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Improving nurses' work environments could lead to lower readmissions

A study published in a recent issue of Medical Care found that increased nurse-to-patient staffing ratios and good work environments for nurses were tied to lower 30-day readmission rates for Medicare patients suffering from heart failure, myocardial infarction and pneumonia.

The research team analyzed data from a cross-sectional survey of registered nurses in California, New Jersey and Pennsylvania about hospital work environment, nurse staffing levels and educational attainment. The team also used data on hospitals' structural characteristics from the American Hospital Association Annual Survey, and data on admissions and readmissions from state discharge abstract databases. They focused specifically on Medicare patients with heart failure, acute myocardial infarction and pneumonia.

According to Matthew McHugh, study leader and assistant professor at the University of Pennsylvania School of Nursing, the study, which was funded by the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program, revealed that, even after accounting for patient and hospital characteristics, nurse staffing levels and nurses' work environment had a significant impact on readmissions for heart failure, myocardial infarction and pneumonia patients. Nurses' education levels (the percentage of nurses with baccalaureate degrees in nursing) also had a significant effect on readmissions, but only for patients with pneumonia.

[See also: Nurse staffing, burnout linked to HAIs]

"Our findings indicate that improving nurses' work environments and reducing their workloads can reduce readmissions for Medicare patients with common conditions," said McHugh. "If it's a good place for a nurse to work, he or she is able to do the things that help prevent readmissions. It's important to have good relationships with colleagues and physicians, and support by managers. This is one thing hospitals know they can do to keep patients out of the hospital. Regardless of what the outcome is, patients are better off in hospitals where nurses are happier doing their job."

According to the study, each additional patient per nurse in an average nurse's workload was associated with a 7 percent, 6 percent and 9 percent higher odds of readmission for heart failure patients, pneumonia patients and myocardial infarction patients, respectively, within 30 days of being discharged. Care in hospitals with good versus poor work environments for nurses was associated with 7 percent, 6 percent and 10 percent lower odds of 30-day readmission for heart failure patients, myocardial infarction patients and pneumonia patients, respectively.

Ann Kutney-Lee, an assistant professor of nursing at the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing, has worked with McHugh on two other studies published in the last few years that indicated higher nurse satisfaction leads to higher patient satisfaction and better outcomes.

 "Patient satisfaction is more important than ever before now that HCAHPS scores are publicly reported and patients can go online and see how these scores compare in their region," said Kutney-Lee. "Increased attention to patient experience is important because not only is it more visible to the public and payers, it's also more important to hospitals because their Medicare reimbursements will be based upon these scores."

[See also: Readmissions increase at Pennsylvania hospitals, but mortality declines]

McHugh added that improving a nurse's work environment by hiring additional staff and having a lot of support from managers are potential answers for higher nurse satisfaction and ways a hospital can attempt to reduce their readmissions.

[See also: Staffing solutions save time, money]