Hospital Nursing and 30-Day Readmissions Among Medicare Patients With Heart Failure, Acute Myocardial Infarction, and Pneumonia

Readmissions for the same illness within 30 days after a hospital stay cost Medicare $15 billion annually. Nurses in the hospital are in frontline positions to promote optimal care that could reduce readmissions.

These researchers sought to understand how the nurse work environment, staffing levels, and nurse education affects 30-day readmission for Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Readmission for these three conditions often are preventable, and new legislation will reduce Medicare payments to hospitals that have higher-than-expected readmission rates. Researchers randomly sampled all licensed nurses working in 412 hospitals in California, Pennsylvania, and New Jersey.

Nearly one-third of the hospitals had good work environments, another third had poor work conditions, and the remainder were mixed. Comparing the good with the poor, good work environment hospitals had lower odds of 30-day readmission for heart failure (7%), myocardial infarction (6%), and pneumonia (10%).

Nurse education (average proportion of BSN-prepared nurses was 39%), generally was not associated with readmission except for pneumonia where 10 percent more nurses with BSNs lowered odds of readmission by 3 percent.

More nurses working in hospitals with good work environments were confident that their patients were able to manage their own care when discharged (59% versus 48%).

“One potentially effective means of reducing overall readmissions may come through improving the organization and delivery of hospital nursing services,” they write.