Recent Research About Nursing, November 2012

New studies find that nurses are reliable assessors of their hospitals’ quality of care, and that nurse managers' own adherence to safety practices has broad effect.

    • November 8, 2012

Study: Nurses' Assessments of Care Accurately Reflect Hospital Quality

As the primary providers of bedside care and frequent intermediaries between patients and other health care providers, hospitals nurses have a unique vantage point. A new study conducted with support from the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program concludes that nurses are extremely accurate and reliable assessors of the quality of care in the hospitals in which they work.

Researchers from the University of Pennsylvania analyzed existing data for hospitals in California, Florida, New Jersey and Pennsylvania, collectively accounting for 20 percent of annual hospitalizations in the United States. The data included: nurses' reports on quality of care from the Multi-State Nursing Care and Patient Safety Study; patient assessments of care from the Hospital Consumer Assessment of Healthcare Providers and Systems from the Centers for Medicare and Medicaid Services; hospitals' reports on care measures for heart failure, pneumonia, acute myocardial infarction and surgical care; and administrative data on mortality and failure to rescue.

Researchers also conducted a mail survey in which nurses were asked to describe the quality of nursing care delivered to patients in their units, and to identify their hospitals. They then compared the nurses' assessments with corresponding data from the other sources.

The researchers concluded that nurses' assessments are an excellent barometer of hospital quality. "Our findings illustrate a straightforward premise: asking nurses—the providers most familiar with patients' bedside care experiences—to gauge hospital quality of care offers a reliable indication of quality that is reflected in patient outcomes and process of care measures," they write.

The study's primary investigators were Matthew McHugh, PhD, JD, MPH, RN, CRNP, assistant professor at the University of Pennsylvania School of Nursing and an RWJF Nurse Faculty Scholar, and Amy Witkoski Stimpfel, PhD, MSN, post-doctoral research fellow at the University of Pennsylvania School of Nursing. The study was also supported by the National Institute of Nursing Research.

Read an RWJF news release about the study.
Read an abstract of the study.
Learn more about the RWJF Nurse Faculty Scholars program.

When Nurse Managers 'Walk the Talk' on Safety, Mistakes Go Down

A new study of hospital nurses in Belgium offers important conclusions about how to avoid medical errors. First, it finds that nurses who regard their workplace environments as "safe" are more likely to report a mistake in patient care. Second, it concludes that nurses are also more likely to report errors if nurse managers in their units personally follow the safety protocols they espouse.

Researchers surveyed 54 nursing teams in four Belgian hospitals, asking nurses to agree or disagree with various statements about their work experience, including, "My head nurse always practices the safety protocols he/she preaches," and "If you make a mistake in this team, it is often held against you."

The data indicated that when nurse managers' words about safety were backed up by their deeds, nurses in the unit developed a stronger commitment to safety procedures and reported errors more frequently. Just as significantly, the sharper focus on safety led to a reduction in patient treatment errors.

"The study offers support for the efficacy of leaders’ behavioral integrity—walking the talk, if you will—and it demonstrates the importance of leadership in promoting a work environment in which employees feel it is safe to reveal performance errors," Deirdre McCaughey, PhD, told Nurse.com. "This benefits patients because work environments in which error is identified offer employees the opportunity to learn from those and, ultimately, prevent similar errors from occurring." McCaughey was one of several investigators on the study, and is an assistant professor of health policy and administration at Penn State University.

The study was published in the September 17, 2012 issue of the Journal of Applied Psychology.

Read a Nurse.com story on the study.
Read an abstract of the study.

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