Study Confirms What We Knew All Along: Nurses Are Key to Hospital Success

Amy Rushlow

Volunteer Nurse with PatientIf you’ve ever had a loved one in the hospital, you know how important nurses are. Studies show that the amount of time that nurses spend with patients is related to fewer errors. And according to a new study, investing in nursing is key to patient outcomes, including the risk of dying while in the hospital.

The study’s researchers, a team from the University of Pennsylvania, wanted to understand why certain hospitals have better outcomes than others. Specifically, the UPenn team was trying to explain why hospitals in the Kaiser Permanente health care system — an integrated health network in eight states that includes hospitals, insurance, and doctors’ offices all in one system — have such efficient and high-quality care.

Other organizations have tried to mimic Kaiser Permanente’s organizational structure in order to improve care, but with mixed results. The researchers thought there might be a different X factor that could explain Kaiser’s success: nurses.

In order to find out, the study looked at more than 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 California-based Kaiser Permanente hospitals and 56 Magnet hospitals. Magnet hospitals are recognized by the American Nurses Credentialing Center for being good workplaces for nurses.

Nurses in each hospital answered surveys about their work environment, level of education, job satisfaction, and the number of patients visited during a typical shift. The researchers also pulled data on patient mortality.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” says study author Matthew McHugh, PhD, RN, a professor at the University of Pennsylvania School of Nursing.

The results were clear: The odds of dying were about 20 percent lower in Kaiser Permanente and Magnet hospitals, and differences in nursing accounted for “a sizeable portion of the advantage,” according to the study. The analysis adjusted for factors such as hospital size and the severity of patients’ conditions.

Academic Nurse

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate into better outcomes,” McHugh tells Yahoo Health.

There were a few specific factors that made Kaiser and Magnet hospitals stand out from the rest, McHugh explains:

1. Better work environments

Happier nurses mean healthier patients, research shows. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs. They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision-making,” McHugh says.

Empowered nurses have better relationships with physicians, “so when they say ‘something isn’t right,’ they’ll be taken seriously,” McHugh adds. And patients can receive faster and more efficient care when nurses are authorized to make decisions such as when to remove a catheter, for example.

In fact, a study published last year in the Journal of Nursing Administration found that empowered nursing units are more effective and report better patient care compared to units with less authority.

Tangible changes matter, too. In response to the nurse shortage in the early 2000s, Kaiser Permanente made a deliberate, research-based effort to invest in nursing, says Marilyn Chow, PhD, RN, Vice President of National Patient Care Services and Innovation for Kaiser Permanente.

A study of Kaiser hospitals conducted in 2005 and 2006 found that nurses spent more than 35 percent of their time on documentation. Starting in 2005, the system switched to electronic medical records, which helped streamline paperwork. They also observed that nurses spent a lot of time hunting and gathering equipment and information — checking to see if a medication was ready, for instance. In response, Kaiser Permanente rearranged the work environment to make things more convenient. (Nurses now receive a notification when meds are ready for pickup.)

“We wanted to make sure that we were a place that nurses wanted to work,” Chow tells Yahoo Health. “If you have nurses who are happy and joyful at their work, they will definitely pass that on and be caring and compassionate.”

Universy of Pennsylvenia School of Medicine

2. More nurses with Bachelor’s degrees

The role of the nurse is much more complex than it used to be, Chow explains. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients … there are so many things to take care of,” she says. Patients also arrive sicker and leave the hospital earlier, Chow and McHugh say, which puts an extra demand on nurses to coordinate care and teach patients and family members what to do when they arrive home.

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh explains. He adds that the study observed a wide variation in nurse education from hospital to hospital, and that variation was associated with adverse events.

3. More nurses, period

Kaiser Permanente hospitals have a 4-to-1 patient-to-nurse ratio, on average, compared to 5-to-1 in non-Magnet hospitals, the UPenn study found.

Having more nurses ensures that there are enough eyes in rooms monitoring patients. It also means that nurses have sufficient time to follow up with patients and communicate effectively. “Nurses are at the bedside and are working with all the other providers. They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response,” McHugh says.

Source: Yahoo Health


AANP and ACNP to Merge

The American Academy of Nurse Practitioners (AANP) and the American College of Nurse Practitioners (ACNP) have announced their intentions to join forces and merge the two organizations, starting January 1, 2013. The new joint organization will be called the American Association of Nurse Practitioners (AANP) and will be co-presidented by the current presidents of both organizations: Dr. Angela Golden from the AANP and Dr. Ken Miller from the ACNP. David Hebert, who has been serving as Chief Executive Officer of the ACNP, will be the CEO of the newly-formed AANP.

The new organization will have approximately 40,000 members, and as such will be the largest professional membership organization in USA for nurse practitioners of all specialties.

