Nursing Staffing and Hospital Outcomes

1
Nursing Staffing and Hospital Outcomes

• Julie Sochalski, Ph.D., R.N.
• Center for Health Outcomes and Policy Research
• University of Pennsylvania

2
Results of Survey of Hospital Nurses

• A survey of over 13,000 staff nurses working in
  210 hospitals in Pennsylvania was done in 1999.
• Over 40 of hospital staff nurses reported being
  dissatisfied with their current job.
• These rates are about 3 times higher than the
  rates of job satisfaction for workers in general
  in the U.S.
• In addition, 43 of the nurses reported high
  levels of job burnout .

Health Affairs, May-June, 2001, 43-53
3
Results of Survey of Hospital Nurses (cont)

• Over 80 of the nurses reported that the number
  of patients they were required to care for had
  increased in the past year.
• Around 45 reported that the quality of patient
  care at their hospital had deteriorated over the
  past year.
• Only about 1/3 of the nurses reported that the
  quality of nursing care at their hospital was
  excellent.
• Only 1/3 expressed confidence that their patients
  were able to manage their own care after being
  discharged from the hospital.

Health Affairs, May-June, 2001, 43-53
4
Relationship Between Nurse Staffing and Patient
Outcomes Mortality Rates

• Nursing workload had a significant impact on
  patient outcomes in hospitals.
• Patient mortality increased 7 for every
  additional patient that is added to the average
  nurses workload.
• Implications A hospital with an average
  patient-per-nurse ratio of 81 has a 31 higher
  mortality rate than a hospital with a ratio of
  41.

JAMA, October 23/30, 2002, 1987-1993
5
Relationship Between Nurse Staffing and Nurse
Outcomes Job Burnout

• Nursing workload also had a significant impact on
  nurse outcomes in hospitals.
• Job burnout increased 23 for every additional
  patient that is added to the average nurses
  workload.
• Implications A nurse working in a hospital with
  an average patient-per-nurse ratio of 81 is
  more than twice as likely to show high job
  burnout than a nurse working in a hospital with a
  ratio of 41.

JAMA, October 23/30, 2002, 1987-1993
6
Relationship Between Nurse Staffing and Nurse
Outcomes Job Satisfaction

• Nursing workload had similar effects on nurse job
  satisfaction.
• Job dissatisfaction increased 15 for every
  additional patient that is added to the average
  nurses workload.
• Implications A nurse working in a hospital with
  an average patient-per-nurse ratio of 81 is 75
  more likely to be dissatisfied than a nurse
  working in a hospital with a ratio of 41.

JAMA, October 23/30, 2002, 1987-1993
7
Responses to Hospital Nursing Shortages Magnet
Hospitals

• Responding to a nursing shortage in the early
  1980s, the American Academy of Nursing embarked
  on the magnet hospital project
• Identify hospitals that attract and retain
  nurses.
• Key Magnet Hospital characteristics
• nurse autonomy and control over practice
• strong nursing leadership
• participation in policy-making
• career development opportunities
• Magnet hospitals also found to have lower patient
  mortality rates, higher job satisfaction, and
  lower nurse turnover.

McClure Hinshaw, Magnet Hospitals Revisited,
2002