Better Nursing Environments Provide Better Value for Patients

Hospitals with a better nursing environment, judged by such factors as nurse-to-bed ratio and nurse mix, is associated with lower mortality with similar costs compared with hospitals that don’t have nursing environment recognition.

A study published in JAMA Surgery analyzed data from Medicare fee-for-service claims for elderly patients admitted for general surgery in Illinois, New York, and Texas. The purpose was to determine if selecting hospitals based solely on excellent nursing environments could identify hospitals with better outcomes and value.

Excellent nursing environments were defined by having both national peer-assessed recognition and above-average nurse staffing. As the recognition indicator was a voluntary accreditation program, the authors identified this as a limitation, but past studies have shown that hospitals in general with accreditation have better work environments than those without accreditation.

“While there is considerable evidence that a better nursing work environment is associated with better outcomes, the question of value has remained uncertain,” the authors wrote.

The researchers found that hospitals with a better nursing environment had a 4.8% 30-day mortality rate compared with 5.8% in the control hospitals. Patients in the highest risk quintile saw the greatest mortality benefit if they were treated in hospitals with better nursing environments.

Hospitals with better nursing environments also had dramatically lower rates of intensive care unit (ICU) use, according to the study. The authors attribute this to better nursing care on the floor, which acts as a substitute for ICU care and leads to a lower use of resources.

“While better outcomes and value may be owing to other features of hospitals with good nursing, excellent nursing environments appear to provide a strong signal to patients and referring physicians for better quality, lower cost, and higher value,” the authors concluded. “This is especially true for higher-risk patients, where the value of a better nursing environment appears to be greatest.”

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