How Hospital Complications Increase as RN Staff Decrease

Our healthcare system is broken in many ways; no one should expect the passing of a healthcare reform bill to control its rising costs. We have to think outside the box; we have to work on other causes that affect the system. Adverse patient outcomes, in hospitals, have a direct effect on the rising costs of healthcare in our country. Studies indicate that these complications may be directly related to the shortage of qualified registered nurse staff.

To make matters worse, according to Stanton, a "Federal Government study predicts that hospital nursing vacancies will reach 800,000, or 29 percent, by 2020.The number of nurses is expected to grow by only 6 percent by 2020, while demand for nursing care is expected to grow by 40 percent."

How Hospital Complications Impact Healthcare Costs

An "AHRQ-funded study found that all adverse events studied (pneumonia, pressure ulcer, UTI, wound infection, patient fall/injury, sepsis, and adverse drug event) were associated with increased costs. For example, the cost of care for patients who developed pneumonia while in the hospital rose by 84 percent. Treating pneumonia raised total treatment costs by $22,390-$28,505, while the length of stay increased 5.1-5.4 days and the probability of death rose 4.67-5.5 percent. Pressure ulcers, another category of adverse patient event sensitive to nursing care, are estimated to cost $8.5 billion per year."(Stanton).

The Relationship between RN Staffing and Adverse Outcomes

Hospital complications related to nurse staffing are generally referred to as nursing-sensitive outcomes; they are indicative of the quality of care. Pneumonia is a major adverse event, particularly after surgery; it is especially sensitive to RN staffing levels. Our healthcare system needs qualified surgical nurses; they possess practice skills to help prevent such complication.

Some hospitals, in response to the nursing shortage, opted to add unlicensed personnel, i.e. nurse assistants, in response to the higher patient acuity. This resulted in the RN having the extra responsibility of supervision; it also decreased their presence at the bedside. According to Stanton, other "adverse patient outcomes potentially sensitive to nursing care are... shock, upper gastrointestinal bleeding, longer hospital stays, failure to rescue, and 30-day mortality".

Under the current healthcare system, patients are admitted to hospitals sicker and discharged quicker. These patients, in turn, require readmission within days, resulting in higher treatment costs, and longer stays. At our institution, this was almost the norm. The higher patient acuity level, the more nursing required but frequently the workload did not allow us to perform specific tasks to prevent complications. We were also bogged down with non-nursing tasks such as patient transport and food service duties. Job dissatisfaction is also related to adverse patient outcomes.

When I worked in an open-heart surgery ICU, only RNs provided direct bedside nursing care with a floating assistant. Pneumonia and wound infections were major possible complications, which required diligent nursing care. The nurse to patient ratio depended on the patient's acuity and care required. However, on the nursing wards, that was not always the case; patient outcomes depended more on the staffing skills and mix.

Solutions

Hospitals must balance hiring more staff that is ancillary with hiring RNs that are more qualified. This is because the more unlicensed personnel, the more supervision required, hence keeping the RN away from the bedside. Of course, hospitals are concerned about the financial implications and rising costs of hiring more RNs but studies have shown that this does not decrease their profits. There is concern that hospitals may decrease unlicensed personnel central to nursing, which, will again place burden on the RN's role in patient care.

Addressing our healthcare system's current and future nurse shortage and job dissatisfaction should be top priorities. Several organizations proposed strategies for nurse recruitment such as student loan forgiveness, tuition support for advance degrees, developing a career ladder to increase opportunities for advancement, continuing education programs, and new methods of determining nurse-patient ratios based on patient acuities.

Research Continues

Ongoing research of our healthcare system continues regarding the effects of staffing on patient safety and the quality of care provided. It should not be a surprise to anyone that less RN staffing and available qualified nurses affects patient outcomes. Hospitals complications increase as nursing staff decrease; no research needed for this fact. Researchers "believe that more accurate and consistent measures of acuity and quality and more complete data on staffing for all types of nursing personnel are needed to explain the complex relationship between nurse staffing and the quality of care.The findings thus far can have a positive impact if used to educate and inform interested parties on how quality of care is changing and how it is linked to the contributions of nurses." (Stanton).

References

Stanton, Mark W. MA. (n.d.). Hospital Nurse Staffing and Quality of Care. Research in Action, Issue 14.

http://www.ahrq.gov/research/nursestaffing/nursestaff.pdf