Study Finds Kaiser Permanente’s Investment in Nurses is Vital to Patient-Care Quality

Kaiser invests in nursesKaiser Permanente’s model of integrated health care delivery has received much attention due to its high-quality patient outcomes and operating efficiencies. But what role do nurses play in those outcomes? A new study from the University of Pennsylvania found that Kaiser’s investment in nursing and their work environment is an important element in the Oakland, California-based organization’s success.

“You cannot forget the bread and butter of what hospitals do, and that is provide nursing care to sick patients,” said Matthew D. McHugh, PhD, JD, MPH, RN, FAAN, the Rosemarie Greco term endowed associate professor in advocacy, Center for Health Outcomes and Policy Research at the University of Pennsylvania in Philadelphia.

The study compared Kaiser hospitals to Magnet-designated and non-Magnet-designated facilities, and found that how nursing is organized accounts for a lot of the quality advantages seen in Kaiser hospitals, McHugh explained. Kaiser hospitals have not applied for Magnet status.

The Magnet Recognition Program, developed by the American Nurses Credentialing Center (ANCC), recognizes healthcare organizations for quality patient care, nursing excellence and innovations in professional nursing practice.

“You can improve nursing delivery in an institution, and that’s one of the ways how you can achieve some of the benefits,” McHugh added.

The odds of dying in Kaiser and Magnet hospitals were less than in non-Magnet hospitals. Kaiser and Magnet hospitals also had lower odds of death following a complication, referred to as failure to rescue.

“Nurses are the early warning; they can watch and see if something is not going right,” said Marilyn Chow, PhD, RN, FAAN, vice president of national patient care services and innovation at Kaiser Permanente in Oakland.

Kaiser hospitals performed similarly to Magnet hospitals in terms of nurse work environment. Kaiser, however, had the lowest patient-to-nurse ratios, 4 patients per nurse, which are better than the California patient-nurse ratios. That compared with 4.8 in Magnet facilities and 5.1 in non-Magnet hospitals. Kaiser nurses were less dissatisfied and less likely to report intent to leave their job than nurses practicing in non-Magnet hospitals, which is important when it comes to turnover.

Kaiser hospitals have a greater proportion of RNs in the nursing mix, a higher percentage of baccalaureate-prepared nurses and better work environments than non-Magnet hospitals.

Marcia Faller, PhD, RN, Chief Clinical Officer for AMN Healthcare, believes the quality of the nursing environment directly influences the quality of patient care. “When more nurses have bachelor’s degrees, a supportive work environment and access to professional development, patient outcomes improve,” she said. “A stronger culture that invests in its nurses will foster better care for patients because nurses are the professionals who are right there, on the front lines.”

Kaiser also has an empowered, visible and nationally recognized nursing leader, Chow, in an executive position. She attributes the organization’s success to multiple factors, including a focus on people, process and technology. Chow reported investing in Kaiser’s 50,000 nurses, including providing learning opportunities, promoting a collaborative work environment, ensuring there are sufficient nurses to care for patients and allowing nursing voices are heard in clinical care delivery.

“It takes all of us to work together to raise the professional practice of the nurses and our service,” Chow said. “It’s not just one thing but a total investment. We want extraordinary care, every patient, every time.”

Chow explained how the electronic medical record system allows nursing to analyze data, identify factors associated with complications and take steps to improve patient outcomes, such as reducing pressure ulcer rates.

“An investment in nursing pays off,” Chow added. “If you invest in nurses and their learning, they have a curiosity about how to make things better.”

Kaiser’s innovation team assesses nursing barriers and challenges and develops processes for smoother operations.

“We are proud of this study, because we have invested in and partnered with our nurses,” Chow said. “Our role is to support nurses and allow them to deliver the best care. The study gives us an external validation that if you invest in your nurses, you invest in getting patients the best outcome.”

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