Inadequate staffing leads to nurse burnout which leads to lower patient outcomes. Someday hospital number crunchers will finally see this truth and be proactive in setting nursing budget. Karen Penn study examines link between nurse burnout, care
July 31, 2012
By Don Sapatkin, Inquirer Staff Writer
AJIC: American Journal of Infection Control Volume 40, Issue 6
For years, as hospitals cut costs to survive ever-increasing financial pressures, nurses argued that inadequate staffing harms patients.
California's controversial and, so far, unique response was to mandate minimum nurse-to-patient ratios, which, if applied locally, would prevent 222 surgical deaths annually in New Jersey and 264 in Pennsylvania, researchers here calculated in 2010.
Now members of that same University of Pennsylvania team say they have figured out a key reason for that. Though it might seem clear-cut - fewer caregivers provide poorer care - they maintain the issue is not simply numbers but a bad work environment.
Staffing, of course, is a big part. When there also is a lack of teamwork and support from the top, and an inability to act independently, "stress builds up and builds up and builds up until the giver of care just detaches," said lead author Jeannie P. Cimiotti, and "all of a sudden they are doing work, but they are not even cognizant of what they are doing, they are so stressed." They may forget to wash their hands.
The study is believed to be the first to examine why staffing matters. It also is among the first to measure the potential harm - both injuries for patients and costs for hospitals - using detailed infection data available only in Pennsylvania, where reporting is mandatory.
If hospitals could reduce their proportion of burned-out nurses to 10 percent from the 30 percent that is typical, according to the study, they would prevent 4,160 cases a year of the two most-common hospital-acquired infections statewide and save $41 million. Insurers are increasingly unwilling to reimburse the expense of treating preventable infections....
..."It is costing hospitals more money not to spend money on nursing," said Linda H. Aiken, another author of the study and director of the Penn nursing school's Center for Health Outcomes and Policy Research.
Burnout builds through a cycle of exhaustion, cynicism, and lack of civility, he said. Nurses, who are licensed and must uphold professional standards, may also experience "a value conflict with their employer" if they believe that finances are trumping patient care, Leiter said.
"Basically, what makes burnout is bad management."
Pressure on nurses has risen in recent years as medical conditions have gotten more complex and lengths of patient stay have shortened. Trenton and Harrisburg are among dozens of state capitals where nurse-backed legislation mandating minimum staffing ratios has been introduced but not passed....
, Pages 486-490, August 2012
Nurse staffing, burnout, and health careľassociated infection
Jeannie P. Cimiotti, DNSc, RN; Linda H. Aiken, PhD; Douglas M. Sloane. PhD; Evan S. Wu, BS
Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association.
We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health careľassociated infections.
There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million.
We provide a plausible explanation for the association between nurse staffing and health careľassociated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities.