Princeton, N.J.—Nurses represent the largest proportion of health care professionals, are the primary providers of bedside care for patients and serve as intermediaries between patients and a host of other care providers. Their unique role in providing care requires close, frequent and long interactions with patients. Now, a new study reveals that they also are extremely accurate and reliable assessors of the quality of care in the hospitals in which they work.
The study, currently available for early view online in the journal Research in Nursing and Health, was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research. The primary investigators were Matthew McHugh, PhD, JD, MPH, RN, CRNP, assistant professor at the University of Pennsylvania School of Nursing and Amy Witkoski Stimpfel, PhD, MSN, post-doctoral research fellow at the University of Pennsylvania School of Nursing. McHugh was recently appointed to the new Institute of Medicine Standing Committee on Nurse Credentialing Research.
The researchers analyzed existing data for hospitals in four states: California, Florida, New Jersey, and Pennsylvania, which represent 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.
The research team asked nurses, “How would you describe the quality of nursing care delivered to patients in your unit?” Responses could be: excellent, good, fair and poor.
The researchers found that nurses’ reports that the quality of care was excellent did correspond with higher levels of patient satisfaction, better scores for processes of care (for instance, giving heart attack patients aspirin when they arrive at the hospital, providing patients with appropriate and complete discharge instructions, or ensuring pneumonia patients get the most appropriate initial antibiotics), and better results for patients in the hospital with regard to mortality and failure to rescue. For every additional 10 percent in the proportion of nurses reporting that the quality of care on their unit was excellent, there was a 3.7 point increase in the percent of patients who would recommend the hospital, and a five percent decrease in the odds of mortality and failure to rescue for surgical patients.
Nurses’ reports of excellent quality were higher in hospitals known to have good work environments that support professional nursing practice. Higher proportions of nurses working in Magnet recognized hospitals and in hospitals with good practice environments, measured by the Practice Environment Scale of the Nursing Work Index also developed at the University of Pennsylvania, reported that the quality of care in their workplace was excellent.
“Nurses have insight into aspects of quality that aren’t always documented, but which can make the all-important difference in patient outcomes,” said McHugh. “They are involved in direct interactions with patients, provide education and support to patients and their families, work alongside other members of the interprofessional health care team, and regularly interact with other frontline staff and management, and know how technology and information systems are integrated into the health care system. These things make a difference.”
McHugh and his colleagues suggest that while patients are the most relevant reporters of quality of care, nurses can also be a valuable source of information about this measure and can report on quality in settings where patients can’t always provide that information, such as critical care, end of life or some pediatric settings.
McHugh is an RWJF Nurse Faculty Scholar, and was one of only 12 nurse educators across the country selected last year to participate in the program and to receive a three-year $350,000 grant to conduct research. The goal of the Robert Wood Johnson Foundation Nurse Faculty Scholars program is to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty. The program aims to strengthen the academic productivity and overall excellence of nursing schools by providing mentorship, leadership training, and salary and research support to young faculty. It is funded by the Robert Wood Johnson Foundation and administered through the Johns Hopkins University School of Nursing. It is directed by Jacquelyn Campbell, PhD, RN, FAAN, who is the Anna D. Wolf chair and professor at the Johns Hopkins University School of Nursing. The program is now in its fifth year. To learn more, visit www.nursefacultyscholars.org.
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