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(con’t) • 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 nurse’s workload. • Implications: A hospital with an average patient-per-nurse ratio of 8:1 has a 31% higher mortality rate than a hospital with a ratio of 4:1. 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 nurse’s workload. • Implications: A nurse working in a hospital with an average patient-per-nurse ratio of 8:1 is more than twice as likely to show high job burnout than a nurse working in a hospital with a ratio of 4:1. 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 nurse’s workload. • Implications: A nurse working in a hospital with an average patient-per-nurse ratio of 8:1 is 75% more likely to be dissatisfied than a nurse working in a hospital with a ratio of 4:1. 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