Surgical patients in hospitals with good working environments for nurses are less likely to be admitted into intensive care and less likely to die, new data suggest.
Those treated in settings with better nurse-physician teamwork and clinical autonomy, for example, had a 16% lower chance of being admitted to the ICU and 11% lower odds of dying within 30 days of hospital admission compared to those in poor or mixed environments.
The study included nearly 270,000 patients and is the first to directly connect nurse working conditions to ICU utilization, researchers explained in AACN Advanced Critical Care.
“Hospitals with better nurse work environments may be better equipped to provide complex patient care in a lower acuity setting without compromising a patient’s odds of mortality,” Anna Krupp, PhD, RN, an assistant professor at the University of Iowa College of Nursing, said in a statement on Monday. “A key difference between ICUs and lower acuity units is the staffing ratio of patients to nurses.”
The results are based on data from the Medicare Provider Analysis and Review, American Hospital Association (AHA) annual survey, and the RN4CAST survey of nearly 34,000 registered nurses at hospitals in four states. All patients included in the study were Medicare beneficiaries undergoing general, orthopedic or vascular surgeries across 450-plus hospitals between January 2006 and October 2007.
Nursing environments were judged using a 31-item scale backed by the National Quality Forum and hospitals were grouped into good (top 25%), poor (bottom 25%) or mixed settings, which included the 50% of organizations that ranked between the high and low scale.
ICU admissions also differed by surgical procedure, with vascular patients most often admitted (47.4%), followed by general (18.2%) and orthopedic (5.9%).
Hospitals with the top working environments for nurses tended to be nonteaching institutions with more than 250 beds, the authors noted.
Additionally, the researchers explained that a hospital’s ability to handle patient surges during the pandemic was “likely” related to the quality of its nursing environments before COVID-19.
“Fewer additional ICU beds may have been needed if hospitals had good nurse work environments prior to the pandemic, with enough nurses to safely care for patients in lower acuity settings,” Krupp added.
You can read the full study in the American Association of Critical Care Nurses flagship journal here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.