Nurses’ thoughts on hospital quality reflect indicators

Nurses’ perceptions about hospital quality of care closely match the quality indicated by patient outcomes and other long-standing measurements, according to a study.

“For a complete picture of hospital performance, data from nurses is essential,” Matthew D. McHugh, RN, PhD, JD, MPH, CRNP, the study’s lead author and a public health policy expert at the University of Pennsylvania School of Nursing, said in a news release.

“Their assessments of quality are built on more than an isolated encounter or a single process — they are developed over time through a series of interactions and direct observations of care.”

The study included more than 16,000 nurses in nearly 400 hospitals in California, Florida, New Jersey and Pennsylvania, which are four of the nation’s largest states and account for more than 20% of hospitalizations annually.

The researchers examined the relationship between nurses’ reports of quality and hospitals known for nursing excellence. Higher proportions of nurses working in hospitals with good practice environments and in Magnet-recognized hospitals reported that the quality of care in their workplace was excellent.

Specifically, according to the study abstract, a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia and surgical patients.

“Obtaining information from nurses takes advantage of their unique perspective within the caregiving context,” McHugh said. “Nurses have insights — patient-provider interactions, integration of technology, patient and family education — that are not always documented in the medical record but often make the difference between good and bad outcomes.”

Healthcare quality measures are integral to decision-making among regulators, consumers and purchasers, with the potential to affect policy, quality improvement efforts and insurance.

“Although the patient’s perspective is the most relevant quality-of-care indicator, nurse-reported quality-of-care is clearly a valuable indicator of hospital quality,” McHugh said.

The study was funded by the Robert Wood Johnson Foundation Nurse Faculty Scholars program and the National Institute of Nursing Research, and is scheduled for publication in the journal Research in Nursing & Health. The study abstract is available at

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