Hospital Acquired Conditions, Patient Safety

Happier Nurses = Better Patient Care

A recent report by Press Gainey, “Nursing Special Report: The Influence of Nurse Work Environment on Patient, Payment and Nurse Outcomes in Acute Care Settings” suggests that happier nurses lead to better patient care. The report examines the impact of nurses’ work environment on key performance measures.

The Press Gainey report found that hospitals with better nurse staffing and work environments tend to have fewer readmissions for heart failure, pneumonia and myocardial infarction. Says the Press Gainey report:

Staffing and work environments influence the efficacy and the efficiency of nurses’ delivery of discharge instructions that ensure patients understand how to care for themselves and when to seek medical attention post discharge. These instructions are critical to reducing readmission rates and must be provided throughout the patient stay … Although readmission rates are generally lower when staffing is better, the nurse work environment has a significant positive impact on readmissions, even in settings with lower staffing scores.

As the chart below illustrates, hospitals with above median staffing scores have a fewer readmissions compared with hospitals with below median staffing scores.

Nurses' Satisfaction and Readmissions

Moreover, hospital-acquired conditions (like patient falls and pressure ulcers) are less likely to occur in hospitals with happier nurses, as illustrated in the chart below:

Nurses' Satisfaction and Patient Falls

According to the report:

Organizations with above-median staffing composite scores outperform those with below-median staffing composites in each work environment quartile. However, hospitals with below-median staffing composites in the highest quartile of work environment outperform the hospitals with above-median staffing composites in the first three quartiles. Further, the difference in fall rates between above- and below-median staffing is virtually indistinguishable among hospitals in the least favorable work environment—demonstrating that in the least-optimal work environments, improving the staffing factors cannot be counted on to reduce falls.

In a recent article in American Nurse Today, Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, FAANP recommends tailoring falls-prevention interventions to each patient and discusses some “do’s” and “don’ts” to prevent patient falls. Examples of “do’s” and “don’ts”:

  • DO schedule time with the patient and family to review results of the nursing and interdisciplinary fall risk assessment and defined fall risk factors.
  • DON’T simply tell a patient he or she is at risk for falls, apply an armband, post a no-falls sign, and report to the next shift that a patient is a high fall risk.

So, what can nurses do on their daily patient rounds?

In an article, “The value of purposeful rounding”, Jane McLeod, MSN, RN, and Sue Tetzlaff, MHA, RN, FACHE, RHIA recommend:

For our patients’ sake, we need to get beyond our frustrations with purposeful rounding efforts and beyond the perception that rounding is just another daily task in a seemingly endless list. Remember—purposeful rounding is purposeful work. Patients aren’t interruptions in our work; they are our work. Purposeful rounding is a proactive strategy that helps us manage our work.

A formal process-improvement initiative driven by frontline caregivers is the vehicle that makes purposeful rounding happen—and makes it stick. If you’ve tried it and it’s not working, try again. If you’re about to make that first attempt, just start.

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