This merge comes at a time when nurse practitioners in this country are facing new challenges: The Patient Protection and Affordable Care Act (ACA) means about 30 million more patients are expected to enter the healthcare system through 2019, and the shortage of primary care physicians is continually growing, and is expected to surpass 52,000 by 2025.

As reported here previously, many of the states are meeting these challenges by giving more responsibility to the nurse practitioners, similar to that of primary care physicians. In other states, NPs are allowed to work only under the supervision of medical care.

The new AANP will add a strong, unified voice to the growing movement working to ensure nurse practitioners can practice to their fullest potential.

This trend is not universally accepted. Reid Blackwelder, MD, president-elect of the American Academy of Family Physicians (AAFP) reitereates the AAFP’s position that patients are better served with physician-led healthcare teams and that NPs should not deliver healthcare independently.


American Academy of Nurse Practitioners – Press Release
Medscape Medical News

Nursing Shortage – Not Only in the USA

We often hear about the big shortage in nurses in the USA. What not everyone knows is that this shortage is not only in the US. Most western countries suffer from such a nurses. As the life span of the general population grows, and the span of medical possible intervention grows too, more and more nurses and needed.

The nurses in Israel have started a strike last week, and no end in sight. The nurses say they cannot continue with the current work load. They demand higher salaries which will draw more students to the nursing schools and to joining the nursing forces in Israeli hospitals.

Ilana Cohen, head of the nursing union in the country, is quoted in Ha’aretz:

“For years the treasury has not allocated resources to significantly improve the wage and labor conditions of nurses, thus leading the nursing system in Israel to the verge of collapse,”

Similar claims are made by Shaul Zakay, the head of the nurses association at the Sourasky Medical Center in Tel Aviv, in ynetnews

“Our profession is facing a serious crisis… There is an immense nurse shortage, which puts the existing nursing workforce under terrible pressure and undermines the quality of care.”

More Recognition in Nurse Managed Clinics

“Studies have shown no difference in outcomes when patients are treated by a nurse practitioner or a physician.”

This quote comes from Courtney H. Lyder, dean of the UCLA School of Nursing, reported in Heral Online. As the shortage of primary care physicians increases, the importance of having nurse-managed clinics becomes evident.

Nurse Practitioners are highly advanced nurses, with an average of 10+ years of clinical work as registered nurses, and an advanced academic degree (a Masters of a Doctoral degree), who have taken specialized courses in various nursing fields. Nurse Practitioners are able to prescribe prescribing or renewing prescriptions for most drugs, perform medical examinations of various types, order blood tests, and provide many of the tasks which are usually done by primary-care doctors.

While in California the important work of Nurse Practitioners seems to be widely recognized, in other states they cannot yet perform their work independently. In Texas, for example, they can only work under the supervision of a medical doctor.

“As we celebrate these vital healthcare providers during National Nurse Practitioner Week, November 11-17, it is also a great time to truly acknowledge their growing importance within the changing healthcare landscape,” said Lyder. “Removing outdated barriers and allowing nurse practitioners to practice to the full extent of their experience and education will serve the industry, the profession and most important the patient in the best possible manner.”

Overcoming Nursing School Faculty Shortage

As the shortage in nurses grows, the salaries paid for nurses, especially those with advanced skills, will also grow. Nurses with advanced degrees are attracted to these high-paid clinical jobs rather than serving as educators for the next-generation nurses. This creates a vicious circle, as without adequate numbers of faculty members the nursing schools cannot admit all the students they want, and so less nurses are prepared to meet the markets demand.

Nursing schools which have to turn away many of their potential students are finding creative ways to overcome their faculty shortage.

One way is to pushing the age of retirement of their senior faculty members. Senior faculty who are approaching retirement age are offered good conditions, such as sharing their full-time position with other senior faculty members so that each of them can continue to work only half-time but still have all the benefits that are normally given only to full-time workers.

Another method is to pay clinical institutions for the time of some of their specialists, so that these specialists keep their positions as clinical nurses with all the benefits of these jobs, but spend some of their time teaching nursing students. This way the students gain from having teachers who are well immersed in the material they are teaching, and the university or college does not have to allocate another full-time position.

Other methods of finding more faculty members is finding grants for advanced-degree students, so that their studies are paid for in return to a commitment to teaching in this institution after graduation.

More ways of filling the faculty shortage is using advanced students for giving some of the clinical courses, or offering some the courses online so that the teachers can be living in different locations.



Nursed Managed Clinic

As we had reported here some time ago, the new trend now is nurse-managed clinics. As more people are entitled to insured health care, the shortage of primary care physicians in becoming evident. The population is aging, and these people have no doctors to turn to, especially in rural areas. The solution to this problem is emerging as nurse-managed clinics are being opened by nurse practitioners – mainly np’s who have specialized as family nurse practitioners, or geriatric nurses, or pediatric nurses.

