Addressing the Restrictive Effect of the MCAT on the Minority Physician Workforce The results showed that the men who met with black physicians asked to receive more preventive services than men who met with nonblack physicians.
Nurse understaffing is ranked by the public and physicians as one of the greatest threats to patient safety in US hospitals. These findings also raise questions about whether characteristics of the hospital RN workforce other than ratios of nurses to patients are important in achieving excellent patient outcomes.
Nurses constitute the surveillance system for early detection of complications and problems in care, and they are in the best position to initiate actions that minimize negative outcomes for patients. Indeed the conventional wisdom is that nurses' experience is more important than their educational levels.
Despite the diversity of educational programs preparing RNs, and a logical but unconfirmed connection between education and clinical judgment, little if anything is known about the impact of nurses' education on patient outcomes.
This variability provides an opportunity to conduct a similar study examining the association between the educational composition of a hospital's RN staff and patient outcomes.
Specifically, we tested whether hospitals with higher proportions of direct-care RNs educated at the baccalaureate level or above have lower risk-adjusted mortality rates and lower rates of failure to rescue deaths in patients with serious complications.
We also examined whether the educational backgrounds of hospital RNs are a predictor of patient mortality beyond factors such as nurse staffing and experience. These findings offer insights into the potential benefits of a more highly educated nurse workforce.
Methods Data Sources, and Variables We analyzed outcomes data derived from hospital discharge abstracts that were merged with information on the characteristics of the treating hospitals, including unique data obtained from surveys of hospital nurses.
Six of the excluded hospitals were Veterans Affairs hospitals, which do not report discharge data to the state. Twenty-six hospitals were excluded because of missing data, most often because their reporting to external administrative sources was done as aggregate multihospital entities. Ten small hospitals, most of which had 50 or fewer beds, had an insufficient number of nurses responding to the questionnaire to be included.
This suggests similar response rates across hospitals and no response bias at the hospital level. Moreover, demographic characteristics of the respondents paralleled those of Pennsylvania hospital nurses in the National Sample Survey of Registered Nurses.
Hospital staff nurses were asked to indicate whether their highest credential in nursing was a hospital school diploma, an associate degree, a bachelor's degree, a master's degree, or another degree.
The proportion of nurses in each hospital who held each type of credential was computed.
Because the educational preparation of the 4. It was later verified that this decision did not bias the results. Because there was no evidence that the relative proportions of nurses holding diplomas and associate degrees affected the patient outcomes studied, those 2 categories of nurses were collapsed into a single category and the educational composition of the hospital staff was characterized in terms of the percentage of nurses holding bachelor's or master's degrees.
Two further variables were derived from the nurse survey. Nursing workload was computed as the mean number of patients assigned to all staff nurses who reported caring for at least 1 but fewer than 20 patients on the last shift they worked.
Because nurse experience was an important potential confounding variable related to both clinical judgment and education, the mean number of years of experience working as an RN for nurses from each hospital was also calculated and used in the analyses.
Three hospital characteristics were used as control variables: Hospitals without any postgraduate medical residents or fellows nonteaching were distinguished from those with 1: High-technology hospitals were those that had facilities for either open-heart surgery, major organ transplantations, or both.
Patients and Patient Outcomes.included acute care California hospitals and , effects of nurse staffing on patient outcomes were exam-ined with controlled patient and hospital characteristics.
The NSPOM also hypothesizes that there are no direct effects of nurse staffing on morbidity, mortality, and costs. This integrative literature review assesses the relationship between hospital nurses’ work environment characteristics and patient safety outcomes and recommends directions for future research based on examination of the literature.
More than a decade of research has shown that the quality of nursing care has a direct effect on patient outcomes across a range of clinical scenarios.
Multiple studies show a positive correlation between a baccalaureate nursing education and patient outcomes.
Aiken and colleagues found that a better patient care environment, as measured using the National Quality Forum's Practice Environment Scale of the Nursing Work Index (PES- NWI), was associated with lower patient mortality and better nurse outcomes.
Matthew McHugh, Ph.D., RN, an assistant professor of nursing at the University of Pennsylvania, noted that a quality work environment usually leads to a number of quality patient outcomes, such as lower mortality rates and lower levels of failure-to-rescue.
The effect of decreasing workloads by 1 patient/nurse on deaths and failure-to-rescue is virtually nil in hospitals with poor work environments, but decreases the odds on both deaths and failures in hospitals with average environments by 4%, and in hospitals with the best environments by .