More TLC (by the Nurse) Better for Hospital Patients

  1. Interesting Article to Share:

    http://www.gjsentinel.com/health/con...sp/507402.html


    More TLC Better for Hospital Patients

    WEDNESDAY, May 29 (HealthScoutNews) -- Tender loving care in the hospital is more than a nicety -- it's key to your health.
    People who get more contact with registered nurses do better across a wide range of measures than patients in hospitals with smaller staffs, a new study has found. They have fewer serious infections, such as pneumonia and sepsis, less gastric bleeding and even fewer heart attacks and bouts of shock.

    However, the effect is limited almost entirely to highly trained registered nurses (RNs), and not to more junior nurses and aides.

    A report on the findings appears in tomorrow's The New England Journal of Medicine.

    By many accounts, the nation is facing a nursing shortage whose worst years are coming. American hospitals will experience a shortage of 400,000 nurses by the year 2020, according to a recent study.

    What's more, the average age of nurses is rising as younger men and women leave the field or reject it for other professions. According to a 2001 report from the General Accounting Office, four in 10 registered nurses will be over age 50 by the year 2010.

    The new study was led by Jack Needleman, of Harvard University's School of Public Health, and Peter Buerhaus, senior associate dean for research at Vanderbilt University's School of Nursing.

    It compared patient outcomes and nurse staffing in 799 hospitals in 11 states -- Arizona, California, New York, Maryland, Massachusetts, Missouri, Nevada, South Carolina, Virginia, West Virginia and Wisconsin.

    It looked at 25 outcomes for both medical and surgical patients, including length of stay, risk of urinary tract infections, hospital-acquired pneumonia and blood infections, leg clots, heart attacks and death.

    The researchers also tracked a catch-all category called "failure to rescue," which included deaths from particular complications -- shock, cardiac arrest, upper gastrointestinal bleeding, pneumonia, sepsis and deep vein clots. These conditions can be caught by registered nurses, but failure to identify them in time can be deadly.

    On average, patients received 11.4 hours of nursing care, nearly 70 percent of which was provided by RNs. The rest was split between licensed practical nurses (LPNs) and nurses' aides.

    Hospitals that provided more RN care had between a 3 percent and 12 percent reduction in adverse outcomes, while higher staffing levels across the board were linked to a 2 percent to 25 percent drop, the researchers found.

    The link between patient welfare and staffing was strongest for the hospitals with the highest share of RNs.

    Although the level of skilled nursing care didn't reduce a patient's overall risk of dying, more RN hours did cut the chances of a "failure to rescue" death, the researchers found.

    "Those complications could easily get away from the team and the patient could die," says Buerhaus, who notes the death rate for these conditions in low-staffed hospitals was 18 percent to 20 percent.

    "The nurse who picks up on these complications and acts quickly to intervene rescues that patient, whereas when you are in a hospital with low staffing, there's less of a chance that a nurse will be able to do so," Buerhaus says.

    Patricia Rowell, a policy specialist for the American Nurses Association, says the study is consistent with earlier work linking nurse-staffing levels to healthier patients. However, it's not simply a question of more bodies on the ward.

    "There is a difference in who you're providing, not just in the numbers but in the knowledge they bring to the work that they're doing," Rowell says. Registered nurses are better able than nurses' aides and nurse practitioners to identify patient conditions that need immediate medical attention, she says.

    Yet for the last decade or so, hospitals have been substituting these more junior staffers for better paid RNs to cut costs, she says.

    The new study met with little surprise at one big-city hospital.

    "There's a direct relationship" between patient health and the number of registered nurses on hand, says Dawn Bloch, an RN at Columbia-Presbyterian Medical Center in New York City. "We love people, and we want the best for them."
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  2. 12 Comments

  3. by   oramar
    Is this a validation of the much talked about earlier study??? I am hoping that it is, that is the way I read it.
  4. by   JohnnyGage
    Quote from nightngale1998
    "There is a difference in who you're providing, not just in the numbers but in the knowledge they bring to the work that they're doing," Rowell says. Registered nurses are better able than nurses' aides and nurse practitioners to identify patient conditions that need immediate medical attention, she says.

    Yet for the last decade or so, hospitals have been substituting these more junior staffers for better paid RNs to cut costs, she says.

    I like it... but I'm a bit concerned with the apparent mistake that LPN=NP. I'm sure it was a misunderstanding by the author, but it could be potentially damaging to nurse practitioners.

    All in all, though, great validationi!
  5. by   leslie :-D
    although i agree with the article contextually, i've also met highly competent lpn's and not so competent rn's. very generally speaking, i agree.
  6. by   mattsmom81
    I think this is important as it is one more study that counters the trend to place more unlicensed assistive staff on duty with less nurses, as well as some hospitals' efforts to staff with mostly LPN's with one RN supervising them.

    Laws have mandated a certain # of RN's on duty; now we have some hard data to support WHY more of us are needed. The public needs to know that facilities are aware of these studies, yet are staffing with LESS RN's to 'save a buck'...and they are risking the health of their patients by doing so.

