Want to know about the quality of care at a hospital? Ask the nurses who work there.A new study, funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research, reveals that nurses are extremely accurate, reliable assessors of the quality of care in the hospitals in which they work. 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 that allows for close, frequent and long interactions with patients.
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.
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.