Karen can you find the new JAMA article?

shygirl · Oct 25, 2002

I'm not Karen but how about this?

http://jama.ama-assn.org/issues/v288n16/ffull/jtw20036.html

Shygirl

rncountry · Oct 25, 2002

Thank you!!

Home Health Columnist / Guide · Oct 25, 2002

also found this commentary in jama re aiken's research:

meeting the challenge of nursing and the nation's health

edward o'neil, mpa, phd; jean ann seago, rn, phd

the confluent issues that create the current crisis in nursing in the united states are complex, interrelated, and long-term in their nature. a number of recent studies and reports point to a common set of concerns including an aging professional population, a shrinking cohort of entry-age workers, increasing economic pressure on the hospital care setting (a large cohort of aging baby boomers who will need and demand more hospital-based care), new health care and information technology, changing nature of work in general, new life and work values for workers, and a historical sense of disenfranchisement by the general nursing population from the decision-making process in health care, particularly in the in-patient setting.1-3

in this issue of the journal, aiken and colleagues4 have once again, as they have for more than a decade, provided an analysis of one very important dimension of this crisis: the direct relationship between the level of nurse staffing and its effect on patient safety, outcomes, and the satisfaction of the nursing professionals in the hospital. they found that each additional patient per nurse was associated with a 7% increase in both patient mortality and deaths following complications and a 23% increase in nurse burnout. these findings provide significant information to the leadership of the health system as it targets efforts to address the gap in quality and performance.

an earlier assessment of the literature around these issues in the context of the california legislation mandating the ratio of nurses to filled beds found a tendency in the direction of better outcomes and higher levels of professional satisfaction with lower ratios,5 but nothing as conclusive as the study by aiken et al. refinements of this study will compare the skill mix and outcomes on different hospital units as they improve their ability to make the most effective use of nursing skills and talents.

to move this important research to action, however, points to the complexity surrounding nursing issues. of primary concern is the supply of nurses. after the california legislature passed the nurse staffing bill in the face of a deep nursing shortage, one frequently made comment was that, given the current supply of nurses, it would have been better if the legislature had enacted mandatory health, as both measures would be about as equally achievable. a recent study revealed significant nursing shortages in all but 1 of the 15 markets examined.2 even if hospital executives were committed to enriching the staffing mix, few places in the country have a readily available supply of nurses. it does not appear that large numbers of licensed nurses work at other jobs or at home waiting for pay to increase or the job environment to change. a recent study projected the gap between supply and demand for registered nurses to be 808 000 by 2020.1 therefore, a step toward improved nursing ratios will be to increase the number of nurses available for employment. this will mean making education more available and attractive, and making the process of education more effective and efficient.

expanded and improved nursing education programs that do not have full classes will not help. the work environment must make the career more attractive. moving toward improved nursing ratios will, of course, contribute to such a change but other concerns must also be addressed in such a transition. in focus groups conducted over the past 2 years, nurses have consistently identified a nonsupportive, demeaning and, at times, hostile relationship with physicians as one of the most important factors deteriorating the quality of work life for nurses.6 these focus groups also revealed dissatisfaction with pay, lack of investment in information technology to support nursing, and a lack of opportunity to deploy the skills and competencies of nurses to improve patient care and the workings of the system.2, 6 a recent report by the american hospital association has covered this set of issues and how all involved in nursing might address them.3

these improvement strategies are essential but may not be adequate to achieve the level of change that must come about if the nursing profession is to meet the challenges it faces. accepting the existing practice model for nursing as a given and more richly staffing may be desirable, but also may be unaffordable. in the context of improving patient-to-nurse staffing ratios, it is important to consider exactly what registered nurses do and when, how, and where they add value to the quality and outcomes for patient care. identifying how and where this value might be enhanced or provided less expensively by other health care workers, new technologies, or new patterns of practice would be useful. although the current system continues to operate as if the practice models throughout health care were given, it is clear that modification in nursing practice should be a part of any overall solution. changes in the practice model will require the concerted effort of the nursing profession, including both labor and management. the deep collaborative commitment that will be needed to sustain such efforts is evident in only a few places. one of the most promising is the labor-management partnership created by several california labor unions and kaiser permanente.6 the partnership serves nurses, allied health care professionals, and nonclinical workers.

