1. Graystone, Rebecca MS, MBA, RN, NE-BC


Nurse-sensitive patient outcome measurements are critical measures of healthcare quality in the United States. In this column, the director of the Magnet Recognition Program(R) calls for nurse-sensitive patient outcome measurements to be standardized and developed across all settings where nurses deliver care.


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Professional nursing makes an essential contribution to healthcare quality through patient, nursing workforce, organizational, and consumer outcomes. In Magnet(R)-designated organizations, the empirical measurement of quality outcomes related to nursing leadership and clinical practice is imperative.1 Nurse-sensitive patient safety outcomes measure the impact of nursing care on patient care and patient outcomes. The patient's morbidity and the care environment also affect patient care outcomes.2 Nurses, the largest body of US healthcare providers, play a critical role in patient safety and nurse-sensitive outcome measurement and interpretation. In their roles as frontline providers and administrators, nurses are essential to ensure accurate data collecting and reporting.

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Nursing care is difficult to measure, definitions are not standardized, and nurse-specific data may not be fully collected by all healthcare organizations. Despite this, research demonstrates the impact of nurse-sensitive outcome measures. In acute care, adverse patients events are associated with lower nurse staffing.3 These adverse events include medication errors, falls, infections, failure to rescue, pressure ulcers, and mortality. "The presence of hospital-acquired conditions, infections, or other adverse events is a reflection of inadequate patient safety and can have short- and long-term impacts of quality of life for patients."4(p73)


Patient falls are a measure of quality that is nurse-sensitive, linking patient falls outcomes with the availability and quality of nursing services. Quigley and White3 found that patient falls caused most patient injuries. As cited by Quigley and White,3 the American Nurses Association posits that nurses are responsible for assessing patient risk for falls and injury, instituting fall prevention programs, and monitoring and evaluating the effectiveness of fall prevention programs. For Magnet-recognized organizations, nurse-sensitive measurement performance is evaluated against national benchmarks requirements for outperformance, a hallmark of nursing excellence.


Despite these findings to support the linkage between nursing care and patient outcomes, work remains to more fully link acute care patient-care outcomes to nursing care.2 Further, other care settings beyond acute care, such as ambulatory care nursing, continue to develop measures to determine how to define, refine, and collect patient safety outcomes for patients cared for by ambulatory care nurses. Therefore, the opportunity, even imperative, exists to empirically define linkages. Ambulatory care nurses can use research to examine relationships in the ambulatory care arena. Examples of applicable nurse-sensitive patient safety measures in ambulatory care might be medication management, reducing risks, and symptom management.5


Studies to directly link nursing care to patient outcomes continue. Lucero et al2 studied the impact of patient care unmet by nursing. The evidence suggested that unmet nursing care needs, as self-reported by nurses, were significantly associated with adverse patient care events in the acute care hospitals studied. Further, the study suggested infection adverse events were more highly correlated with unmet nursing care than other adverse safety events such as patient falls or medication errors. Lucero et al2 report this is the 1st study known to link patient care outcomes to nursing care considering the care environment and the patient's own risk factors.


Nurse-sensitive patient outcome measurements must be standardized and developed across all settings where nurses deliver care. They are linked to critical measures of healthcare quality in the United States and reflect the value that nurses contribute to patient well-being and organizational fiscal health.




1. American Nurses Credentialing Center. 2019 Magnet Application Manual. Silver Spring, MD: American Nurses Credentialing Center; 2017. [Context Link]


2. Lucero RJ, Lake ET, Aiken LH. Nursing care quality and adverse events in US hospitals. J Clin Nurs. 2010;19(15-16):2185-2195. [Context Link]


3. Quigley P, White S. Hospital-based fall program measurement and improvement in high-reliability organizations. Online J Issues Nurs. 2013;18(2):5. [Context Link]


4. Pappas S, Davidson N, Woodard J, Davis J, Welton JM. Risk-adjusted staffing to improve patient value. Nurs Econ. 2015;33(2):73-78. 87; quiz 79. [Context Link]


5. Swan BA, Conway-Phillips R, Griffin KF. Demonstrating the value of the RN in ambulatory care. Nurs Econ. 2006;24(6):315-322. [Context Link]