The Link Between Nurses and Quality Care

    • February 19, 2009

At a time when poor quality, high costs and inefficiency plague our nation’s health care system, a Robert Wood Johnson Foundation (RWJF) initiative, Interdisciplinary Nursing Quality Research Initiative (INQRI), is exploring ways to demonstrate how nurses’ skills and expertise more effectively improve the quality of care. INQRI has 29 expert teams in place that are conducting rigorous research to identify the contributions nurses are making—and can make—to keep patients healthier, improve outcomes, and save lives. 

Multi-disciplinary teams of researchers across the country are examining nursing interventions and quantifying their effects on patient safety, quality and cost of care. By providing evidence that the best nursing care practices produce better and often less costly outcomes, INQRI hopes to convince hospitals and other health care institutions to reorganize their care teams and work environments in order to produce similar results. 

INQRI’s research teams are examining a wide variety of quality and safety issues.  They are examining how best to: measure nursing care; understand children’s perceptions of pain; improve care for patients with chronic heart failure; and assess use of supplemental nurses to address staff shortages. Following are a few examples of the ways INQRI is working to improve the quality of care patients receive:

  • Do nurses play a role in reducing hospital-acquired infections? Research being conducted at Johns Hopkins University is producing promising results. Researchers there examined the effects of an evidence-based practice intervention to reduce central-line associated blood stream infections among patients in hospital intensive care units. Many ICUs that have embraced this nurse-driven protocol have eliminated bloodstream infections among patients.
  • Does the nurse-to-patient ratio matter?  Researchers from the University of Pennsylvania are demonstrating that a higher ratio of nurses to babies can improve outcomes for newborns in neonatal intensive care. This study shows that having more nurses at the bedside reduces the number of serious health problems, such as brain hemorrhage, infection, and lung disease. The findings will have national policy implications and can guide policy-makers who are grappling with whether to set nurse-patient ratios by law or regulation. The National Institutes of Health has already provided a grant to fund further study of this issue.
  • How important is care coordination? A team from Emory University has developed the first tool of its kind for examining the role that staff nurses play in coordinating care for hospital patients. This research team has identified which nurses’ care coordination activities improve patient care and outcomes. The team plans to refine the tool for the clinical setting to help nurses and discharge planners provide the highest quality care to patients. This work has been recognized by the National Quality Forum, which has asked Gerri Lamb, its co-investigator, to sit on its steering committee on care coordination. 
  • Why do medication errors happen? Medication errors are among the most common medical errors, harming at least 1.5 million people each year. The Institute of Medicine estimates that the costs of treating drug-related injuries occurring in hospitals alone amount to $3.5 billion per year. A team from Rutgers University is helping identify the systems and care processes that facilitate nurses’ ability to intercept medication errors and the barriers that prevent them from doing so. By looking at 14 hospitals in New Jersey, the team expects to provide critical information that can help facilitate a more error-free health care environment for dispensing medications.