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Nurses Extremely Accurate in Assessing Hospital Quality of Care, Study Finds

A new study reveals nurses are very accurate in assessing the quality of hospital care in the hospitals in which they work.

The study, published online in the journal Research in Nursing and Health, was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research

The primary investigators were Matthew McHugh, PhD, JD, MPH, RN, CRNP, assistant professor at the University of Pennsylvania School of Nursing, and Amy Witkoski Stimpfel, PhD, MSN, post-doctoral research fellow at the University of Pennsylvania School of Nursing (Penn Nursing Science) in Philadelphia.

The researchers analyzed existing data for hospitals in California, Florida, New Jersey and Pennsylvania, which represent 20 percent of annual hospitalizations in the U.S.

The data included:

  • nurses' reports on quality of care from the Multi-State Nursing Care and Patient Safety Study;
  • patient assessments of care from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) from the Centers for Medicare and Medicaid Services;
  • hospitals' reports on care measures for heart failure, pneumonia, acute myocardial infarction and surgical care; and
  • administrative data on mortality and failure to rescue.

The research team asked nurses, "How would you describe the quality of nursing care delivered to patients in your unit?" Responses could be: excellent, good, fair and poor.

The researchers found that when nurses wsaid the quality of care was excellent at a hosital it corresponded with:

  • higher levels of patient satisfaction;
  • better scores for processes of care, e.g., giving heart attack patients aspirin when they arrive at the hospital, providing patients with appropriate and complete discharge instructions, or ensuring pneumonia patients get the best initial antibiotics; and
  • better results for patients in the hospital with regard to mortality and failure to rescue.

For every additional 10% in the proportion of nurses reporting that the quality of care on their unit was excellent, there was a 3.7 point increase in the percent of patients who would recommend the hospital, and a 5% decrease in the odds of mortality and failure to rescue for surgical patients.

Nurses' reports of excellent quality were higher in hospitals known to have good work environments that support professional nursing practice. Higher proportions of nurses working in Magnet recognized hospitals and in hospitals with good practice environments, measured by the Practice Environment Scale of the Nursing Work Index also developed at the University of Pennsylvania, reported that the quality of care in their workplace was excellent.

"Nurses have insight into aspects of quality that aren't always documented, but which can make the all-important difference in patient outcomes," said McHugh. "They are involved in direct interactions with patients, provide education and support to patients and their families, work alongside other members of the interprofessional healthcare team, and regularly interact with other frontline staff and management, and know how technology and information systems are integrated into the healthcare system. These things make a difference."

McHugh and his colleagues suggest that while patients are the most relevant reporters of quality of care, nurses can also be a valuable source of information about this measure and can report on quality in settings where patients can't always provide that information, such as critical care, end of life or some pediatric settings.

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