it is also essential to consider changes in the professional model for the organization and governance of nursing. for example, nursing education and practice have spent the better part of a century separating from one another. the challenges of the current and future crisis may require much closer collaboration and, perhaps, new integration. the professional employee model for much of nursing practice also needs to be reconsidered. in almost every location, nurses bring their professional skills to practice as employees while other health professionals, such as dentists, psychologists, speech therapists, and physical therapists, practice as independent professional groups. perhaps it is time to begin exploring how the organization, governance, and financing of nurses as professional groups might move closer to other models of professional organization in hospitals such as with radiologists and anesthesiologists. in many ways, the story of nursing in the 20th century is one of an incomplete revolution in which the independence and autonomy of the profession remained fettered and unable to demonstrate fully its potential contributions to care and health.7 to complete the revolution will require encouragement from outside of nursing as well as significant leadership from within. without such a change, the promise of nursing will remain unrealized.

the nursing shortage is a part of a wider range of problems that beset health care in general. efforts to address the shortage of nurses, and to do so in the context of hospital care, must recognize that in many ways a hospitalization remains an expensive failure of the overall health system. that is, many, if not most, hospitalizations represent a failure to prevent an unintentional injury, properly manage a chronic disorder, or use an appropriate alternate therapy such as hospice. the policy question should not be limited to including only how a more intensive ratio of nurses in the hospital can be provided, but, given limited resources, where the addition of nursing care and service can be best applied both for the patient as well as for society. would an expanded and aggressive public and community nursing program provide more benefit? or could giving every patient access to primary care using nurse practitioners, physician assistants, and physicians actually reduce the demand for in-patient care and the need for more nurses in hospitals? these and other difficult questions must be answered to meet the needs of an aging society and to ensure effective use of human and economic resources.

aiken et al have provided an important piece of scholarship that helps us to understand more completely the contributions of more intensive nurse staffing to patient safety, outcomes, and the job satisfaction of nurses. policy makers and institutional leaders must be mindful of this as they move to respond to issues in nursing and in health care. it will be essential to pose these larger questions continuously to seek the best answers and outcomes for the profession of nursing, the patients they serve, and society as a whole.

http://jama.ama-assn.org/issues/v288n16/ffull/jed20059.html

-jt · Oct 25, 2002

The only thing new about it is the media response after it was published in JAMA.

Just goes to show how nurses continue to be ignored by the media. Everything is a non-issue until the physician community decides its an issue. THEN its newsworthy.

-jt · Oct 25, 2002

FOR IMMEDIATE RELEASE October 23, 2002

CONTACT:

Carol Cooke, 202-651-7027

Cindy Price, 202-651-7038

[email protected]

rn[email protected]

http://www.nursingworld.org/rnrealnews

JAMA Article Links Hospital Staffing and Patient Mortality, Nurse Burnout and Job Dissatisfaction

ANA's Blakeney calls on hospitals to utilize Principles for Nurse Staffing to address problem

Washington, DC -- A study published today in the Journal of the American Medical Association (JAMA) found that Registered Nurse (RN) staffing levels have a significant effect on preventable hospital deaths among surgical patients. According to researchers, the odds of patient mortality rose 7 percent for every additional patient added to the average nurses's workload.

The difference between four to six and four to eight patients-per-nurse was accompanied by a 14 percent and 31 percent increase in mortality respectively. The study from the University of Pennsylvania affirms the critical role RNs play in patient safety when able to make direct assessments and life-saving interventions.

