Linda Aiken and others have established a link between hospital nurse staffing and patient outcomes. Now researchers have attempted to determine how nursing variables contributed to differences in care among patients undergoing surgery for cancer. They reviewed data from the 1998-1999 Pennsylvania Cancer Registry and the Pennsylvania Health Care Cost Containment Council and from 1999 surveys by the American Hospital Association and the University of Pennsylvania.

Variations in nurse staffing, nurses' educational preparation, and practice environments (characterized by staffing and resources; the nurse manager's ability, leadership, and support of nurses; and nurses' participation in hospital affairs) produced substantially different outcomes.

Patients were more likely to die within 30 days of hospitalization or suffer complications when staffing levels were poor. Outcomes were significantly better when each nurse cared for four or fewer patients and significantly worse when each cared for eight or more patients. When fewer than 20% of nursing staff held bachelor's degrees, 30-day mortality and failure-to-rescue rates were higher. Poor practice environments were also associated with higher mortality and failure-to-rescue rates.

Patients at hospitals designated as cancer centers by the National Cancer Institute had better 30-day survival rates, fewer complications, and lower failure-to-rescue rates; those hospitals also had higher levels of nurse staffing, more nurses with a baccalaureate education, and better scores on measures of the practice environment. After adjusting for other factors, the researchers found that certain hospital characteristics (number of beds, teaching status, and performance of advanced procedures) were not associated with rates of 30-day mortality, complications, or failure to rescue.

Attention by hospital administrators to the nurses' practice environments, increasing the facility's proportion of nurses with baccalaureates, and improving nurse-patient ratios could enhance outcomes for surgical oncology patients.

Fran Mennick, BSN, RN