1. Humphrey, Carolyn J. MS, RN, FAAN

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Three recently published studies have reinforced that adequate nursing care is essential to positive patient outcomes, decreased costs, and the retention of nurses. Although nurses have known this fact throughout their careers, scientific study results are important in making the case for change. In reviewing the study outcomes that follow it seems that the problem has been thoroughly studied. Making changes based on the recommendations should be a priority for all healthcare organizations, including home care.


Research of this type is almost exclusively conducted in hospitals, and we should study these results carefully. In particular, regarding staff retention, all the studies indicate nurses who work in an environment that has unreasonable patient- and work-related demands will not stay in their current jobs for long or in nursing at all.


Other variables to consider specific to home care and adequate nursing staffing include:


* the level of qualified and certified professionals;


* determining that the content of each visit is appropriate for the patient's need;


* evaluating the frequency and duration of professional visits needed per episode, per patient; and


* carefully examining other nurse-related variables that affect an agency's adverse events, benchmarks, and OBQI data.



Harvard University Study Identifies Inadequate Nurse Staffing as a Major Factor in Medical Errors

More than one-third of practicing physicians and 40% of the public say they or a family member have experienced a medical error, according to a survey reported in the New England Journal of Medicine (Aiken, 2002). While causes and solutions varied, the shortages of nurses, overwork, stress, and fatigue among healthcare workers were identified as "very important" causes of errors.


The survey found that >53% of physicians and 65% of the public cited nurse understaffing in hospitals as a factor in errors, while 50% and 70% of physicians and the public, respectfully, blamed errors on workers due to excess work, stress, or fatigue.


As many recent reports and studies have illustrated, nurse staffing is insufficient in many healthcare organizations today, resulting in preventable complications and, in some instances, patient deaths. Insufficient nurse staffing also increases nurse burnout, fueling an exodus from the profession, and thereby further exacerbating the escalating nurse shortage.


This study follows a January 2003 Consumer Reports cover story, based on a survey of nearly 21,000 readers, which revealed an enormous variance in the quality of care patients receive, with much of the variability being attributed to whether a facility has an adequate staff (especially nurses) along with a well-organized care system.


Full results of the errors study are available at the Kaiser Family Foundation Web site:


Nurses Ranked Number One in Honesty and Integrity Again

The nation's nurses again ranked number one for honesty and integrity in the November 22-24, 2002, CNN/ USA Today/Gallup Poll, receiving "high" or "very high" ratings from 79% of survey participants. Nurses have been the highest-rated profession since first being included in Gallup's "Honesty and Integrity" survey in 1999, except in 2001, when firefighters outranked them in wake of the September 11 terrorist attacks. (Firefighters were not included in this year's poll.)


In addition to nurses, other top-ranking professions in the Gallup survey include pharmacists (67%) military officers (65%), high school teachers (64%), and medical doctors (63%). Visit for additional data.


Nurse Staffing Levels Affect Patient Outcomes and Nurse Retention

Effect on Patients

Registered nurse (RN) staffing levels have a significant effect on preventable hospital deaths among surgical patients as reported by a study in the October 23/30 issue of JAMA. The study assessed hospital and Medicare data in 9 states in 5 categories of adverse outcomes: length of hospital stay, hospital-acquired pneumonia, postoperative infection, bedsores, and hospital-acquired urinary tract infections. All 5 measures were markedly lower with higher levels of RN involvement in patient care.


According to researchers, the odds of patient mortality rose 7% for every additional patient added to the average nurse's workload. The difference between 4 to 6 and 4 to 8 patients-per-nurse was accompanied by a 14% and 31% increase in mortality, respectively. The study affirms the critical role RNs play in patient safety when able to make direct assessments and life-saving interventions.


Effect on Retention

The study also reported a direct correlation between patient load and nurse retention rates. Adding one patient-per-nurse to a hospital's staffing level increased the rate of nurse burnout by 23% and job dissatisfaction by 15%. The data indicate that >40% of nurses who reported high burnout and job dissatisfaction intended to leave their job within the next year.


The authors also noted that, assuming recently published estimates of the costs of replacing a hospital medical and surgical general unit and a specialty nurse ($42,000 to $64,000) are correct, improving nurse staffing may not only save patient lives and decrease nurse turnover but also reduce hospital costs.


Several other recently published studies, one in the New England Journal of Medicine and one by the Joint Commission, as well as The ANA's report, "Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting" (released in February, 2001 []), found direct links between nurse staffing levels and better patient outcomes. For many of these findings plans have been developed in Nursing's Agenda for the Future (




1. Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., Silber, J.H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. Journal of the American Medical Association, 288( 16), 1987-1993. [Context Link]


How safe is your hospital? Consumer Reports, 68 (1), 12-18.