effects of Nurse Staffing Levels, Nurse Human Capital, and Nursing Teams on Patient Outcomes for VA Inpatient Care

   Presenter: Ciaran Phibbs (Veterans Affairs Palo Alto and Stanford University)

   Discussant: Dennis Scanlon (Pennsylvania State University)

2. Nurse Staffing, Nurse Education and Experience, and Patient Outcomes in Neonatal Intensive Care

   Presenter: Jeannette Rogowski (University of Medicine and Dentistry of New Jersey)

   Discussant: Laurence Baker (Stanford University)

3. Does Public Reporting of Process of Care Lead to Improvements in Outcomes?

   Presenter: Richard Lindrooth (University of Colorado, Denver)

   Discussant: Mark Smith (Health Economics Resource Center, VA)