"This new study is dramatic because it highlights the fact that people can die when nursing care is inadequate," said Barbara A. Blakeney, MS, APRN,BC, ANP, president of the American Nurses Association (ANA). "It is an important contribution, but, frankly, this is something that nurses have known for years," she said. "Nurses make the critical, cost-effective difference in providing safe, high-quality patient care," she added. Blakeney pointed to ANA's own report, Nurse Staffing and Patient Outcomes in the Inpatient Hospital Setting," which was released in May 2000.

The ANA study looked at hospital and Medicare data in nine states in five categories of adverse outcomes: length of hospital stay, hospital-acquired pneumonia, postoperative infection, bed sores and hospital-acquired urinary tract infections. All five measures were markedly lower with higher levels of RN involvement in patient care.

Two other studies published this year, one in the New England Journal of Medicine and one by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), also found direct links between nurse staffing levels and better patient outcomes. Today's JAMA article also reported that patient load had a direct impact on nurse retention rates. Adding one patient-per-nurse to a hospital's staffing level increased nurse burnout by 23 percent and job dissatisfaction by 15 percent.

The data indicate that more than 40 percent of nurses who reported high burnout and job dissatisfaction intended to leave their job within the next year."Inappropriate staffing is the number one concern of nurses today," ANA president Blakeney said. "Nurses already face great stress and challenges on the job. They must care for greater numbers of patients than ever before and patients in hospitals are more acutely ill than in the past. Adequate nurse staffing is critical to the delivery of quality patient care because it allows nurses time for appropriate assessment of patients and their needs and initiation of suitable interventions."

Blakeney emphasized that nurses are dissatisfied because of a lack of control over their work environment which prevents them from delivering high-quality nursing care. In addition to the right number and mix of direct-care staff for hands-on care, other resources are necessary to support RNs' ability to deliver the best possible care.

ANA has developed and strongly encourages the use of its Principles for Nurse Staffing, which include: nurse control over the practice environment; effective and efficient support services; readily available and current patient information; sufficient orientation and mentoring for new staff and new nursing graduates; education in the use of new technology; and sufficient time for collaboration, planning, coordination and delivery of care that meets both patient and family needs.

Research has shown that hospitals which incorporate much of the philosophy embedded in the Principles for Nurse Staffing into their organizational culture and practice have higher rates of satisfaction and retention among nursing staff, and better outcomes for patients. ANA is advocating for a comprehensive set of strategies to address the nurse staffing crisis, including state and federal legislation that would limit mandatory overtime, provide whistle-blower protections for nurses, mandate collection of workforce and nursing-sensitive quality data, establish patient staffing systems and provide funding for nursing education. In addition, hospitals that utilize nursing "best practices" can apply for designation as "Magnet" facilities a recognition made by the American Nurses Credentialing Center, a subsidiary of ANA. Hospitals that have achieved "Magnet"status have higher retention rates for nurses and improved patient outcomes.

Many of the issues touched on in the JAMA study have been addressed in Nursing's Agenda for the Future (http://www.NursingWorld.org/naf). The plan, which was released in April, is the result of an in-depth strategic planning process that involved leaders from more than 60 national nursing organizations. It reflects the "brain trust" of nursing and includes strategies to address basic issues, such as recruitment, as well as more complex issues, such as the economic value of nursing.

The authors of the new JAMA study said that improving nurse staffing may not only save patient lives and decrease nurse turnover but also reduce hospital costs, if recently published estimates of the costs of replacing a hospital medical and surgical general unit and a specialty nurse ($42,000 to $64,000) are correct.

"Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction," by Linda H. Aiken, et. al, appears in the October 23/30, 2002 issue of JAMA. The study, funded by the National Institute of Nursing Research of the National Institutes of Health, looked at 232,342 patients between the ages of 20 and 85 who underwent general surgical, orthopaedic, or vascular procedures in 168 Pennsylvania hospitals from April 1, 1998, to Nov. 30, 1999.# # #

http://www.ana.org/pressrel/2002/pr1023.htm