RN Staffing Affects Patient Success After Discharge

Release Date: April 26, 2011 | By Sylviane Duval, Contributing Writer
Research Source: Health Services Research

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Higher non-overtime staffing levels of registered nurses lower the probability of patient readmissions to the hospital, a new study finds. However, higher levels of RN overtime increase the likelihood of unplanned visits to emergency departments after discharge.

“The study clearly documents for nurse managers and hospital administrators that staffing decisions have consequences for patient outcomes,” said study author Marianne Weiss, an associate professor at Marquette University College of Nursing. “RN staffing affects the quality of discharge teaching provided to patients, which in turn affects how ready patient feel to go home from the hospital and impacts readmission and ED visit rates in the first 30 days after discharge.”

The researchers looked at 1,892 medical/surgical patients in 16 nursing units of four acute-care hospitals in 2008. When the units had higher RN non-overtime staffing levels, readmission to hospital was 44 percent lower for each extra 45 minutes of nursing care per patient per day. When RN overtime was lower, so too were the number of ED visits after discharge.

The authors attribute this in part to nurses teaching patients how to manage their condition after discharge and to the skill of the nurses as teachers. Patients reported higher satisfaction rates with the quality and content of this teaching when RN staffing was higher, and said they felt well prepared and “ready” for discharge.

In contrast, the stress and fatigue of working overtime can affect the quality of this teaching negatively, leading to poorer discharge outcomes and higher ED visits, according to the study appearing online in the journal Health Services Research.

According to the authors, this study also implies that health care costs could be lower in the long run − but not under current payment systems. They project that if the 16 nursing units studied implemented the 45-minute increase in non-overtime nursing care, they could save more $11 million annually from reduced readmissions and another $500,000 annually with the decrease in overtime.

“Preventable readmissions and emergency room use following hospitalization are concerning sources of unnecessary costs,” said Matthew McHugh, Ph.D., at the Center for Health Outcomes and Policy Research of Pennsylvania School of Nursing.

“Although programs for intensively managing patients as they transition from the hospital to home are vital, the availability and funding for such services is limited,” McHugh said. “On the other hand, virtually all patients receive bedside nursing care during hospitalization. Sufficient levels of these vital nursing resources are necessary to ensure not just good outcomes in the hospital but after patients leave. The authors’ cost analysis further supports the business case for sufficient, high-quality nurses as a good investment for hospitals and patients.”

The study was funded by the Robert Wood Johnson Foundation, under its Interdisciplinary Nursing Quality Research Initiative.

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Health Services Research is the official journal of the AcademyHealth and is published by John Wiley & Sons, Inc. on behalf of the Health Research and Educational Trust.  For information, contact Jennifer Shaw, HSR Business Manager at (312) 422-2646 or jshaw@aha.org. HSR is available online at www.blackwell-synergy.com/loi/hesr.

Weiss ME, Yakusheva O, Bobay KL. Quality and cost analysis of nurse staffing, discharge preparation, and postdischarge utilization. Health Services Research online, 2011.

Tags for this article:
Medical/Hospital Practice   Patient Engagement  

Comments on this article
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Beware Bias says
April 27, 2011 at 12:38 PM

I would like a number please, rather than the phrase,

Melodie Thompson says
April 28, 2011 at 8:18 AM

Thank you for your very informative article which sheds more light on nurse staffing issues. Patients are seen with multisystem problems these days and it takes a great deal of time to address their needs and properly educate them for discharge. Couple this with inadequate or ineffective staffing and it becomes problematic on both sides. Managers must redesign the staffing patterns to meet these needs or hospitals will continue to lose money as a result of high readmission rates.

Mark Stambovsky says
April 29, 2011 at 3:03 PM

The fact that overtaxed nurses results in compromised patient care continues to supported by evidence. Still, hospitals fight tooth and nail to micromanage staffing as if the practice of nursing is as predictable as assembly line work.
Without celebrated disasters as a result of unsafe staffing policies nothing will change.

unemployed lpn says
April 29, 2011 at 9:16 PM

How much more are hospitals making from the re admissions? If you cut nursing care to minimum and have an increase in returning patients your profit margins increase... simple equation. I graduated from an LPN program in October 2010 and am licensed but can't find a position any where... I keep hearing about nursing levels being seriously low and and how nurses are over worked and patients are not receiving adequate care and how hospital profits are up... this is all just another way for corporate America to take advantage of everyone they can!!!

Overworked RN says
May 15, 2011 at 6:32 PM

We give minimal attention to patient education-no time. We are tied to our computers and the task list ahead of us. If patient education were part of the management reimbursement chart, then it would happen.

Vicki, Krohn says
June 10, 2011 at 1:56 PM

To unemployed lpn, hospitals are not going to be paid at all for readmissions in the first 30 days after discharge, so your argument is false. As long as nursing care is not part of the billing structure, hours per patient day will continue to be driven by the accountants. Outcomes and quality are the new drivers of reimbursement which is why this article is so important for those accountants to read. If we can reduce readmissions by improving the RN staffing levels and increase hours per patient day (number of hours of nursing care for every 24 hours patient is in hospital bed), then one may surmise that quality and outcomes would also improve.

Patricia Kendall Rn,ONC says
September 22, 2011 at 5:21 PM

I agree a hundred percent. It also effects the quality of care the patient receives. The patients just don't get the care they need.

Jeanne Beers RN, HI says
September 22, 2011 at 7:46 PM

Some excellent comments. My training concentrated on spending quality time with our patients, we learned from them their priorities and educated them along the way. Its overwhelming for the nurse and paient to have everything thrown at them on discharge. As the years go by we are more and more short staffed. The bean counters and generally administrators, high level supervisors are not concerned with burned out nurses. Only the bottom line--profits. Many states have enforced staffing guidlines and are still working short staffed. The only way we can get back to adequate staffing and providing good quality care is to take the PROFIT out of HEALTHCARE.