ICU Nurse Working Conditions Linked to Rise in Patient Infections
Hospitals that have better working conditions for nurses are safer for elderly intensive care unit (ICU) patients, according to a recent report led by Columbia University School of Nursing researchers that measured rates of hospital-associated infections.
Hospital associated infections are the number six cause of death in the United States (CDC March 2007). Nurses, as the largest workforce in the nation’s hospitals, are in a unique position to positively impact the safety of ICUs if systematic improvements to their working conditions can be made.
A review of outcomes data for more than 15,000 patients in 51 U.S. hospital ICUs showed that those with high nurse staffing levels (the average was 17 registered nurse hours per patient day) had a lower incidence of infections. Higher levels of overtime hours were associated with increased rates of infection and skin ulcers. On average nurses worked overtime 5.6 percent of the time.
These findings, reported in the June issue of Medical Care, one of the leading health care administration journals, support the notion that a systematic approach aimed at improving nurse working conditions will improve patient safety.
Researchers evaluated several measures of working conditions to assess their effect on hospital-associated infections. They analyzed the organizational climate as measured by nurse surveys, and reviewed objective measures of staffing, overtime, and wages with payroll data. They also looked at hospital profitability and magnet accreditation (a national recognition program for nursing excellence in hospitals). Patient outcome data came from the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance system and Medicare files.
After careful review, findings revealed that ICUs with higher staffing had lower incidence of central line associated bloodstream infections (CLSBI), a common cause of mortality in intensive care settings. Other measures such as ventilator-associated pneumonia and skin ulcers, which are common among hospitalized patients who cannot move regularly, were also reduced in units with high staffing levels. Patients were also less likely to die within 30 days in these higher-staffed units.
Increased overtime hours in ICUs were associated with increased rates of another common hospital-associated infection, catheter-associated urinary tract infection, as well as increased rates of skin ulcers on patients.
One possible solution presented in the study suggests increasing the availability of highly qualified float nurses through cross training. This would allow hospitals to more appropriately staff their ICUs and further develop the skills of nursing staff based on other units.
The sample comprised 15,846 patients in 51 adult intensive care units in 31 hospitals; 1095 nurses were surveyed. Severity of patient illness was controlled in this study.
The results measuring the effects of organization climate and hospital profitability were not consistent. Magnet status and wages also were not significant predictors for poor patient outcomes.
Columbia University Medical Center provides international leadership in basic, pre-clinical, and clinical research, in medical and health sciences education, and in patient care. The medical center trains future leaders and includes the dedicated work of many physicians, scientists, nurses, dentists, and public health professionals at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions.
