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In December 1999 I wrote an editorial on the State of the Science Congress held in Washington, DC, in September of that year. There, nurse researcher Linda Aiken noted the failure of health services researchers to consider nursing care a predictor of patient outcomes. She reported that not a single study by these researchers had considered nurse staffing as a variable shaping the relationship between volume of cases (such as the number of asthma patients per year) or procedures (such as cardiac surgery) and mortality rates.
It's hard to be a nurse and fathom that anyone needs hard data to understand the link between staffing and outcomes. It should be intuitive, noted NewsHour with Jim Lehrer health correspondent Susan Dentzer at a dinner preceding the 2002 State of the Science Congress in September. She pointed out that we need hard data that will pass muster with the most skeptical of analysts.
In 2002 nurse researchers and their colleagues produced it: evidence that links nursing with improved clinical outcomes. In one study, published in the May 30 issue of the New England Journal of Medicine, Needleman and colleagues documented a link between nursing care and lower rates of urinary tract infections, gastrointestinal bleeding, shock, cardiac arrest, and pneumonia. A second study, published in the October 23 issue of the Journal of the American Medical Association, by Aiken and colleagues (including AJN editorial board member Julie Sochalski), demonstrated that increasing by one the number of patients in the average nurse's caseload had serious results: a 7% increase in the likelihood of surgical patients' death within 30 days of admission, as well as a 15% increase in nurses' job dissatisfaction and a 23% increase in their rate of burnout.
Every nurse should capitalize on these important works and their high profile. Consider the following actions you might take.
When Aiken's study was released, at least one nursing Listserv ignored it, prompting one person to ask whether the users had simply not seen it. Let's light up nursing Listservs to discuss how to use these findings.
Dentzer also noted that hard data will not be sufficient-we should contact journalists and tell our stories to illustrate what the data show. The studies have already received some excellent media coverage, but let's keep the staffing issue in the public eye. An October 25 editorial in the New York Times suggested a response to Aiken's study that's worth pursuing: "make hospitals report their patient-nurse ratios so that prospective patients can decide where to take their chances." Send a copy of the study and the Times editorial to your state and federal legislators, challenging them to require hospitals to make staffing ratios public. Then ask your local media outlets to report on the community's hospital staffing reports.
Send copies of the studies and the subsequent media reports to hospital boards and executives, challenging these leaders to commit to transforming their institutions into Magnet hospitals that can recruit and retain highly qualified staff nurses and thereby ensure improved patient outcomes. (For more on Magnet hospitals, see the February 2000 issue of AJN, or go to http://NursingWorld.org/ancc/magnet/magnet.htm.)
Congressional passage of the Nurse Reinvestment Act (NRA) was a major coup, but it hasn't yet been funded (see Washington Watch, page 14). We must use the evidence we have now to tell Congress and the White House that patient morbidity and mortality will worsen if they don't fund the NRA for 2003. Call Congress at (202) 224-3121; call the White House at (202) 456-1111.
The studies mentioned here demonstrate that the profession needs highly qualified nurse researchers who will address the questions and issues that nonnurse researchers don't even think about. And they reinforce the notion that our raison d'etre is to provide excellent nursing care to the people of this nation.
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