New Study Shows Improving Nurses’ Work Environments and Staffing Ratios Can Reduce Hospital Readmissions for Medicare Patients

    • January 10, 2013

Princeton, N.J.—Preventable hospital readmissions cost Medicare more than $15 billion each year. Now, new provisions in the Affordable Care Act (ACA), intended to improve patient care, penalize hospitals for excess preventable readmissions of Medicare patients. A study in the current issue of Medical Care suggests that improving nurses’ work environment can help to reduce Medicare readmissions.

The study, led by Matthew McHugh, PhD , JD, MPH, RN, FAAN, assistant professor at the University of Pennsylvania School of Nursing, found that  increased nurse-to-patient staffing ratios and a good work environment for nurses were associated with reduced 30-day readmission rates for Medicare patients with heart failure, myocardial infarction, and pneumonia. Funding for the study came from the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program.

The research team analyzed data from a cross-sectional survey of registered nurses in California, New Jersey, and Pennsylvania about hospital work environment, nurse staffing levels, and educational attainment. The team also used data on hospitals’ structural characteristics from the American Hospital Association Annual Survey, and data on admissions and readmissions from state discharge abstract databases. They focused specifically on Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Under the ACA, the Centers for Medicare and Medicaid Services will reduce payments to hospitals that have higher than expected readmission rates for patients with these three conditions.

The study revealed that, even after accounting for patient and hospital characteristics, nurse staffing levels and nurses’ work environment had a significant impact on readmissions for heart failure, myocardial infarction, and pneumonia patients. Nurses’ education levels (the percentage of nurses with baccalaureate degrees in nursing) also had a significant effect on readmissions, but only for patients with pneumonia.

“Our findings indicate that improving nurses’ work environments and reducing their workloads can reduce readmissions for Medicare patients with common conditions,” said McHugh. “It is certainly worthwhile for hospital administrators to examine these two factors and explore whether they can be optimized to improve patient outcomes and reduce readmissions.”

Each additional patient per nurse in an average nurse’s workload was associated with a 7 percent higher odds of readmission for heart failure patients, a 6 percent higher odds of readmission for pneumonia patients and a 9 percent higher odds of readmission for myocardial infarction patients within 30 days of being discharged. Care in hospitals with good versus poor work environments for nurses was associated with 7 percent lower odds of 30-day readmission for heart failure patients, 6 percent lower for myocardial infarction patients, and 10 percent lower for pneumonia patients.

McHugh is an RWJF Nurse Faculty Scholar, and was one of only 12 nurse educators across the country selected in 2011 to participate in the program and to receive a three-year $350,000 grant to conduct research. The goal of the RWJF 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, Ph.D., R.N., F.A.A.N., 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

Read the study.

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