Newswise — Surgical patients in hospitals with better nurse work environments were less likely to be admitted to an intensive care unit (ICU) and less likely to die, according to an analysis of nearly 270,000 patient records.
“After Major Surgery, the Nurse Work Environment and the Intensive Care Unit” is the first study to directly link the nurse work environment to ICU use. The study’s findings suggest that nurses can reduce ICU utilization and reduce the risk of ICU admissions by improving their work environment. The article is published in AACN Advanced Critical Care.
Researchers examined large numbers of Medicare beneficiaries who had undergone general, orthopedic, or vascular surgery between January 2006 to October 2007. The study covered 269,764 adult patients who had undergone surgery in 453 hospitals.
They found that surgical patients admitted in hospitals with excellent nurse work environments had 16% lower odds for ICU admission, 12% lower in-hospital mortality rates, and 11% lower death rates within 30 days than patients admitted in hospitals with poor or mixed nurse environments. They found that patients who had good nurse work environments had 15% lower odds of dying within 30 days after hospital admission.
Co-author Anna KruppRN, PhD, MSHP, MSHP is an assistant professor at the University of Iowa College of Nursing. This research was performed during her post-doctoral fellowship at the University of Pennsylvania School of Nursing on health services and outcomes research. Center for Health Outcomes and Policy Research(CHOPR), were she was a National Clinician Scholar. Other co-authors are Karen Lasater, PhD, RN, FAAN, and Matthew McHugh, PhD, MPH, JD, RN, CRNP, from CHOPR and Penn’s Leonard Davis Institute of Health Economics.
“Hospitals with better nurse work environments may be better equipped to provide complex patient care in a lower acuity setting without compromising a patient’s odds of mortality,” Krupp said. “A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses. In the context of the COVID-19 pandemic, our findings suggest that a limiting factor in a hospital’s capacity to respond to the COVID-19 surges of critically ill patients is likely related to the quality of the nurse work environments prior to the pandemic. Fewer additional ICU beds may have been needed if hospitals had good nurse work environments prior to the pandemic, with enough nurses to safely care for patients in lower acuity settings.”
The data came from three sources: Medicare Provider Analysis and Review, hospital characteristics derived from an American Hospital Association annual study, and the RN4CAST survey involving approximately 34,000 registered nurses at hospitals across California, Florida and New Jersey. To link the different sources, hospitals were assigned unique individual identifiers.
The National Quality Forum endorses the 31-item Practice Environment Scale for Nursing Work Index. This scale measures the nurse work environment. Hospitals were then classified as either good (top 25%), poor(bottom 25%), or mixed. These were the 50% of the low and high scales.
Patients with the best nurse work environments had a lower occurrence of ICU admissions and 30-day mortality. Patients in hospitals with poor nursing environments had the highest incidence.
Hospitals with good or poor nursing environments had 29% lower chances of admitting patients to an ICU. 23% lower odds were for in-hospital mortality, 21% lower 30-day mortality odds, 28% lower admission odds to an ICU and 28% lower 30-day mortality.
The surgical group that admitted patients to an ICU differed greatly. Vascular surgical patients had the highest admission rate (47.4%), followed closely by general (18.2%), and orthopedic (5.9%).
Hospital characteristics, such as number of beds, teaching status and technology capabilities, varied significantly. The analysis revealed that hospitals with more than 250 beds were the most supportive of nurse work.
AACN Advanced Critical CareThis quarterly peer-reviewed publication contains in-depth articles for experienced critical care and acute-care clinicians at the bedside, advanced nurses, and clinical and academic teachers. Each issue features a topic-based symposium, feature article and columns of interest for critical care and acute healthcare clinicians.
The issue can be accessed by visiting the AACN Advanced Critical CareWebsite at http://acc.aacnjournals.org/.
About AACN Advanced Critical Care: AACN Advanced Critical CareThis quarterly peer-reviewed journal contains in-depth articles for experienced critical care and acute-care clinicians at the bedside, advanced nurses and clinical and academic educators. The journal is an official publication of the American Association of Critical-Care Nurses (AACN). It has a 1,500-copy circulation and can be accessed at http://acc.aacnjournals.org/.
About the American Association of Critical-Care Nurses: The American Association of Critical-Care Nurses has been dedicated to excellence in critical and acute care nursing for more than 50 years. The organization’s vision is to create a healthcare system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. AACN is the world’s largest specialty nursing organization, with more than 130,000 members and over 200 chapters in the United States.
American Association of Critical-Care Nurses. 27071 Aliso Creek Road. Aliso Viejo. CA 92656. 949-362-2000; www.aacn.org; facebook.com/aacnface; twitter.com/aacnme
