October 29, 2008


By Anne Harding
WEDNESDAY, Oct. 29 ( — No one looks forward to a hospital stay, but a new study suggests you may be happier with your visit if your hospital has more nurses per patient than other facilities.

The analysis of patient satisfaction surveys from nearly 2,500 hospitals across the United States also found that many people are pleased with hospitals in general—about 67% said they would definitely recommend their hospital to someone else.

Geographic locations matter too: People in Birmingham, Ala., were most satisfied with care; 71.9% gave their hospital a high rating. Those in Fort Lauderdale, Fla., and East Long Island, N.Y., were the least satisfied; only 51.9% and 49.9%, respectively, highly rated their facilities.

One of the study researchers, Arnold M. Epstein, MD, of the Harvard School of Public Health, points out the findings don’t necessarily mean that patients are more satisfied with their care because there are more nurses on staff; instead, he says, relatively high nurse staffing levels may indicate that a hospital emphasizes the importance of interpersonal communications and treating patients with care and respect.

Also, these are likely the types of hospitals that are able to recruit nurses and keep them, say experts in the field.

“Nurses really are the face of health care,” says Deirdre Mylod, PhD, vice president of acute services at Press Ganey Associates, a South Bend, Ind.–based firm that administers patient satisfaction surveys and consults with hospitals on quality improvement.

“If nurses are engaged, they’re in an environment that fosters better patient care, and patients feel that,” says Mylod, who was not involved in the study. “When an organization is struggling with not enough nurses, you get burnout, you get more turnover, you get nurses who are less emotionally available to patients."

In the study, Ashish K. Jha, MD, of the Harvard School of Public Health, and colleagues analyzed survey data from 2,429 hospitals.

Hospitals started giving the 27-question surveys to patients in October 2006 and reported the data to the Centers for Medicare & Medicaid Services (CMS), which has been struggling for years to find ways to measure hospitals’ quality of care. Asking patients what they think is a relatively new approach, and CMS began releasing the survey data in March 2008.

The researchers found that hospitals in the top 25%—in terms of the nurse-to-patient-per-day ratio—also received top marks for communication with nurses, nursing services, communication about medications, pain control, and discharge instructions, according to the report in The New England Journal of Medicine.

While 70.2% of patients at these hospitals said they would recommend them to others, 63.5% of patients at the hospitals with the lowest nurse-to-patient-per-day ratios said they too would recommend their facilities.

Patients were more satisfied with care at nonprofit hospitals as opposed to for-profit hospitals, but it didn't seem to matter if it was a teaching facility or not.

Next: Keeping nurses on staff is a big challenge for hospitals

Recruiting and keeping good nurses is a major challenge for U.S. hospitals, notes Patricia W. Stone, PhD, RN, an associate professor of nursing at Columbia University who has studied nurse staffing levels and quality of care, but wasn’t involved with the current study.

“We have real problems with the nursing shortage,” Stone says. The nursing workforce is getting older, with up to 40% of registered nurses set to retire within the next few years. "[Meanwhile] there’s a huge shortage of nursing faculty,” Stone adds—so much so that U.S. nursing schools now have to turn away thousands of qualified applicants because they don’t have enough people to teach them.

Hospitals that maintain adequate nurse staffing in this environment are likely those that have “visionary leadership,” and are investing in both nursing and quality improvement efforts, rather than coping with a lack of staff by forcing nurses to work mandatory overtime shifts, Stone says.

The researchers also found that hospitals with patients who were most satisfied with care were also providing the highest quality of care, as measured by treatment of heart attacks, congestive heart failure, pneumonia, and surgical procedures.

“Prior research has shown that higher nurse staffing levels are found in hospitals that have better outcomes,” notes Julie Sochalski, PhD, RN, an associate professor at the University of Pennsylvania School of Nursing in Philadelphia. "[This study] provides a new and important insight on at least one reason why this might be the case—that is, better communication between nurses and patients about critical aspects of their care occurs in these better-staffed hospitals.”

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