In a study published in Medical Care, researchers from the University of Alabama reviewed medical records of 118,940 Medicare patients hospitalized with acute myocardial infarction (AMI). After adjusting for numerous variables not accounted for in previous studies, including hospital volume, teaching status, and nursing-skill mix, they found that higher RN staffing levels were associated with lower mortality rates among patients with AMI, while higher LPN staffing levels were associated with higher mortality rates. Staffing levels of both RNs and LPNs were represented as nurse-to-patient ratios and divided into quartiles. From the highest quartile of RN staffing (the largest nurse-to-patient ratio) to the lowest, mortality rates were 17.8%, 17.4%, 18.5%, and 20.1%, respectively. From the highest quartile of LPN staffing to the lowest, mortality rates were 20.1%, 18.7%, 17.9%, and 17.2%, respectively.
"Although hospital staff restructuring often carries the admirable goal of increased efficiency, care must be given to how this goal is achieved," the researchers concluded.
Another study published in the Journal of the American Medical Association found that when discussing the details of a clinical trial with families, it helps to have a nurse on hand. Even though most children diagnosed with leukemia become research subjects in randomized clinical trials, a research team from Case Western Reserve University found that half of the parents did not understand the process of randomization, despite oral and written explanation. And although factors related to physicians, such as their years of experience, training status, and sex, were not associated with differences in parental comprehension, the presence of a nurse at the discussion was significantly associated with it.
Nurses were present at roughly half of the parent meetings, but they never led the conference or explained randomization. However, the researchers speculate that the presence of a nurse "may reflect the benefits of better emotional support for parents at this difficult time, creating an environment in which parents feel empowered to speak up, ask questions, and seek clarification."-Roxanne Nelson
Person SD, et al. Nurse staffing and mortality for Medicare patients with acute myocardial infarction. Med Care 2004.42(1):4-12; Kodish E, et al. JAMA 2004;291(4):470-5.