The cost of being treated by these clinics will be much less than the cost of going to see a physician, or going to an emergency room. This doesn’t mean that the treatment one receives there is worse. In many cases, what patients need is somebody who will sit with them, listen to them patiently and help them while attending to their specific needs. Nurses, apparently, will often do this job better. They will focus on the patient and not on the disease, making the medical care more humane.

Donna Torrisi, the executive director of the Family Practice and Counseling Network, says to the NY times: “In the hospital you’ll often hear doctors refer to a patient as ‘the cardiac down the hall”. This doesn’t happen when treated by nurses, as they are educated to see the patient. They will spend the time to talk to their patients, educate them about their disease and teach them how to manage it if it is chronic disease. As Jennifer Coddington, a pediatric nurse practitioner who is a co-clinical director of Family Health Clinics, says (in the above mentioned NY Times article):

A physician might suggest that a patient lose weight and hand him a diet plan — or refer him to a nutritionist. At the Family Health clinics, nutrition counselors — graduate students at Purdue — will sit down with patients to talk about the specific consequence of their diet, and suggest good foods and how to cook them, Coddington said. “When you don’t have enough money to buy fruits and vegetables, so you go to the dollar menu at McDonald’s — we help those people put planners together for the week.”


Although the education given by nurse practitioners programs is very extensive, and some of these nurses are very highly qualified, only 16 states (and Washington D.C.) give nurse practitioners complete independence. In most countries they have to overcome many legal obstacles, which is a shame considering the evidence being gathered of the professional treatment given by these clinics.

New Accelerated Nursing Programs to be Opened in Utica

Over 1600 people were interested in enrolling to the new Accelerated Nursing Program to be opened in Utica College in Januray during the program’s planning stages. This just goes to show how hot is the nursing profession these days, when the grim economic situation has been hitting one industry after the other. The need for nurses is always in the grow. With the longer life expectation, the growing number of previously known as fatal diseases which are now curable, and with the bigger percentage of infant survival, the demand for nurses is rocketing.

The new program will have 24 slots for people who already have a bachelor degree in a field other than nursing, and are looking to change careers. The program is built to fit people who are already older and do not have the time or patience for another 3-4 years of studies. It will run for 4 semsters (16 months), with no summer or winter breaks, and will be partially online.

The prerequisites for the program will be given on individual basis, examining the previous study curriculum of each candidate and determining what pre-nursing programs should be done.

The Rush to Fulfill Nursing Prerequisites

How can future nursing students fulfill all their pre-nursing requirements, when part of the courses are given only in the spring or summer semester, and the nursing course will be starting already in the spring?

Some pre-nursing students found an innovative though demanding way to overcome this obstacle: In order not to miss a semester (or in some cases a full year) while waiting for the nursing prerequisite courses to open, they cross-enroll in more than one university or college, picking in each institute the courses that will give them the right credits towards nursing studies.

The Spartan Daily reports from San Jose:

“People want to graduate as soon as possible,” said Ngo, a junior pre-nursing major. “They don’t want to be stuck here just because they couldn’t get their classes. They don’t want to want to throw away $3000 because they couldn’t get their classes, which is the unfortunate part.”

So Kenny Ngo, a future nursing student in the San Jose State University (SJSU), had enrolled for some classes in the Evergreen Valley College.

Sometimes cross-enrollment is the solution even if the required class is given during the “right” semester: The demand for nursing classes is high, and the prerequisite class may be already full.

Not everyone finds this solution satisfactory. Studying in two different campuses may come out more expensive, and takes much more of your time as you are required to travel between the two different campuses. some find it is just not worth it, as says Esther Kiang, in the same article:

The time I needed to spend commuting to different schools meant that I didn’t have time to work if I wanted to maintain the minimum GPA required to apply for the nursing program,” Kiang said.



New RN to BSN Bridge Program to be Opened in Minnesota

The South Minnesota State University announced a new RN to BSN bridge program to be opened in fall 2013.

A task force had been assessing the need for nurses in the area, and has come to the conclusion that a bridge program is indeed needed in the region. The 19-county region has several 2-years RN programs which give an associate degree, but nurses who wish to advance their career have to go elsewhere in order to complete their bachelor studies.

A registered nurse who has not completed a BSN can only work in the more basic roles – typically as a floor nurse or in a clinic. When a nurse wants to go into any nursing specialties or administrative work, a bachelor degree is needed.

The studies in the bridge program at SMSU will be open to both part-time and full-time students, and part of the program will be done online, thus making it easier for working nurses to complete their studies while working.

The new program has not yet received its accreditation. SMSU will apply for accreditation to the Commission on Collegiate Nursing Education. This process should be straightforward, so that interested students should not be worried about this.