Increased Nurse Staffing Leads to Greater Patient Satisfaction
By Debra Wood, RN, contributor
American patients generally express satisfaction with their hospital stays, and those treated in facilities with a high ratio of nurses to patient days feel more positively about their experience than other patients, according to a new study published in the New England Journal of Medicine.
“Whenever there is more attention paid to the consumer, the product is more popular,” said Patricia M. Chute, EdD, dean of the School of Health and Natural Sciences at Mercy College in Dobbs Ferry, New York. “From a perspective of having a higher nurse staffing level, it results in a perception by consumers that the hospital is a better place.”
Researchers from the Harvard School of Public Health, Brigham and Women’s Hospital, and the Boston Veterans Affairs Healthcare System, all in Boston, assessed the performance of hospitals using data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Agency for Healthcare Research and Quality. The data reflected the experiences of patients treated from July 2006 through June 2007 at more than 2,400 hospitals. Thirty-six percent of patients returned the surveys.
The team found that patients had moderately high levels of satisfaction with the care they received, as reported in the published study. On average, 63 percent of patients gave their care a high rating of nine or 10 on a 10-point scale.
“Hospitals need to be doing a better job at caring for their patients,” said Barbara Ficarra, RN, BSN, MPA, administrative head nurse at Hackensack University Medical Center in New Jersey, who also serves as executive producer of the “Health in 30” radio show.
An additional 26 percent of the patients surveyed rated their care as seven or eight, and 11 percent gave a rating of six or less. In addition, 67.4 percent of patients “would definitely recommend the hospital” and 27 percent said they “would probably recommend it.”
“It may depend on the patient and his or her relationship with the hospital,” said Marilyn A. DeLuca, PhD, RN, executive director of the Jonas Center for Nursing Excellence in New York City. “Of the recently discharged patients surveyed, just 36 percent responded, and we don't know what prompted these patients to participate.”
Seventy-nine percent of patients said their doctors communicated well, but only 54 percent reported having a quiet room.
“Patients value continuity in their care and having their health needs well-understood by their providers, be they physicians or nurses,” DeLuca said.
Investigators linked the HCAHPS data to the American Hospital Association’s annual survey, which provided information about nurse staffing levels, profit status, beds, rural or urban location and membership in the Council of Teaching Hospitals and Health Systems. They then examined the relationship between some of these characteristics and the HCAHPS results.
The team found a moderate relationship between the ratio of nurses to patient days and the patients’ hospital experience. More than 65 percent of patients treated in hospitals in the top quartile of nurse-to-patient days gave the hospital a rating of nine or 10 compared with 60.5 percent of patients in the bottom quartile when it came to staffing.
According to the study, the biggest satisfaction differences between hospitals with higher vs. lower nurse-to-patient ratios showed up in the specific areas of nursing services (4.2 percentage points between the highest and lowest quartile), discharge instructions (3.2 percentage points between the highest and lowest quartile), communication with nurses (3.0 percentage points between the highest and lowest quartile) and communication about medications (3.0 percentage points between the highest and lowest quartile). Nearly a third of patients did not give high ratings to pain control.
“Nurses and doctors need to be talking to their patients more,” Ficarra said. “Information about medications and discharge instruction need to get better.”
Ficarra added that, with emergency rooms bursting at the seams, nurses are under more pressure to get patients on the floors discharged to make room for new arrivals. Consequently, discharge instructions may need to be performed quickly, but it’s not an area where nurses should be taking short cuts.
Patient satisfaction was associated with quality of clinical care on quality indicators for the conditions assessed: acute myocardial infarction, congestive heart failure, pneumonia and surgery.
The researchers also found that patients in nonprofit hospitals ranked their satisfaction higher than patients in proprietary hospitals, something the authors suspect might be related to patient expectations. There was no significant difference in satisfaction between teaching and non-teaching hospitals.
Regional differences also played a part in the ratings, with 49.9 percent of patients in East Long Island, New York, giving their hospital a nine or 10 rating, while 71.9 percent of patients in Birmingham, Alabama, gave their hospital stays top ratings.
The researchers concluded that the ratings leave room for improvement, specifically in areas such as nursing care, communication about medications, pain control and provision of clear discharge instructions.
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