Increased nurse staff levels tied to lower odds of Medicare readmissions penalties, s - page 2

by herring_RN 2,625 Views | 15 Comments Guide

Nursing unions wanting higher staffing ratios have more ammunition thanks to a new study concluding that increasing nurse staffing levels could help hospitals avoid Medicare penalties for avoidable readmissions. The study... Read More


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    Nurses have more time to actually teach with less patients. I'm not talking about one on one but say in Med Surg, you have 6-7 instead of 10 with no nurses aid or only one aid for 40 patients etc. (just an example) If patients actually understand their disease and can perform their own care properly, then they are less likely to have readmissions.
    herring_RN likes this.
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    In 2002 an extensive study determined that for every additional more than four the odds of dying due to "failure to rescue' increased by 7% and each additional patient assigned to a nurse increased the odds of death.

    Hospital Nurse Staffing and Patient Mortality

    ... Results
    After adjusting for patient and hospital characteristics (size, teaching status, and technology), each additional patient per nurse was associated with a 7% (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11) increase in the odds of failure-to-rescue....

    ... Our results imply that had the patient-to-nurse ratio across all Pennsylvania hospitals been 4:1, possibly 4000 of these patients may have died, and had it been 8:1, more than 5000 of them may have died. While this difference of 1000 deaths in Pennsylvania hospitals across the 2 staffing scenarios is approximate, it represents a conservative estimate of preventable deaths attributable to nurse staffing in the state...

    JAMA Network | JAMA | Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
    Altra, laborer, and gonzo1 like this.
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    Maybe we should shift this to the "what baffles you" thread.
    It certainly makes no sense.
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    I understand the recommended ratios, and I think 4:1 or 5:1 for med surg is fine generally speaking. What I don't agree with in these studies is the concept that every single nurse you add improves patient care equally...say 5% or 10% improvement in measurement 'X.' That logically doesn't make sense. Having 6 nurses versus 5 for a 35 bed floor is a much bigger change than 8 versus 7 for a 35 bed floor. You're watering things down when you say "every extra nurse saves you 10% in readmission rates." That's like saying every cigarette cuts your life by 10 minutes based on a statistical analysis of life spans of smokers and non-smokers controlled for socioeconomic status and healthcare access; you don't actually get that 10 minutes back by not smoking 1 more cigarette.

    You have to make the data applicable to the specific situation, and a lot of these studies don't do that. Administrators want to know: "What should my ideal ratios be to minimize costs?" They want research to support specific ratios for a specific acuity level. Without that focus, I think these studies won't have nearly the impact that they otherwise could have.
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    Quote from jfratian
    Administrators want to know: "What should my ideal ratios be to minimize costs?" They want research to support specific ratios for a specific acuity level. Without that focus, I think these studies won't have nearly the impact that they otherwise could have.
    Which is why we, as nurses, need to give up on trying to convince a group of people whose behaviour towards safe staffing is that of a sociopath. Unless staffing is mandated by law with penalites for failure I have yet to meet a hospital adminstrator who is persuaded by any study that calls for better staffing. The CDC ten years ago linked nosocomial infections to staffing ratios but every time I have mentioned that to a nurse manager there is....silence.
    wooh and herring_RN like this.
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    Quote from Chisca
    Which is why we, as nurses, need to give up on trying to convince a group of people whose behaviour towards safe staffing is that of a sociopath. Unless staffing is mandated by law with penalites for failure I have yet to meet a hospital adminstrator who is persuaded by any study that calls for better staffing. The CDC ten years ago linked nosocomial infections to staffing ratios but every time I have mentioned that to a nurse manager there is....silence.
    Bring it to the people that matter...our patients.

    Also, I thought that there were penalties for unsafe staffing in place...if so, there needs to be a way for no loopholes to occur.
    laborer and herring_RN like this.


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