    I have seen this going on for a long time and I'm glad the studies are supporting what I am seeing out there. Facilities ARE beginning to pay attention, I see this in their effort to place RN's in higher visibility and different uniforms, etc.
  7. by   Tweety
    More nurses........better outcomes...........duh.

    Mattsmom, whenever I'm critically short staffed and talking with the supervisor she'll say "I've got plenty of CNA's, I'll give you another one". Me: "I've already got three CNAs, having another CNA will just help the other CNAs get done quicker and isn't going to help me or the RNs at all." You can have 20 CNAs on the floor, but you still need a safe Licensed nurseatient ratio, IMHO.
  8. by   RN4NICU
    i think the public would understand it better if people would stop referring to rn care by cutesy little euphamisms such as "tlc" and start calling it what it is: professional assessment. that, not tender loving care, is what separates what the rn brings to the table versus what "junior nurses and aides" bring. anyone can care. not everyone is qualified to assess. hospitals fell into the trap of thinking it was just tlc when they went gung-ho on replacing rn's with junior staff. patient outcomes suffered - proof that it takes more than tlc. it takes the skill and expertise of a professional nurse.
  9. by   leslie :-D
    Quote from rn4nicu
    i think the public would understand it better if people would stop referring to rn care by cutesy little euphamisms such as "tlc" and start calling it what it is: professional assessment. that, not tender loving care, is what separates what the rn brings to the table versus what "junior nurses and aides" bring. anyone can care. not everyone is qualified to assess. hospitals fell into the trap of thinking it was just tlc when they went gung-ho on replacing rn's with junior staff. patient outcomes suffered - proof that it takes more than tlc. it takes the skill and expertise of a professional nurse.
    i couldn't agree with you more. i for one, am sick and tired of nsg. being so underestimated. your post was right on the money.
  10. by   JohnnyGage
    I agree about the "TLC". So... get involved!

    Write: Letters to the Editor, The Daily Sentinel, P.O. Box 668, Grand Junction, 81502. Fax: 244-8578. E-mail: letters@gjds.com. Include name, address and telephone number. Letters should be no longer than 300 words.

    Here's my letter. I know it's short, but I wanted to keep it under the 300 and I wasn't about to count by hand...


    I read with great interest your article of May 29, "More TLC Better for Hospital Patients." I find it odd that while you discuss the importance of "highly trained registered nurses" you still refer to their care as stereotypical "TLC". Anyone can give "tender, loving care". In fact, this is what hospitals were counting on when they started cutting back their registered nursing staff for lesser trained personnel such as LPNs and nurse assistants. Registered nurses, however, are highly trained, college educated professionals with backgrounds in anatomy, physiology, pharmacology, chemistry, and nursing science. It is this training and education that benefits patients, not their ability to give a little extra "TLC". Summing up years of education and training with the quaint phrase "TLC" only does a disservice to the professionalism of registered nurses everywhere.
    Last edit by JohnnyGage on Jun 14, '04 : Reason: Adding my letter
  11. by   mattsmom81
    Quote from JohnnyGage
    I agree about the "TLC". So... get involved!

    Write: Letters to the Editor, The Daily Sentinel, P.O. Box 668, Grand Junction, 81502. Fax: 244-8578. E-mail: letters@gjds.com. Include name, address and telephone number. Letters should be no longer than 300 words.

    Here's my letter. I know it's short, but I wanted to keep it under the 300 and I wasn't about to count by hand...


    I read with great interest your article of May 29, "More TLC Better for Hospital Patients." I find it odd that while you discuss the importance of "highly trained registered nurses" you still refer to their care as stereotypical "TLC". Anyone can give "tender, loving care". In fact, this is what hospitals were counting on when they started cutting back their registered nursing staff for lesser trained personnel such as LPNs and nurse assistants. Registered nurses, however, are highly trained, college educated professionals with backgrounds in anatomy, physiology, pharmacology, chemistry, and nursing science. It is this training and education that benefits patients, not their ability to give a little extra "TLC". Summing up years of education and training with the quaint phrase "TLC" only does a disservice to the professionalism of registered nurses everywhere.
    Great points...I am soooo tired of the 'cutsie pie nurse' image, the hug-a-nurse stuff, little bears on our uniforms, etc ad nauseum.

    If we want to be professionals we must act professional.
    Last edit by mattsmom81 on Jun 16, '04
  12. by   oramar
    Don't forget now, the basic study is solid. The way I read it the TLC part came up as result of interpetation by a journalist.
  13. by   RN4NICU
    Quote from oramar
    Don't forget now, the basic study is solid. The way I read it the TLC part came up as result of interpetation by a journalist.
    That was my point. It's irresponsible journalism to report that RN's are "TLC" providers rather than educated professionals.
  14. by   mattsmom81
    Quote from RN4NICU
    That was my point. It's irresponsible journalism to report that RN's are "TLC" providers rather than educated professionals.
    So ...the media again...a familiar trend....start writing letters guys 'n gals!

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